Gingival Display Research Articles

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.

Intrusion Of Maxillary Anterior Teeth: A Comparative Clinical Study Between Mini-Implants And Utility Arch

Background: Deep bite is a common orthodontic malocclusion caused by factors like incisor supra-occlusion, molar infra-occlusion, or incisor angulation. Nonsurgical correction of deep bite involves extrusion of posterior teeth, intrusion of incisors, or both. Extrusion of posterior teeth in growing patients provides stable results due to secondary remodelling. In patients with deep bite and excessive gingival display, intrusion of incisors is typically required which can be accomplished using intrusion arches or mini-implants. Materials and Methods: A total of 10 subjects with an anterior deep bite (overbite >4mm) with excessive incisal display at rest and at smile were taken. Participants were evenly allocated into two groups based on their gingival display. Group I included five participants with less than 4 mm of gingival display, who received treatment using Rickett’s intrusion utility arch. Group II consisted of five subjects with more than 4 mm of gingival display, who were treated with two anterior mini-implants. Lateral cephalograms were utilized to evaluate maxillary anterior intrusion at two specific time points: Pre-treatment (T1) and following a 6-month interval (T2). Results: The amount of bite opening in both groups was comparable, however the amount of incisor intrusion was greater with mini-implants than with the utility arch. The utility arch group showed significantly greater labial tipping (P<0.01) and increased overjet (P<0.05) compared to the mini-implant group. The distance between the maxillary first molar (U6) and palatal plane (PP) significantly increased with the utility arch but decreased with mini-implants. The mandibular plane angle (GoGn-Sn) increased with the utility arch and decreased with mini-implants; however, the difference was statistically non-significant. Conclusion: Deep bite correction with intrusion utility arch occurs through incisor intrusion, incisor flaring, and molar extrusion, whereas with mini-implants, bite opening mainly occurs through incisor intrusion, making it an efficient alternative in cases where dental side effects such as incisor flaring and molar extrusion are undesirable.

Role of canine vertical position and gingival zenith level on smile aesthetics and qualitative evaluation of perception by orthodontists, general dentists and laypersons: A descriptive cross-sectional study

: Our objectives were to verify the impact of alterations in the vertical position of the maxillary canines in smile aesthetic perceptions and to determine whether exposure of the gingival margins directly affects laypersons' and orthodontists' perceptions.: To evaluate the impact of vertical position and gingival zenith level of maxillary canine on smile esthetics as judged by orthodontists, general dentist and laypersons: This is a qualitative, descriptive cross-sectional study aimed at studying the role of vertical position and gingival zenith level on the smile esthetic perception. A smiling photograph of a male subject with and without exposing the gingival zeniths was selected, and vertical positions and gingival zenith levels of canine were symmetrically modified in increments of 0.5 mm, creating two sets of 4 new modified images varying from 1.0 mm of intrusion to 1.0 mm of extrusion and 1.0 mm of increasing and decreasing the height with gingival exposure. The total of 15 images were evaluated by 40 orthodontists, 40 general dentists and 40 laypersons, who determined the level of attractiveness of each smile on a visual analog scale.: Both smile arc ( <0.05) and gingival display amount ( <0.001) had statistically significant influences on the perception of smile attractiveness. Smile attractiveness scores with reference to gingival display amount showed a statistically significant ( <0.001) difference between the rater groups. A significant ( <0.05) interaction between smile arc and gingival display amount was observed. No significant difference were noted with standard smiles and intrusion smiles. Also, with 0.5mm extrusion and intrusion images in low smile. The intra-evaluator groups showed no significant difference between intrusion and extrusion high as well as low smile images, (value<0.05 for all). significant difference was seen in extrusion and intrusion high smile at 0.5mm and low smile images at 1mm level, extrusion and intrusion low smile images at 0.5mm level, (value>0.05 for all), significantly higher intrusion and extrusion high smile images at 0.5mm level, (-value<0.05 for all). extrusion and intrusion high as well as low smile images at 1mm and 0.5mm levels, (-value<0.05 for all).: Orthodontists were more critical in their assessments. There were no differences in the esthetic evaluations of smiles with and without gingival margin exposure for both groups of evaluators. For all the three evaluator groups, the most attractive ones were the standard smile and smile with the intrusion of 0.5 in high smile, standard and extrusion of 0.5 mm in the low smile group 0.5 mm of increased gingival zenith level (GZL) as perceived by orthodontists and general dentists, while for laypeople it was the standard smile. The unattractive smiles have extrusion and intrusion of 1mm for all the three evaluator groups 1 mm followed of decreased GZL of canine, for orthodontists and general dentist with 1mm increased. Laypeople, orthodontists scored all the images more critically by giving lesser scores compared to the general dentists and laypeople.

