Correction Of Gummy Smile Research Articles

Efficacy of Resorbable versus Non Eugenol Packs in Enhancing Early Wound Healing following Gingival Excisional Procedures: A Randomised Controlled Study

Introduction: Conventionally, the raw wound after gingival excision is protected with non eugenol periodontal pack, in order to alleviate pain and preserve healing tissue which includes some potential disadvantages such as patient intolerance, pack loosening, speech difficulties and plaque accumulation. Aim: To clinically evaluate wound healing following the use of a resorbable periodontal dressing following gingival excisional procedures and to compare the outcomes with the conventional COE-PAKTM periodontal dressing. Materials and Methods: A randomised controlled trial was conducted in the Department of Periodontology, SRM Dental College, Chennai, Tamil Nadu, India from June 2022 to March 2023. Patients requiring gingival excision for gingival pigmentation, gummy smile correction and crown lengthening were included in this study, 36 patients in control group were treated with Laser assisted surgery followed by conventional COE-PAKTM and 36 patients in test group were treated with Laser assisted surgery protected with resorbable pack (RESOPAC®). Wound healing scores (Landry’s scale) and patient comfort assessment {Visual Analogue Score (VAS)} was recorded at 7, 14 days following therapy. Data were analysed with IBM Statistical Packages for Social Sciences (SPSS) software 17.0 version using Independent t-test with level of significance 5%. Results: A total of 72 patients (38 males and 34 females) with a mean age range of 32.6 years were randomised into two study groups. Following the intervention, two participants in the test group and one subject in the control group could not report for the seven day follow-up and hence, the data of 69 participants, control (n=35) and test (n= 34) was used for final analysis. Both test and control groups showed satisfactory healing. Results in the test group were significantly better with respect to both wound healing and VAS assessment. Statistically significant difference was noted in the Wound Healing Index (WHI), VAS and Pain Intensity (PI) scores at the 7th and 14th day follow-ups (p<0.001). VAS and PI scores at 7th and 14th day (p<0.001). No of analgesics consumed during the first week were also significantly higher in the control group as compared to the test group (p<0.001**). Conclusion: RESO-PAC®, resorbable pack aided in wound healing following gingival excision and improved patient comfort during the initial healing phase. To add on the patients in the test group reported better compliance to the resorbable dressing and reported no adverse effects. Resorbable dressings could possibly facilitate secondary wound healing following surgical excision of gingiva.

Effectiveness and Personalized Approaches in the Correction of Gummy Smile: A Systematic Review of Orthodontic and Surgical Treatments.

Background/Objectives: This systematic review seeks to assess the effectiveness of different orthodontic and combined orthodontic-surgical approaches for correcting gummy smile, with a focus on treatment efficacy, duration, and the potential for integrating various techniques. The objective is to offer evidence-based recommendations for the optimal management of gummy smile. Methods: A thorough search of the literature was conducted in the PubMed, Cochrane Library, Scopus, and Web of Science databases, covering publications from 1 January 1982 to 4 November 2024. Only randomized controlled trials involving adult human subjects with available full-text articles were included, while systematic reviews, editorials, case reports, and studies involving animals or in vitro experiments were excluded. Studies were selected based on their relevance to orthodontic or combined orthodontic-surgical treatments for correcting excessive gingival display (gummy smile), particularly in cases where residual growth does not impact treatment outcomes. The primary focus was on evaluating the efficacy of these interventions in improving smile aesthetics. Follow-up data were considered when available, though not required for inclusion. Results: The findings revealed that both orthodontic and surgical methods are effective in reducing gingival display. Orthognathic surgery offers lasting outcomes, particularly for patients with vertical maxillary excess, whereas orthodontic treatments, including the use of skeletal anchorage devices, are particularly effective for less severe cases. Minimally invasive approaches, such as botulinum toxin injections, provided temporary but promising results for patients reluctant to undergo surgery. Conclusions: Orthodontic and surgical techniques are viable options for treating gummy smile, with treatment choices depending on the condition's severity. Future research, particularly long-term randomized studies, is required to further refine treatment protocols and improve patient outcomes.

