Facial profile changes due to bone cement graft to manage the hyperactive muscles of the gingival smile.

Érica Miranda De Torres,Carlos Estrela,Luis Fernando Naldi,Karina De Oliveira Bernades,Hianne Miranda De Torres,Alexandre Leite Carvalho,José Valladares-Neto

doi:10.1590/2177-6709.25.2.044-051.oar

Érica Miranda De Torres, Carlos Estrela + Show 5 more

Open Access

https://doi.org/10.1590/2177-6709.25.2.044-051.oar

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Abstract

ABSTRACT Objective: To evaluate facial profile changes promoted by polymethyl methacrylate (PMMA) cement graft to reduce excessive gingival display due to hyperactivity of the elevator muscles of the upper lip during smiling. Methods: Eleven patients (all females, age range: 20 to 43 years) presenting gingival smile that were treated with PMMA cement grafts in a private clinic were selected for this retrospective study. Three angular and ten linear cephalometric facial profile measurements were performed preoperatively (baseline, T1) and at least 6 months postoperatively (T2). Differences between T1 and T2 were verified by Wilcoxon test, and the correlation between the thickness of the graft and facial profile changes was statistically evaluated by Spearman’s Coefficient test. The significance level was set at p< 0.05. Results: The nasolabial angle (p= 0.03) and the labial component of the nasolabial angle showed statistically significant differences (p= 0.04), with higher values in T2. No correlations were found between the graft thickness and the statistically significant facial profile changes (p> 0.05). Conclusions: The PMMA bone cement graft projected the upper lip forward, thereby increasing the nasolabial angle without affecting the nasal component. No correlations between the graft thickness and the facial profile changes were detected.

Highlights

The smile is the spontaneous expression linked to joy, pleasure and receptivity.[1]
Significant differences between T1 and T2 angular and linear measurements were found for the nasolabial angle (Pn.Sn.Ul) (p = 0.03) and the labial component of the nasolabial angle [(Sn-Ul).Sn hor] (p = 0.04)
This original study investigated the cephalometric changes that occurred due to the use of bone cement based on polymethyl methacrylate (PMMA)

Summary

Introduction

The smile is the spontaneous expression linked to joy, pleasure and receptivity.[1]. Tarantili et al.[2] defined a pleasant smile as one in which there is complete exposure of the anterior maxillary teeth and a mild gingival display of 1 to 3 mm. Several etiological factors have been associated to gingival smile, and it is important for the clinician to properly identify its etiology, for an adequate treatment These factors occur separately or in combination,[4,5,6,7,8] and according to the origin, they can be grouped into: dental (excessive dentoalveolar extrusion9), gingival (altered passive eruption[10,11] or gingival enlargement12), skeletal (excessive maxillary vertical growth8) or muscular (short upper lip or hyperactivity of the elevator muscles of the upper lip[1,2,6]). Various treatments have been proposed according to the etiology of the gingival smile, including orthodontic intrusion,[5,7,9] gingivectomy,[7,13] periodontal plastic surgery,[13] maxillary teeth intrusion by skeletal anchorage,[14,15] maxillary impaction by orthognathic surgery;[7,8] upper lip repositioning,[16,17,18,19] and botulinum toxin injection.[20,21,22]

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