Lip Repositioning, Aesthetic Crown Lengthening, and Gingival Depigmentation: A Combined Approach for a Gummy Smile Makeover.

Abstract

This clinical report describes the successful use of aesthetic crown lengthening, lip-repositioning technique as well as gingival depigmentation for the reduction of excessive gingival display and dark gums, respectively. Lip-repositioning technique was performed with the main objective of reducing gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli oris, orbicularis oris, and levator labii superioris) during smiling, thereby restricting the upper lip from shifting apically while smiling. This technique includes removing a strip of mucosa from the maxillary labial and buccal vestibule, creating a partial-thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. The results obtained with lip repositioning for the treatment of gummy smile are substantial and it is a simple and effective procedure, well accepted by patients. Proper case selection is important for using this procedure.