Efficacy of Miniscrew-Assisted Maxillary Arch Intrusion in Gummy Smile Correction

Efficacy of Miniscrew-Assisted Maxillary Arch Intrusion in Gummy Smile Correction

Long-term Efficacy and Patient Satisfaction with Micro-Autologous Fat Transplantation (MAFT) for Gummy Smile Correction

Long-term Efficacy and Patient Satisfaction with Micro-Autologous Fat Transplantation (MAFT) for Gummy Smile Correction

Assessment of Prolonged Effect of Repeated Botulinum Toxin-A Injection for Gummy Smile Correction

Assessment of Prolonged Effect of Repeated Botulinum Toxin-A Injection for Gummy Smile Correction

GINGIVAL SMILE CORRECTION USING THE FLAPLESS TECHNIQUE

Introduction: The gummy smile is characterized by the extensive display of gingiva when smiling and ends up unfavoring the aesthetic aspect, generating dissatisfaction in many patients. This gingival disharmony has several etiologies and, taking into account that each individual presents their uniqueness, it is essential that the dentist knows the cause of each clinical situation, so that an effective, specific and respective treatment plan can be elaborated to the patient’s complaint. Objective: The present work aimed to present, through a case report, a gummy smile treatment using the “Flapless” technique. Case report: A 20-year-old female patient sought care in the undergraduate course in dentistry at the Centro Universitário da Serra Gaúcha – FSG, complaining of a gummy smile. The proposed treatment plan was a gingival surgery, using the “Flapless” technique, associated with the application of botulinum toxin, which would intensify the result of the gummy smile correction. However, after the surgical healing, the patient approved the result of the procedure and chose to end the treatment. Conclusion: Based on the clinical case presented, it was possible to conclude that gingival surgery through de Flapless technique was effective for the correction of the gingival smile, the patient obtained the desire result, without the need to associate other techniques to achieve the aesthetics of the smile.

Correction of Gummy Smile by Surgical Lip Repositioning with Myotomy versus Botox Injection Technique

Purpose: This study aimed to compare surgical lip repositioning with myotomy and Botox injection in treatment of patients with excessive gingival display. Subjects and Methods: A sample of 10 female patients with age range (19-42) yearold with excessive gingival display greater than 2 mm were randomly allocated into 2 groups, Group I: patients were treated with surgical lip repositioning with myotomy. Group II: patients were treated with Botox injection. Treatment changes were evaluated for each group and compared between groups. Data were collected and analyzed using paired t-test for each group and student t-test to compare between groups at baseline, 3, 6 and 9 months. Results: Results of intragroup comparisons of gingival display revealed a significant difference between values at 3, 6 and 9 month intervals (p < 0.001). When compared at baseline, 6 and 9 months time points, the results at 3 months were better. Both groups showed deterioration of the outcomes obtained over time. Botox group values in gingival display had returned to base line at 9 months in contrast to surgical repositioning suggesting that the surgical lip repositioning combined with myotomy resulted in a more stable outcome. The amount of post-operative pain measured in Botox injection group (0.60±0.89) was significantly lower than that of surgical lip repositioning group (5.40±1.14) (p < 0.001). Conclusion: surgical lip repositioning with myotomy and Botox injection give satisfactory results in gummy smile patients in terms of reducing gingival display. However, surgical lip repositioning has more stable results for more than 9 months.

Are There Other Muscle Fibers on the Orbicularis Oris Muscle in the Upper Lip?

The elevator muscles of the upper lip are the levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor muscles, which function by means of their insertions into the skin of the upper lip. However, many textbooks and journal articles state that no muscle fibers are present on the orbicularis oris muscle in the upper lip. The authors attempted to determine whether there is a superficial muscle layer in addition to the orbicularis oris muscle in the upper lip. The authors performed gross dissections of 10 formalin-fixed cadavers and applied micro-computed tomography to six formalin-fixed cadavers. The fine dissection of the upper lip was performed in a layer-by-layer manner that elucidated its muscle layers. The entire layer of the upper lip was separated and pretreated with phosphotungstic acid for micro-computed tomography. The samples used for micro-computed tomography were repurposed for use in histologic analysis. An ultrasonography study was also performed. The presence of a muscle layer on the orbicularis oris muscle was confirmed in all samples. The elevator muscle fibers of the upper lip formed a layer by combining with connective tissue. Micro-computed tomography indicated lower terminal insertions of the elevator muscles throughout the upper lip. All parts of the upper lip skin were inserted into the orbicularis oris muscle. The histologic findings were similar to those of micro-computed tomography. The authors' findings could be used to improve aesthetic and surgical procedures performed on the upper lip, such as correction of gummy smile and transverse upper labial crease, or postresection reconstruction of the upper lip.

