Abstract
A beautiful smile comprises a perfect balance of the white and pink. A gummy smile has been a prevalent esthetic disorder with varied etiologies including of skeletal, dento-alveolar, or soft-tissue origin. It can be managed by a variety of treatment modalities after appropriate diagnosis and treatment planning. If it is due to jaw deformities, altered passive eruption or tooth malpositioning, the corrective measures incorporate orthognathic surgery and orthodontic treatment. However, this requires hospitalization and entails significant discomfort. Lip repositioning is a simple and predictable technique that restricts the muscle pull of the elevator lip muscles thereby reducing the gingival display. This case report demonstrates the successful management of a young patient with moderate gummy smile using the conventional LR surgery thereby proving to be a promising alternative that is less invasive in nature and with minimal postop complications. At 6 months, the results were stable.  Â
Highlights
Smile, a person’s ability to express a range of emotions with the structure and movement of the teeth and lips, can often determine how well a person can function in a society
A surgical technique for doing exactly this has been developed and is known as lip repositioning surgery (LRS). It can limit the retraction of the elevator muscles of the lip which is achieved by removing a strip of mucosa from the maxillary buccal vestibule and creating a partialthickness flap between the mucogingival junction and the upper lip musculature
A recent systematic review by Tawfik et al in 2018 concluded that LPS successfully improved EGD by a mean of 3.4 mm, suggesting it to be a successful approach for the treatment of GS, especially for patients with minor discrepancies desiring a less invasive alternative to orthognathic surgery and a more immediate and enduring result when compared to orthodontics and botox treatment
Summary
A person’s ability to express a range of emotions with the structure and movement of the teeth and lips, can often determine how well a person can function in a society. If it is due to the sole etiology of altered eruption—passive or active, short clinical crown heights may be managed with anterior gingivectomy or crown lengthening only It is a well documented treatment modality that mainly involves soft tissue and hard tissue resection and is proved to be effective in restoring normal tooth dimensions and dentogingival relationships.[3] Other possible etiologies include i) vertical maxillary excess (VME) with incompetent or hypermobile upper lip (HUL), wherein skeletal Class II relationships and vertical growth patterns are presented, ii) compensatory eruption of maxillary teeth with concomitant coronal migration of attachment apparatus including the gingival margins; in such cases surgical intervention such as Le Fort osteotomy, orthodontic intrusion, and/or osseous crown lengthening may have to be performed.[4] Besides requiring significant time and financial investments, these therapies have multiple inherent risks, chances of postoperative complications and the results may vary.[5] The average length of the upper lip is about 20–22 mm in young females and 22–24 mm in young males, and GS has been associated with a short upper lip.[6] HUL results in GS that is due to the hyperactivity of the elevator muscles of the lip. The case presented here discusses the novel conventional lip repositioning procedure which was used for the correction of excessive gingival display, with 6 months follow-up
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