Modified Technique of Gummy Smile Treatment: Double M-V Plasty for Esthetic and Functional Lip Reposition Surgery.

Excessive gingival display is a common problem that results in an unaesthetic appearance while smiling. Lip reposition surgery is a powerful, noninvasive surgery approach for gummy smile treatment, frequently performed in outpatient oral and maxillofacial surgery units. The procedure as such, provides camouflage of the increased gingival display through re-attachment of the upper lip and limits the pull effect of the muscles by reducing the depth of the upper vestibule. Few techniques of surgical treatment of maxillary gingiva overexposure have been described so far. Proposed midline double V- plasty provides anatomic reposition of the frenulum, whereas bilateral vertical M-plasty enables wider excision of the mucosa than the conventional approach providing better adaption of the wound margins without residual dog-ear defects giving more functional, esthetic, and satisfactory effect to the patients. It can also be performed in patients who do not desire orthognathic surgery with good esthetic results.

A Modification of Fenestration Technique (MOFT) to Increase Vestibular Depth: A Case Series.

The most prevalent mucogingival issues include insufficient gingival width, decreased vestibular depth, abnormal frenal attachment, gingival recession, pockets that reach the mucogingival junction, excess gingival, inconsistent gingival margin, excessive gingival display and abnormal gingival colour. Numerous periodontal plastic operations have been used to treat these issues. However, each approach has its own drawbacks and is technique-dependent. Adequate depth of vestibule is necessary to maintain good oral health as shallow vestibule leads to accumulation of food and thus impedes oral hygiene maintenance. This case series describes a vestibular deepening procedure performed using modification of periosteal fenestration technique. This technique includes a series of eight cases of shallow vestibule where vestibular deepening was conducted by giving a full-thickness incision to expose the periosteum and create a window of fenestration followed by suturing the labial mucosa to the periosteum at the apical level. The results reported an excellent post-operative outcome showing increased depth of the vestibule.

Treatment of excessive gingival display with lip repositioning procedure

Treatment of excessive gingival display with lip repositioning procedure

Assessment of mini-aesthetics in Class I malocclusion subjects who underwent orthodontic treatment with or without extraction of four premolars – A prospective study

Smile and facial attractiveness are strongly correlatedThis study aimed to assess the effect of extraction or non-extraction orthodontic treatment on mini-aesthetics in patients with Class I malocclusion by measurement of the smile variables.A total of 56 subjects were selected and grouped as Group 1- treated non-extraction, Group 2A-treated with extraction of first premolars and groups 2B- treated with extraction of second premolar teeth. Each subject was photographed with a posed smile and NHP using DSLR camera. The images were then imported into a computer software and the following smile parameters were assessed: gingival display, smile index, maxillary incisor display on smile and buccal corridor ratio.The mean measured maxillary incisor display was 1.39±0.34, 2.31±0.50 and 0.90±0.19mm in Group 1, Group 2A and Group 2B. The mean measured gingival display on smiling was 0.07±0.07, 0.38±0.65 and 0.07±0.15mm in Group 1, Group 2A and Group 2B. The mean measured smile index was 0.15±0.68, 1.20±0.22 and 0.95±0.41 in Group 1, Group 2A and Group 2B. The mean measured buccal corridor ratio was 0.83±0.39, 1.59±0.26 and 1.26±0.31 in Group 1, Group 2A and Group 2B. There was an increase in maxillary incisor display after fixed Orthodontic treatment in the non-extraction group and a decrease in first premolar extraction group while second premolar extraction group showed no changes. Smile index was increased post-treatment in first premolar and second premolar extraction group while non-extraction group showed no significant difference. Buccal corridor ratio decreased in first premolar and second premolar extraction groups while non-extraction group showed no changes.