Rationale of total arch intrusion for gummy smile correction

Excessive gingival display during smile, also referred to as gummy smile, is often perceived as esthetically unpleasant. While different etiological factors are known to be associated with gummy smile, it eventually results from an imbalance between the dentoalveolar hard tissue and the covering soft tissue. There are a number of different approaches to gummy smile correction. They range from a relatively simple and quick injection of Botulinum-toxin in the hyperactive lip elevator muscles to more invasive procedures such as maxillary impaction by orthognathic surgery. In the meanwhile, the surgical repositioning of the maxilla can be replaced by the intrusion of the whole maxillary arch with the help of orthodontic miniscrews. This article conveys the rationale, biomechanical evidence and clinical effect of total arch intrusion applied to the correction of gummy smile accompanied by lip incompetence.

Anterior maxillary osteotomy for correction of gummy smile

Repositioning of the anterior dento-osseous segment posteriorly is carried out with the Anterior Maxillary Osteotomy (AMO) procedure. Maxillary excess can be corrected by a combined orthodontic and orthognathic approach. Anterior Maxillary Osteotomy has been performed since its inception in 1921 by Cohn Stock wherein, elastic force was used to retract the anterior maxillary segment. Wassmund, Wunderer and Cupar proposed modifications for AMO. This article gives an insight of a case treated by anterior maxillary osteotomy along with fixed orthodontic treatment for correction of maxillary anterior excess.

Gummy smile correction with miniscrews in Class II vertical maxillary excess

Clinical orthodontic treatment of gummy smile with VME has conventionally treated by Lefort 1 osteotomy and superior impaction of maxilla. Recent advents in TADs has broadened the scope and is replaced as less invasive procedure for such patients. This case reports describes the biomechanics and shows the excellent changes obtained with dual buccal mini screws supported orthodontic treatment.

Evaluation of the botulinum toxin effects in the correction of gummy smile 32 weeks after application

Introduction: The use of botulinum toxin type A (BTX-A) to correct gummy smile has become popular in recent years. Objective: To evaluate the effects of BTX-A application in the correction of gummy smile 2 and 32 weeks after application. Methods: The sample comprised 35 patients (30 female, 5 male) at a mean age of 25.51 years (±5.59) with gummy smile due to muscular hyperfunction. In each patient, 2U of botulinum toxin was applied in the levator labii superioris alaeque nasi, 2 mm from the nasolabial fold. Photographs of spontaneous smiles were taken at 3 stages: before, 2 and 32 weeks after BTX application. Measurements of the gingival display were performed with the Radioface Studio 2 Software, and the calibration used the actual size of the right maxillary central incisor. Comparison of the three stages evaluated was performed with repeated measures ANOVA and Tukey tests. Results: Gingival display decreased significantly 2 weeks after BTX-A application and increased after 32 weeks but did not return to the initial value. Conclusion: There was a significant improvement in gummy smile 2 weeks after botulinum toxin application, and a significant relapse in the gingival display after 32 weeks, however not returning to baseline values.

Correction of Gummy Smile with or without Bone Contouring: A Report of Four Cases

Usually, in function of smile, the lips are retracted and elevated to expose a portion of upper incisor teeth .Unlike the case of gummy smile so called “horse smile” there is exposure of all incisors in addition with a large portion of gums above it. A harmonious smile is considered an icon of beauty in modern society

Koreksi Gummy Smile dengan Alat Ortodonti Cekat Kombinasi Miniscrew (Literature Review)

Background: Gummy smile is a condition where the maxillary front gingiva looks excessive when someone smiles. This condition is often aesthetically unpleasant. There are several causes of gummy smile, the most common is alveolo-skeletal etiology. Treatment of gummy smiles with an alveolo-skeletal etiology is often performed by intrusion of anterior segment teeth. Recently, there have been several technique of tooth intrusions using fixed orthodontic appliances combined with miniscrews. Objective: To study the treatment results of gummy smile correction using orthodontic appliance combined with miniscrew. Conclusion: Treatment of gummy smile using orthodontic appliance combined with miniscrew gives satisfaying results in cases with alveolo-skeletal etiology, especially in patients with long faces.

