Abstract
ABSTRACTObjective: This study evaluated the effectiveness of guided bone regeneration (GBR) carried out with xenogenic bone substitute (Bio-OssTM) and collagen resorbable membrane (Bio-GideTM) to improve gingival smile (GS) in patients with excessive vertical maxillary growth (EVMG). Methods: Twelve healthy women aged between 20 and 49 years old (mean age of 26 years), with 5 mm or more of gingival exposure during fully posed smile (FPS) due to EVMG, were included. Baseline digital photographs were taken with standardized head position at rest and FPS. In eight out of 12 cases, crown lengthening procedure was indicated and the initial incision was made 2 to 4 mm from the gingival margin. In four cases, with no indication for crown lengthening procedure, a sulcular incision was performed. GBR was performed in all cases, using micro screws and/or titanium mesh associated with Bio-OssTM and Bio-GideTM. After 10 days, sutures were removed. Recall appointments were scheduled at 1, 6, and 12 months when standardized photographs were again taken. ImageToolTM software was used to measure the gingival exposure (GE) during FPS from the standardized close-up smile photographs at baseline and 12 months. Results: GE mean at baseline was 275.44 mm2. After 12 months, patients who undergone exclusively GBR procedure, presented GE reduction of 40.7%, ∆ = 112.01 mm2 (statistically significant, p = 0.12), and patients who had crown lengthening associated with the graft had a reduction of 60%, ∆ = 167.01 mm2. Conclusion: Our results using GBR to improve GS in cases of EVMG showed an exceptionally high patient acceptance and satisfaction. One-year follow-up confirmed stable results.
Highlights
The appearance of the smile is clearly of substantial importance and often one of the key criteria by which patients judge the success of their own treatment.[1]
The aim of this study is to evaluate the effectiveness of guided bone regeneration (GBR) carried out by means of xenogenic bone substitute (Bio-OssTM) and resorbable membrane (Bio-GideTM) to improve gingival smile (GS) in patients with excessive vertical maxillary growth (EVMG)
When crown lengthening was associated with graft, the mean improvement was ∆ = 167.01mm[2] which represents a GS reduction of 60%
Summary
With the increased emphasis on facial esthetics, both patients and dentists are developing a greater awareness of the impact of gingival display on the beauty of smile. The varied nomenclature for gingival smile (GS) includes “gummy smile,” “high lip line,” “short upper lip” and “full denture smile.”. In a group of 454 dental and dental hygiene students, Tjan et al found that 11% had high smile.[2] The literature has shown that increased gingival display at smiling has worse esthetic evaluation by dentists and laypeople.[3,4,5]. To accurately diagnose and treat GS, the clinician must be able to recognize its different causes. The smile exhibiting gingival excess can be caused by altered passive eruption, dentoalveolar extrusion, vertical maxillary excess or a combination of these.[6]
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