Is Botulinum Toxin Type A Safe for Gummy Smile Treatment in Bronchial Asthma Patients? A Case Report

Background and Aim: The increasing demand for aesthetic enhancements has led to the widespread use of Botox for various facial concerns, including gummy smiles. While its efficacy in treating gummy smiles is established, the safety profile of Botox in patients with underlying medical conditions, such as asthma, remains relatively unexplored. This case report presents a patient with asthma who underwent Botox treatment to correct excessive gingival display. The study aims to demonstrate the potential of Botox for aesthetic improvement in this patient population while emphasizing the need for further research to assess its safety profile. Results: A two-week Botox treatment course successfully eliminated the patient's gummy smile without inducing any asthma-related complications or adverse effects. Conclusion: Although this case suggests the potential of Botox for treating gummy smiles in patients with asthma, it is essential to conduct larger studies to establish its safety and efficacy. A comprehensive medical evaluation is crucial before considering Botox treatment for individuals with underlying health conditions.

Management of Gummy Smile Using Esthetic Crown Lengthening Technique

Abstract Excessive gingival display is a major concern for a large number of patients visiting the dentist. It is a multifactorial condition that needs to be managed in a sequential manner in order to reach proper treatment technique that targets and resolves the underlying etiologies. There are different etiologies of a gummy smile, such as vertical maxillary excess, short and hyperactive upper lip, altered passive eruption, anterior dentoalveolar extrusion, or a combination of these causes. Many techniques have been used to restore the dentogingival relation for the management of gummy smile. The various treatment modalities for Excessive Gingival Display includes gingivectomy, modified lip repositioning, orthognathic surgery, orthodontic therapy, hyaluronic acid infiltration, botulin toxin injections. This case report deals with the correction of Excessive Gingival Display using conventional gingivectomy.

Etiologies of excessive gingival display in a Saudi population

IntroductionExcessive gingival display (EGD) is a mucogingival deformity characterized by overexposure of the maxillary gingiva while smiling. This cross-sectional study aimed to identify EGD etiologies and their prevalence in participants at King Saud University, Saudi Arabia. MethodsAdults with a gummy smile, who resided in Saudi Arabia, were nonsmokers, had good overall health, and had all their maxillary anterior teeth were eligible for inclusion. Participants were first screened by phone, and those who met the eligibility criteria were further screened at the Dental University Hospital (King Saud University, Riyadh, Saudi Arabia). The demographic characteristics of all eligible participants were recorded. Participants were further subjected to extraoral examination, which included gingival display (GD), vertical maxillary excess (VME), hypermobile upper lip (HUL), smile line, altered passive eruption (APE), gingival overgrowth, and short upper lip (SUL). Intraoral examination included periodontal pocket depth and bleeding upon probing. Student’s t-test was used to compare the mean GD values across the main etiologies (VME, HUL, APE, and SUL). ResultsAll 123 participants (mean age: 23.1 ± 0.2 years; 74 females) had EGD (i.e., GD ≥ 4 mm), of whom 55 (44.7 %) had a single etiology, and the remaining 68 (55.3 %) had > 1 etiology. APE was the predominant etiology (n = 90, 73.2 %) in the study population. Of these (n = 90), APE alone was prevalent in 29 (32.2 %) participants, whereas the remaining patients had APE in combination with other EGD etiologies (n = 61; 67.8 %). The presence of more than one EGD etiology in the same participant was associated with greater GD. The VME and HUL were significantly associated with smile line classes (p < 0.05). ConclusionsAPE (alone or in combination) was the predominant etiology of EGD in the study population. The presence of multiple EGD etiologies in the same patient emphasizes the need for an etiology-based, sequential, and multiple-treatment strategy to effectively manage EGD.

Digital resources for surgical and restorative treatment of excessive gingival display in one session.

This article aims to showcase the implementation of a digital workflow in addressing a case of multifactorial excessive gingival display in a patient with high esthetic demands, incorporating both surgical and restorative interventions in a single session. A 28-year-old female patient presented with excessive gingival display, attributed to a combination of short teeth due to altered passive eruption, lip hyperactivity, and a sub-nasal depression that lodged the upper lip during spontaneous smiling. The multidisciplinary treatment strategy encompassed surgical crown lengthening, the placement of a biovolume in the maxillary concavity, and the rehabilitation of the six anterior teeth with direct composite resin, all done in a single session. Smilecloud Biometrics was used to digitally plan the smile, and the final wax-up/mock-up was approved by the patient prior to any irreversible procedure. A digital planning center (GuiderLab) enabled the materialization of the virtual planning and the printing of the periodontal surgical guide, the biovolume, and the resin layering guides for the restorative technique. Adopting a digital workflow in multidisciplinary cases with excessive gingival display leads to predictable and more expedited outcomes, ensuring a favorable result between soft and hard tissues. Excessive gingival display is a condition with multifactorial etiologies, including dentoalveolar, periodontal, skeletal, or muscular origins, or a combination of these factors. The diagnoses of altered passive eruption and a hypermobile upper lip are common in daily clinical practice and can be successfully managed through surgical crown lengthening and filling of the maxillary concavity, respectively. To achieve the desired outcome, restorative procedures often complement these surgical interventions.

