Abstract
Purpose This study is aimed at synthesizing the available evidence regarding effectiveness of various modalities (combinations of LRS tasks) and comparison between each two modalities in terms of gingival display reduction, success rate, stability of the results, patient's satisfaction, and postoperative morbidity. Materials and Methods The electronic databases including PubMed, Scopus, Web of Science Cochrane Library, Google Scholar databases, ClinicalTrials.gov, and WHO International Clinical Trial Registry Platform were searched up to 27th June 2020 regarding lip repositioning surgery. The modalities were defined as the combinations of the following tasks: frenectomy (yes/no), flap thickness (full/partial), and myotomy (yes/no). Meta-analyses were performed on gingival display change from baseline to months 3, 6, and 12 in each modalities using Stata (v.16). Results 38 studies (including three clinical trials, two quasiexperimental studies, seven case series, and 26 case reports) met the criteria for final inclusion. The mean gingival display reduced from baseline to 6 months (WMD = −2.90, 95% CI: -4.85 to -0.95) in the patients undergoing the “frenectomy + full-thickness flap + myotomy” modality. This parameter decreased from baseline to 6 and 12 months, respectively (WMD = −2.68, 95% CI: -3.49 to -1.86; WMD = −2.52, 95% CI: -4.40 to -0.64), in patients undergoing the “frenectomy + partial-thickness flap + without myotomy” modality. In patients who undergone the “without frenectomy + partial-thickness flap + without myotomy” modality, gingival display reduced from baseline to 6 months (WMD = −3.22, 95% CI: -5.61 to -0.84). Almost 83% of patients with modality 1 had satisfaction. Conclusions Gingival display within the 6 months after LRS could be reduced with all modalities. Descriptively, the greatest reduction was observed in patients with the modality not including the frenulum.
Highlights
Smile is the most important facial expression that has a positive impact on the facial attractiveness and social interactions [1]
While excessive gingival display” (EGD) has been regarded as an anatomic variation [5], there are an increasing number of patients seeking for correction of gummy smile
We found three relevant systematic reviews that were designed to answer some questions related to lip repositioning surgery (LRS)
Summary
Smile is the most important facial expression that has a positive impact on the facial attractiveness and social interactions [1]. An ideal smile is based on a balance among three interrelated components: teeth, gingiva, and lips [2]. The exposure of more than 3 mm of maxillary gingiva has been considered as “unattractive smile,” “gummy smile,” or “excessive gingival display” (EGD) [3]. While EGD has been regarded as an anatomic variation [5], there are an increasing number of patients seeking for correction of gummy smile. The possible etiologic factors for EGD are based on skeletal, soft tissue, and dental discrepancies. The management of patients complaining of EGD is based on the etiology of this manifestation. Among the various treatment options, lip repositioning surgery (LRS) is utilized in a wide range of clinical situations with EGD and is the primary indication for mild-to-moderate vertical maxillary excess as well as excessive mobility of maxillary lip [7]. With the growing trend toward the use of less invasive treatment options, recently, LRS has been gaining popularity among the clinicians
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