Surgical Procedures Reducing Excessive Gingival Display in Gummy Smile Patients With Various Etiologic Backgrounds

Abstract

Introduction Gummy smile (GS) is an esthetic issue which causes a person to show a larger than average amount of gum tissue when smiling. Lip repositioning procedure is a surgical treatment option performed by removing a partial thickness strip from the maxillary buccal vestibular mucosa and suturing back the lip mucosa to the mucogingival line. High rate of relapse has been recorded with this procedure. In this study, different treatment options were applied according to the etiology and clinical background of each individual case in an attempt to overcome relapse. Furthermore, modification of the conventional lip repositioning procedure and the clinical outcome of this technique will be demonstrated in this report. Case Series Among the four selected patients who requested correction of their GS, the amounts of gingival display (GD) measured using digital Vernier were from 5 to 7 mm. Clinical examination revealed variation in the length of the clinical crowns, and vestibular depth and width of keratinized gingiva. Since the causes of their GS were different, different surgical modalities were applied to address GS in this case series. The procedures were gingivectomy, osteoplasty, and modification of lip repositioning procedure performed by removing a partial thickness ribbon of the keratinized attached gingiva and then suturing the labial alveolar mucosa to the attached gingiva at a level more coronal to its previous position. Conclusion One‐year follow‐up showed that all these surgical procedures reduced excessive GD by 2 mm without relapse and the patients were satisfied with the esthetic outcome.

Effectiveness of Different Modalities of Lip Repositioning Surgery for Management of Patients Complaining of Excessive Gingival Display: A Systematic Review and Meta-Analysis

“…The 38 included studies assessed different modalities of LRS in 160 patients. Two RCTs [ 23 , 24 ] one clinical trial (with unknown type) [ 25 ], two quasiexperimental studies without control group [ 12 , 26 ], seven case series [ 27 – 33 ], and 26 case reports [ 10 , 34 – 58 ] met the inclusion criteria. For the one RCT with two arms of LRS and botulinum toxin type-A injection, we included the LRS arm in our study [ 24 ].…”

“…Two quasiexperimental studies had 29 patients (27 females and 2 males), aged 19 to 49 years old, with 4 to 10 mm gingival display [ 12 , 26 ]. Seven case series reported 43 patients aged 18 to 59 years old and 4.73 to 8 mm gingival display [ 27 – 33 ]. There were 25 females and 2 males in 27 included case reports from 18 to 38 years old with EGD during dynamic smile Table S3 (a, b, c, and d) [ 10 , 34 – 58 ].…”

The Lip Repositioning Surgery: A Review of the Technique's Evolution

“…However, concerning the upper horizontal incision, authors report performing it on the sulcus, 5 the labial mucosa. 4,26 In contrast, others perform an apical projection to the inferior incision at 5 mm, 27 6 to 8 mm, 28 8 mm, 29 8 to 10 mm, 29,30 between 10 and 12 mm, 23,24 or twice the amount of the EGD. [31][32][33][34][35] The most frequent reference for the distal projection of the horizontal incision was the maxillary first molar.…”

“…39 In contrast, some authors recommend using the LRT with other therapeutic options in cases of APE, gingival enlargement, and preventing relapse. 20,27,45 One approach is with gingivectomy, 23 in association with gingivectomy and osteotomy 26,[40][41][42] and even with digital workflows. 46 BT type A has been recommended in cases of excessive muscle function and HUL to prevent muscle contraction.…”

Comparison of general and aesthetic effects between flapless and flap techniques in dental implantation: a meta-analysis of randomized controlled trials

“…Sites with KM width < 2 mm showed a higher chances of suppuration and marginal bone loss [50]. Nonetheless, chances are really high that the patients have gummy smile issues when an excessive KM width is presented in the maxillary anterior region [51]. Flapless techniques for delayed implant placement require a circumferential excision of keratinized mucosa at the implant site.…”