A Systematic Review and Meta-Analysis Comparing Surgical and Nonsurgical Treatments for Excessive Gingival Display.

Excessive gingival display (EGD) is defined as more than 2 mm of gingiva display above the maxillary incisors at maximum smile. Various skeletal, dental, and soft tissue etiological factors for EGD have been suggested. This study assessed the effectiveness and stability of surgical (SX) and nonsurgical (NSX) interventions for correction of EGD through a systematic review and meta-analysis following PRISMA 2020 guidelines. An electronic search of Ovid MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, and LILACS was conducted (2010-2023). Results were expressed as mean change in gingival display using the random-effects model at 1, 3, 6, and 12-month follow-up. At 1 month, SX and NSX treatments yielded a comparable mean reduction of 3.50 mm (2.13-4.86) and 3.43 mm (2.67-4.19) in gingival display, respectively. However, by 6 months, NSX treatments showed a reduction of 0.51 mm compared to 2.86 mm with SX treatments. SX outcomes remained stable past 6 months, while NSX outcomes partially relapsed at 6 months and returned to baseline levels at 12 months. Notably, NSX treatments were more effective in cases with mild initial EGD, while SX treatments showed a better outcome in severe cases. To draw more robust conclusions regarding the treatment outcomes, future primary studies of greater rigor are required.

Digital Planning to Enhance Diagnosis and Precision in Correcting Excessive Gingival Display in the Presence of Asymmetrical Maxillary Position: A Case Report.

This case report addresses the treatment of excessive gingival display (EGD) in the context of maxillary asymmetry, zenith irregularities, and occlusal plane inclination. Digital planning was pivotal in formulating a precise treatment strategy by incorporating facial photographs, digital models, and cone-beam computed tomography data. Parameters, including occlusal plane inclination, teeth position, and lip-to-gingival margin relationships, were considered to ensure treatment alignment with the patient's facial characteristics. Notably, during the planning phase, it was evident that the conventional approach using the cementoenamel junction as the apical limit for incisions would result in asymmetry. Consequently, the gingival margin position was defined in accordance with facial and lip features. The chosen treatment, flapless crown lengthening, was tailored to the patient's thin phenotype and guided by measurements derived from digital planning. Postsurgery, the patient experienced a swift and painless recovery. A harmonious smile with a stable gingival margin position was achieved at the 1-year follow-up, seamlessly complementing the patient's facial attributes. This case underscores the importance of personalized EGD treatment and the value of digital planning in enhancing diagnostic accuracy and precise treatment planning, ultimately facilitating optimal treatment strategies.

Altered Passive Eruption among Patients Visiting Dental Outpatient Department in a Tertiary Care Center: A Descriptive Cross-sectional Study.

The eruption of teeth is considered to be a continuous phenomenon. Two types of eruption are possible namely, active and passive eruption. Failure in passive eruption (by the apical movement of gingiva from the enamel surface) generally results in a clinical condition known as altered passive eruption. It can result in the shortened crown height of a tooth and an esthetically unpleasant situation i.e., excessive gingival display or gummy smile. The main motto of this study was to find out the prevalence of altered passive eruption and associated gingival biotypes in adult patients visiting for dental treatment in tertiary centers along with strategically placed outreach centers. A descriptive cross-sectional study was done in the Department of Dentistry, Dhulikhel Hospital, and four outreach centers of the same hospital. The study was conducted from October 2022 to April 2023 after obtaining the ethical approval. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 165 patients, the prevalence of altered passive eruption was 21 (12.72%) (7.62-17.78 at 95% Confidence Interval). Furthermore, among 21 patients, the altered passive eruption was seen in the thick biotype patients in 16 (76.19%) and thin biotype patients in 5 (23.81%). The prevalence of altered passive eruption appeared to be equivalent when compared with the previous studies.