Botulinum Toxin-A in the Treatment of Excessive Gingival Display: A Clinical Study.

The aim of this study was to elucidate the efficiency of BTX-A injections as an alternative approach in patients with excessive gingival display and to observe the patient's satisfaction in order to obtain cosmetically promising results. Fifteen patients of whom ten female and five male with different types of gummy smiles such as anterior (53%), posterior (7%) and mixed (40%) reported to the Department of Oral and Maxillofacial Surgery at Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu from December 2018 to October 2019 those who were willing to undergo corrections using Botulinum Toxin Type A (BTX-A) were selected for the present study using various inclusion and exclusion criteria. The patients were injected with BTX-A on Yonsei triangle accordingly. The clinical evaluation and patient satisfaction evaluation were carried out. A significant decrease in the gingival exposure of about 3.5 ± 1mm at 2weeks after injection was observed and it lasted for 4months. It was also noted that there was no difference in the measurement of gingival display on maximum smile for postinjection during 5th and 6th month when compared with preinjection measurements. This study confirms that the efficacy of BTX A injection lasted for 4months and then gradually reduced resulting in reversal of gingival display during maximum smile. The authors conclude that in the cosmetic correction of gummy smile by BTX-A, it is important to identify the type of smile and the main muscles involved, so that the correct injection technique can be used. It also confirms that BTX-A is a novel, competent, risk-free and minimally invasive nonsurgical therapy that can extensively improve smile aesthetics.

Perio Esthetics: Correction of Gummy Smile by Lip Repositioning

Perio Esthetics: Correction of Gummy Smile by Lip Repositioning

Comparative efficacy of Botox and surgical lip repositioning in the correction of gummy smile

A smile plays an important role in determining a person's initial impression. This study aims to evaluate the effectiveness of both injection botulinum toxin type A (botox) and surgical lip repositioning in the correction of the gummy smile due to hyperactive upper lip according to the resulting smile and the patients' satisfaction. The study consisted of 24 patients: 12 received the BTX-A (botulinum toxin type-A) injection and the remaining 12 underwent the surgical procedure (lip repositioning). The patients rated their satisfaction according to their gingival display that was defined as the difference between the lower margin of the upper lip and the superior margin of the right incisor, and patients were followed at 2 weeks, 2 months, and 6 months. Post injection and post-surgery with changes documented by photographs. Both groups answered a questionnaire addressing the overall appearance and they were asked to rate the improvement of their smile according to a 5-point aesthetic scale. The patients rated the effects of BTX-A as highly favorable if we take into consideration that BTX-A had a temporary effect while the surgical procedure (lip repositioning) had a relapse likelihood of more than 80% because the lip reverted back to its original position with almost complete relapse after 6 months and not to mention the risks affiliated with the surgical procedures. BTX-A injection exhibits better results than those of surgery and had given safer and more satisfactory results and achieved the required cosmetic patient requirement than lip repositioning.

Non-surgical correction of gummy smile using temporary skeletal mini-screw anchorage devices: A systematic review.

