Laser‐Assisted Lip Repositioning With Smile Elevator Muscle Containment and Crown Lengthening for Gummy Smile: A Case Report

Abstract

Introduction Treating the patients with excessive gingival display to provide a pleasant smile is a challenge to the periodontist. Gummy smile can be due to excessive vertical bone growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, or altered passive eruption. Gummy smile associated with hyperactivity of smile elevator muscles can be treated by surgical techniques like lip repositioning, botulinum toxin injection, lip elongation with rhinoplasty, detachment of the lip muscles, and myectomy. Regardless of the technique used, to achieve a predictable result with long‐term stability limiting upper lip movement when the patient smiles, firm muscle containment is imperative. Case Presentation The case report describes the excessive gingival display having a multifactorial etiology in a 25‐year‐old female patient. Altered passive eruption in upper anterior teeth was treated by crown lengthening followed by management of hyperactive lip using a diode laser‐assisted lip repositioning along with traction and muscle containment. Excellent and predictable results were obtained after a 1‐year follow‐up without the relapse of gummy smile. Conclusions The case report showed an excellent result when treated by a combined approach of an innovative procedure with laser‐assisted lip repositioning aimed at maintaining the traction and containment of the smile elevator muscles along with crown lengthening procedure by gingivectomy.

Lip repositioning with or without myotomy: a systematic review

“…Excluding 28 articles (Table 1) 15, , 16 studies remained for data extraction.(Fig. 1) Table 2 8,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] shows the data extracted from these remaining studies.…”

“…The risk of bias assessment for non-comparative studies is presented in Table 3 8,47,48,50,[52][53][54][55][56][57][58][59][60][61] . The risk of bias for one nonrandomized comparative study 51 was estimated at 23 (of 24) based on the MINORS scoring criteria.…”

“…The included studies assessed lip repositioning procedures in 144 patients aged between 15-59 years (134 females and 10 males, not reported in one study with 14 patients 50 ). The most prevalent reported etiology was hypermobile upper lip 47,48,[50][51][52][53][55][56][57]59,60 , followed by altered passive erup- tion 25,28,30,39,47,48,53,57,60 , vertical maxillary excess 48,56,57 , and short upper lip 50,51 . All but two studies 50,54 used a partial-thickness flap.…”

“…However, one comparative study reported better results with a full-thickness approach 51 . Some authors used additional interventions including crown lengthening 47,[50][51][52][53]57,60 and frenectomy 8,23,33,37,52,54,57 to achieve more favorable results with higher stability. Alammar et al 51 mentioned two cases with complete relapse in their conventional surgical group.…”

“…Six studies provided sufficient data (sample size, mean, and either standard deviation or standard error) to contribute to estimation of the overall effect size for improvement after lip repositioning surgery.(Fig. 2) In five studies, myotomy was performed along with lip repositioning surgery 8,[49][50][51]54 , while two investigations used sutures to confine the elevator muscles 47,52 . The analyzed data indicate an improvement of 1.76 mm (95% confidence interval, 1.34-2.18 mm) with myotomy/muscle containment.(Fig.…”