FUNCTIONAL CROWN LENGTHENING AS A PRE-RESTORATIVE PROCEDURE IN THE AESTHETIC ZONE

Introduction: Crown lengthening is a surgical procedure to increase the height of the clinical crown for aesthetic and restorative purposes, or combination. The indications include treatment of subgingival caries and altered passive eruption. Functional crown lengthening for restorative purposes in the esthetic zone should consider the concept of biologic width and the ideal proportion of the dentogingival complex. Case: A 39-year-old male patient was referred from the Department of Conservative Dentistry, RSGM UGM Prof. Soedomo to expose the maxillary anterior teeth crowns for full crown and veneer restorations. Clinical examination showed 11, 12, and 12 post root canal treatment with 3-4 mm remaining crowns. Teeth 13, 21, 22, and 23 appear short, excessive gingival display of 3 mm, with a diagnosis of altered passive eruption type 1B. Treatment: Functional crown lengthening was performed by gingivectomy followed by flap elevation, ostectomy, and osteoplasty. A fenestration was found at the apical of 22 and treated with regenerative procedure. Full crowns and veneers insertion was done 3 months after surgery. Crown lengthening as a pre-restorative procedure is a multidisciplinary treatment that considers the need for restoration by re-establishing the biologic width, to prevent inflammation and bone loss. In addition, adequate post- surgical tissue healing time prior to restoration is necessary to avoid gingival margin rebound and to assure long-term success of the restoration. Conclusionn : Functional crown lengthening as a pre-restorative procedure in the esthetic zone can gives satisfactory and stable results, with careful examination and correct surgical procedure.

Effects of polymethyl methacrylate-based bone cement graft for treating excessive gingival display and its dimensional facial changes: 12-Month clinical study

Objectiveto present a 12-month follow-up with photographic and tomographic analyses of the effect of polymethyl methacrylate-based bone cement graft (PMMA) in gingival exposure (GE) in patients with excessive gingival display (EGD). MethodsTwelve patients with EGD were included. The PMMA was surgically placed. A frontal and lateral photograph protocol was performed at baseline (T0), 3 (T3), 6 (T6), and 12 months (T12) post-operatively. Soft tissue cone-beam computed tomography (ST-CBCT) was performed at T0 and T12. Measures included GE, length of the lip vermilion (LLV), lip shape (LS), nose width (NW), filter width (FW), nasolabial angle (NAS) while smiling, and nasolabial angle at rest (NAR). The height, thickness, and volume of the cement graft were also measured in the ST-CBCT. The comparisons were performed by Kruskal-Wallis test at 5 % of significance (p < 0.05). ResultsThe height, thickness, and volume of the PMMA were respectively 12.84 ± 1.59 mm, 3.83 ± 0.53, and 1532.02 ± 532.52 mm3. PMMA significantly decreased GE from 8.33 ± 1.25 mm (T0) to 6.60 ± 0.93 mm (T12) (p < 0.01). NAR was 98.34 ± 9.28° at T0 and increased to 105.13 ± 7.33° at T12; however, the angle value was not statistically different (p = 0.08). LLV, LS, NW, FW, and NAS did not exhibit statistical differences between the baseline and follow-up periods. ConclusionsPMMA significantly decreased GE in a 12-month follow-up without influencing adjacent soft tissue anatomical structures.

Indonesian orthodontists and laypeople’s perception of the four components of smile analysis in individuals with various vertical skeletal patterns

Objectives: The objective of this study was to analyze the difference towards orthodontists’ and laypeople’s perceptions of four smile analysis components in individuals with various vertical skeletal patterns. Material and Methods: Each of the 100 orthodontists, and laypeople aged 26–65 years old were asked to complete an online questionnaire about four smile analysis components in individuals with various vertical skeletal patterns. The questionnaire consists of 36 modified photos according to various smile curves, buccal corridors, gingival displays, and incisor displays in normal, hypodivergent, and hyperdivergent skeletal patterns. Perceptions were assessed using a visual analog scale. Results: Significant differences were found in straight and parallel smile curve, maximum buccal corridor, and gingival display 4 mm components in all vertical skeletal patterns. Additionally, differences were also found in the medium buccal corridor in hypodivergent skeletal pattern, gingival display 2 mm in normal and hypodivergent skeletal patterns. Moreover, significant differences were also observed in the 100% incisor display in normal vertical skeletal pattern, and 50% incisor display in hyperdivergent skeletal pattern Conclusion: Orthodontists and laypeople have similar perceptions toward the most esthetic components (parallel smile curve, minimum buccal corridor, gingival display 0 mm, and incisor display 75%) in all vertical skeletal patterns.

