Treatment of bilateral maxillary buccal exostoses on gummy smile

Abstract

Backgrounds: Buccal exostoses is benign, broad-based surface masses of the outer or facial aspect of the maxilla and less commonly at the mandible, found usually in the premolar and molar region. A definitive female sex predictions is characteristic of this condition. They are painless, self limiting and may increase patient concern about poor esthetics. Gummy smile is an excessive gingival display during smiling which can occur in response to certain medications--e.g., phenitoin -- or smaller than normal teeth due to developmental events, tooth eruption abnormalities, orthodontic treatments and even congenital defects. Objectives: The objective of this treatment are eliminate buccal exostoses and gingival overexposure with osseus resective surgery and crown lengthening for improve the esthetics of the gingiva, especially on anterior teeth. Case Presentation: A 30 years old female presented buccal exostoses with gummy smile on the buccal aspect from molar to caninus region of the bilateral maxillary arch. This case managed by a combination of osseous resective surgery to treat exostosis and crown lenghtening for removing alveolar bone and excessive gingival. Discussion: Selection treatment for this case is osseus resective surgery and crown lengthening that aims to removal of bone and achieving a physiological bone architecturebilateral exostoses, functional of gingiva and aesthetic. The surgical procedure is aimed at re-establishing the biological width, apically, while exposing more tooth structure. Conclusion: The exostoses and gummy smile increase poor esthetics. Osseus resective surgery andcrown lengthening are the option treatment to makes patient smile more proportional and achieving optimal aesthetics.