Labial Repositioning Using Print Manufactured Polymethylmethacrylate- (PMMA-) Based Cement for Gummy Smile

Abstract

Treating patients with excessive gingival display (EGD) to provide them with a pleasant smile is a challenge to periodontists. A gummy smile can be due to excessive vertical bone growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, or altered passive eruption (APE). In addition, many patients have a lack of lip support due to marked depression of the anterior process of the maxilla. In these cases, lip repositioning using polymethylmethacrylate (PMMA) cement could be performed. This article describes a case of EGD with subnasal depression. In the clinical examination, the presence of a marked subnasal depression was found, in which the upper lip lodged during a spontaneous smile. In addition to this, gingival exposure extending from the maxillary molar on one side of the mouth to the one on the opposite side was also found during the spontaneous smile. Therefore, the periodontal surgical intervention proposed consisted of performing a procedure to fill the subnasal depression with PMMA cement. This article describes a digital approach to plan the use of PMMA cement in lip repositioning in a patient with gummy smile and subnasal depression. The patient reported no postoperative complications. Six months after the surgery, the patient revealed a more harmonious smile than before, with reduction in the gingival exposure and new adequate support for and repositioning of the upper lip.

Effects of polymethyl methacrylate-based bone cement graft for treating excessive gingival display and its dimensional facial changes: 12-Month clinical study

“…In both documented case reports detailing the utilization of three-dimensionally printed PMMA grafts, the 3D planning software known as Mimics, developed by Materialise NV in Belgium, was employed. These studies encompassed a follow-up period between six months 19 and two years, 20 during which no post-operative complications were recorded, and patients consistently expressed a high degree of satisfaction with the treatment outcomes. 19 , 20 Caution is needed due to the limited availability of evidence concerning the implementation of 3D planning and printing techniques for PMMA grafts.…”

“…These studies encompassed a follow-up period between six months 19 and two years, 20 during which no post-operative complications were recorded, and patients consistently expressed a high degree of satisfaction with the treatment outcomes. 19 , 20 Caution is needed due to the limited availability of evidence concerning the implementation of 3D planning and printing techniques for PMMA grafts. Existing research primarily comprises single-patient case reports, thereby offering a restricted scope of evidence.…”

“… 14 , 15 The use of PMMA combined with surgical ACL for EGD treatment was first reported in 2010, 9 with encouraging clinical results in some cases reports. 9 , 12 , 16 , 17 , 18 , 19 , 20 The authors described the surgical procedure as being simple and with satisfactory outcomes since the gingival display was resolved due to diminished upper lip mobility. The function of the PMMA is to fill the depression where the upper lip lodges, which results in less lip contraction during natural smiling.…”

Reposicionamiento labial como tratamiento de la sonrisa gingival: Revisión narrativa de la literatura

“…Se realizó una incisión en bisel interno, con incisiones intrasulculares y un colgajo de espesor total además de la osteotomía y la osteoplastia se eliminó el tejido óseo a una distancia de 3mm entre la cresta ósea y el nuevo margen gingival. Después del alargamiento de corona el bloque de PMMA se fijó con dos tornillos de titanio se posicionó el colgajo con suturas de colchonero verticales a los 14 días se retiraron las suturas (Freitas de Andrade et al, 2021).…”

“…El uso de cemento de PMMA podría considerarse un enfoque exitoso para el tratamiento de exposición gingival en casos con depresión subnasal. (Freitas de Andrade et al, 2021) Fuente: Autores (2024).…”