Periodontal Plastic Surgery to Improve Aesthetics in Patients with Altered Passive Eruption/Gummy Smile: A Case Series Study

Abstract

Altered passive eruption/gummy smile is a common challenge in patients requiring aesthetic treatment. A specific surgical protocol was designed and tested in patients with altered passive eruption. Standardized preoperative X-rays were used to assess crown length at baseline and to place submarginal incisions. Osseous respective therapy was performed to achieve biological width. Clinical outcomes were recorded 6 months after surgery. Eleven patients with a total of 58 teeth were treated with flap surgery and osseous resective therapy at upper anterior natural teeth. At the last followup, a significant and stable improvement of crown length was obtained when compared to the baseline (P < 0.0001). All patients rated as satisfactory in the final outcomes (final VAS value = 86.6). In conclusion, this study showed that periodontal plastic surgery including osseous resection leads to predictable outcomes in the treatment of altered passive eruption/gummy smile: A careful preoperative planning avoids unpleasant complications and enhances postsurgical stability of the gingival margin.

The treatment of gummy smile: integrative review of literature

“…A total of 48 patients undergoing surgery and follow-up monitoring by researchers were included in the studies, of whom 37 were women and 11 were men. The predominant surgical technique was based on the use of gingivectomy with osteotomy, with follow-up times of two months 21 , six months [22][23][24] or 12 months (one study only) 18 . The main findings relate to patient satisfaction after surgery.…”

Periodontal plastic surgery for treatment of gummy smile with cosmetic restauration treatment

“…In this question, a pleasant smile is considered a symbol of beauty and well-being in the modern society. Other authors [3] claim that the shape, the position of the teeth and the gum tissue levels can influence on the aesthetics of the smile.…”

“…Some authors [3,5,9,15] cite the characteristics of a perfect smile. Da Silva [5] states that the perfect smile is characterized by exposure of the total length of the upper anterior teeth up to the premolars, showing the incisal curve of these teeth parallel to inner curvature of the lower lip, and slightly touching or leaving a minimum space with the lower lip.…”

Treatment of Altered Passive Eruption Related Gummy Smile

“…Esthetic treatment of a smile line is often a multifaceted scenario where teeth, periodontal tissues, and lip position interact [5]. The average smile exhibits approximately the full length of the maxillary anterior teeth, with an incisal curve of the teeth parallel to the inner curvature of the lower lip [6].…”