BackgroundThere are no studies that have systematically reviewed randomized control trials and/or prospective cohort studies that have assessed the significance of temporary skeletal mini-screw anchorage devices (TSAD) for the correction of gummy-smile. The aim of the present systematic review was to assess the significance of non-surgical correction of gummy smile using TSAD. Material and MethodsThe addressed focused question was “Are temporary skeletal mini-screw anchorage devices effective for the correction of gummy smile?” Indexed databases were searched up to and including May 2020. Different combinations of the following key-indexing terms were used: anchorage; gummy smile, mini-screw; orthodontic; and vertical maxillary excess. The literature search was performed without time and language barriers. Randomized clinical trials and prospective cohort studies that addressed the focused questions were included. Risk of bias was assessed using the Downs and Black and Cochran collaboration tools. Letters to the Editor, commentaries, case-reports/series and articles published in non-indexed databases were excluded. ResultsThe initial search yielded 2118 studies out of which, four studies met the inclusion criteria and were processed for data extraction. All studies had a prospective research design. One study was a clinical trial and 3 had a non-randomized design. Results of the clinical trial showed no statistically significant difference in the extent of intrusion between the test- and control-groups. The non-randomized studies showed that TSAD are useful in reducing deep overbite. All studies had a high risk of bias. ConclusionsThe TSAD are an effective and practical option in facilitating reduction of excessive gingival display or gummy-smile. However, further long-term follow-up, well-designed and power-adjusted clinical trials are warranted in this regard. Key words:Anchorage, Excessive gingival display, Gummy-smile, Mini-screw.

DEEP BITE CORRECTION BY INCISORS INTRUSION WITH CONNECTICUT INTRUSION ARCH - case report

Deep overbite as one of the most common malocclusion that can occur along with other associated malocclusions can be treated with several mechanisms. One such mechanics is true intrusion of anterior teeth. Deep overbite correction by intrusion of anterior teeth affords a number of advantages and is the desired treatment option for gummy smile correction, esthetics improvement as well as correction of mandible rotation in order to improve vertical dimension and to correct Class II malocclusion. This case report describes the orthodontic treatment of a 17-year-old patient diagnosed as severe Angle’s Class II malocclusion with maxillary prognathism and skeletal deep bite, dental Class II division 1 malocclusion associated with 4 mm overbite, an increased overjet and excessive gingival display on smiling. After the analyses and due to the fact that the patient avoided surgical method for her malocclusion correction, our treatment plan in this case was alternative (camouflage) with upper premolars extraction. In the first phase we did 9 mm canine retraction with preserved vertical dimensions of upper incisors. In the second phase of our treatment we did incisor intrusion and en masse retraction of the incisors. Intrusion of upper incisors was done using a 0.017 × 0.025 Connecticut intrusion arch and 0.019 x 0.025 stainless steel as base archwire was used. Outstanding results were achieved with an improved facial profile, smile harmony and stable occlusal relationships. Through this case report we highlight the efficiency of Connecticut intrusion arch as а clinically manageable biomechanical system to optimize the orthodontic treatment. The use of good biomechanical principles helped us to achieve all treatment goals and objectives with minimal side effects. Keywords: deep bite, maxillary incisors intrusion, Connecticut intrusion arch

Prevalence of Gummy Smiles in Leptoprosopic Patients and Various Treatment Modalities Employed in South Indian Population

Patients with a vertical growth pattern have a tendency for a long face and gummy smile due to the clockwise rotation of the mandible and ensuing divergence of maxillary bases. A patient can be said to have a gummy smile when there is gingival exposure of 3mm or more while smiling. A gummy smile is unaesthetic and warrants correction. The common treatment modalities employed for correction are dental intrusion and surgery. The study aimed to determine the number of patients with leptoprosopic facial patterns having gummy smiles and the various treatments for its correction. The objective of this study was to determine whether all leptoprosopic patients have a tendency towards gummy smiles and the treatment plan most commonly used for its correction. Records from the Department of Orthodontics were retrieved and searched for the patients with leptoprosopic facial type. Only 42 patient records were eligible according to the selection criteria of which (n=22) were females and (n= 20) were males. Selection criteria included patients who had a long face with facial index between 90-94%, on cephalometric evaluation female patients with upper dental facial height &amp;gt;27.4+/-1.7 mm and male patients &amp;gt;30.5+/-2.1. The results showed that the patients with leptoprosopic facial patterns had a tendency towards gummy smiles and the treatment plan most commonly used for its correction in the Department of Orthodontics in Saveetha dental college was skeletal intrusion using dental mini implants and IZC. Other treatment modalities included Le-Fort Superior Impaction of maxilla in severe cases. Association between gender the various treatments employed for gummy smile correction was statistically insignificant. (p&amp;gt;0.05). We can conclude that gummy smile and facial patterns have a positive correlation.