Comparison of Two Different Techniques to Achieve Gingival Depigmentation: A Case Series With 6-months Follow-up

Background: Melanin pigmentation of the gingiva produces an unpleasant and unesthetic appearance to an individual especially if they have excessive gingival display. The present study aims to compare the two different depigmentation techniques to achieve gingival depigmentation. Materials and methods: A total number of 10 patients with 56 sites for depigmentation were recruited for the study. The patients were equally divided into groups, i.e., group I scalpel treatment and group II laser treatment. The gingival pigmentation was analysed using Dummett’s Oral Pigmentation score before and after the treatment. Additionally, the clinical parameters such as gingival index (GI) and plaque index (PI) were assessed. The above-mentioned parameters were assessed at the baseline, 3-months and 6-months post-operative period. Also, to evaluate the post-operative discomfort, Visual Analog Scale (VAS) was also employed. Result: In both groups, a statistically significant difference in pigmentation score was observed. Furthermore, group II displayed a lower VAS score and a decrease in post-operative pain, including bleeding, redness, and burning. Following both operations, no discernible changes in pigmentation were observed between the three and six-month follow-up. Conclusion: Both, the scalpel and laser depigmentation techniques offer better clinical outcomes in terms of reduction in pigmentation. Laser technique offers improved post-operative comfort for the patients. Keywords: Depigmentation, Diode Laser, Melanin pigments, Scalpel

Treatment of excessive gingival display using conventional esthetic crown lengthening versus computer guided esthetic crown lengthening: (a randomized clinical trial)

BackgroundSurgical guides have been proposed in an attempt to reach more predictable outcomes for esthetic crown lengthening. The objective of the present study was to evaluate the effectiveness of esthetic crown lengthening using 3D-printed surgical guides in the management of excessive gingival display due to altered passive eruption type 1B.Materials and methodsSixteen patients diagnosed with altered passive eruption type 1B, were divided into two groups. In the control group, the procedure was carried out conventionally, and in the study group, a dual surgical guide was used. The parameters of wound healing (swelling, color, probing depth, bleeding index, and plaque index), pain scores, gingival margin stability, and operating time were assessed at 1 week, 2 weeks, 3 months, and 6 months postoperatively.ResultsThere was no statistically significant difference in terms of wound healing, pain scores, and gingival margin stability between both groups at different time intervals (P = 1), however, there was a statistical difference between both groups in terms of operating time with the study group being significantly lower (P < 0.001).ConclusionDigitally assisted esthetic crown lengthening helps shorten the operating time and reduces the possibility of human errors during the measurements. This will be useful in helping practitioners achieve better results.Practical implicationsThe conventional method remains to be the gold standard. However, shorter operating time and lower margins for errors will help reduce costs as the chair side time is reduced as well as the possibility for a second surgery is lower. This will improve patient satisfaction as well.

Attractive combinations of female gingival displays, buccal corridor sizes, and facial heights according to orthodontists, dentists, and laypeople of different ages and sexes: a psychometric study

IntroductionEsthetics plays a crucial role in orthodontics and many other dental and medical fields. To date, no study has assessed the combined effects of the 3 facial features ‘facial height, gingival display (GD), and buccal corridor size (BC)’ on facial/smile beauty. Therefore, this study was conducted for the first time.MethodsIn this psychometric diagnostic study, beauty of 27 randomized perceptometric images of a female model with variations in facial heights (short, normal, long), gingival displays (0, 2, 4, 6 mm), and buccal corridor sizes (2%, 10%, 15%, 20%, 25%) were evaluated by 108 judges (36 orthodontists, 36 dentists, 36 laypeople) using a 5-scale Likert scale (1 to 5). Combined effects of facial heights, GDs, BCs, judges’ sexes, ages, and jobs, and their 2-way interactions were tested using a mixed-model multiple linear regression and a Bonferroni test. Zones of ideal features were determined for all judges and also for each group using repeated-measures ANOVAs and the Bonferroni test (α=0.05).ResultsJudges’ sex but not their age or expertise might affect their perception of female beauty: men gave higher scores. The normal face was perceived as more beautiful than the long face (the short face being the least attractive). Zero GD was the most attractive followed by 4 mm; 6 mm was the least appealing. BCs of 15% followed by 10% were the most attractive ones, while 25% BC was the worst. The zone of ideal anatomy was: long face + 0mm GD + 15% BC; normal face + 2mm GD + 15% BC; long face + 2mm GD + 15% BC; normal face + 0mm GD + 15% BC.ConclusionsNormal faces, zero GDs, and 15% BCs may be the most appealing. Facial heights affect the perception of beauty towards GDs but not BCs.