Gingival Display Research Articles

Eficacia del reposicionamiento de labios en el tratamiento de la exposición gingival excesiva: revisión sistemática y metanálisis

Background: The objective of this systematic review and meta-analysis was to answer the questions ‘’Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?’’ and ‘’Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?’’ to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO). Keywords: Lip; Gingiva; Smiling; Lip repositioning; Excessive gingival display; Esthetic periodontal surgery

Lengkung Senyum dan Tampilan Gingiva Pada Senyum

A smile is a form of one's facial expression that is widely used and easy to see. Having an aesthetic and attractive smile can make a person more confident when interacting socially in their environment. There are eight main components that are assessed in a smile, two of which are the smile arc and gingiva display. Both have received a lot of attention because they are known to have a major influence on an aesthetic smile.The harmony of the smile arc and gingival display will produce an attractive smile. A consonant smile and a moderate smile line are considered the ideal smile arc and gingival display.

Aesthetic perception of gingival display on smiling among laypeople seeking dental treatment

Abstract Objective The present study aimed to determine the influence of gingival display on smile perception of adult patients seeking dental treatment. Materials and methods A smiling photograph was digitally modified to simulate gingival exposures from -4 mm to +4 mm, each in 2 mm increments. Using a validated questionnaire, 117 subjects were recruited and asked to rate the attractiveness of the smile displayed by the photographs. Friedman tests were applied to compare the perceptions of the overall subjects in addition to subjects within each category. Kruskal–Wallis tests were used to compare perceptions between the genders, different ages, and ethnicity. Statistical significance was set at P < 0.05. Results The most aesthetic gingival display was at -2 mm and the least aesthetic at -4 mm among all subjects. Females were more critical in evaluating smiles than males. Subjects 50 years or older and the Chinese ethnicity were less sensitive to the range of gingival displays. Conclusions Smile perception of varying gingival display among adult laypeople was found to be the most aesthetic at -2 mm, least aesthetic at -4 mm and was influenced by gender, age, and ethnicity.

Compensatory treatment for hyperdivergent skeletal Class II using temporary anchorage device

Introduction:Treatment of hyperdivergent skeletal Class II is one of the most challenging for orthodontists. With the advent of temporary anchorage devices, patients who previously had an indication of orthognathic surgery may be favored with counter-clockwise rotation of the mandible, resulting from vertical control of the posterior teeth. Also, cases with increased incisors display at rest may benefit from these biomechanics in the anterior segment. Methodology and resources:This case report illustrates a successful treatment of a patient with hyperdivergent skeletal Class II malocclusion with an unaesthetic smile involving excessive gingival display at smile and absence of passive lip seal. Results: This way, a suitable functional and aesthetic result was obtained with the correction of the increased gingival exposure, passive lip sealing and improved angulation of the mandibular plane.In addition to the conventional cephalometric superimposition, three-dimensional superimposition was performed and evaluated to validate the treatment outcome.Discussion: Although it does not replace orthognathic surgery, such a modality of treatment may benefit patients who are not willing to undergo a more invasive procedure.

The buccal corridor as a possible morphological risk indicator for sleep disordered breathing.

To explore a possible morphological relationship between buccal corridor, gingival display, transpalatal molar width, palatal height, and a cephalometric measurement (PV-A Line) as a risk indicator for sleep-disordered breathing. Thirty subjects were enrolled. Full face maximum smile images and CBCT scans were taken. A Pearson correlation coefficient was used to identify any relationships between the variables. No correlations were identified between any of the variables investigated in this study as they relate to risk factors for sleep-disordered breathing. The amount of buccal corridor space in relation to a patient's smile and the amount of gingival display does not appear to be a reliable metric in identifying certain morphological risk factors for sleep-disordered breathing. Assessing the amount of buccal corridor space in relation to a smile does not appear to be a reliable predictor of morphological risk for certain risk factors of sleep-disordered breathing. In addition, utilizing the amount of gingival display in a patient's maximum smile does not appear to relate directly to risks in sleep-disordered breathing. Other tests and discovery may be necessary to identify these types of patients.

Digital Smile Makeover: A Multidisciplinary Team Approach.

Aesthetics is a fundamental part of contemporary dental practice. A pleasant smile depends on the gingival tissue architecture and dental characteristics. Excessive gingival display (gummy smile) is considered an unattractive smile and can affect a person's confidence. There are many etiological factors related to a gummy smile. Aesthetic rehabilitation of these cases often requires an interdisciplinary approach and close collaboration between dental specialties. This article describes an approach to excessive gingival display management caused by short teeth and hyperactive lips using a digital workflow for crown lengthening. A digital approach enables predictable planning and decreases the need for postsurgical modifications, thus shortening the treatment duration. Computer software is used for planning and 3D-printed guide for crown lengthening and implant placement. Two months later, lip repositioning was performed to reduce the hyperactive lip. After 4 months, prosthetic treatment and Botox injections were done to restore an aesthetic smile.

Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption.

To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE). An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks. This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case. Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.

Maxillary lip dynamics and gingival display revisited: Utilizing standardized metrics.

This study was initiated to validate a predictable system for establishing maximum maxillary lip dynamics and highlight the clinical significance of the findings. Seventy-five subjects, ranging in age from 25 to 71 years old were photographed with lips in maximum and minimum reveal. The images were digitally analyzed using set references. The statistical analysis was performed using Meta. Numerics version 4.1.4. A Pearson correlation coefficient (r) was carried out to identify relationships between age and maxillary lip dynamics. A p-value less than or equal to 0.05 was considered to be significant. A greater percentage of participants have posterior gingival display than anterior gingival display. There is greater movement of the maxillary lip at the cuspid than at the central incisor. There was a tendency for lip dynamics to increase at the right central incisor when there is an increase in lip dynamics at the right cuspid. Lip dynamics does not appear to decrease with age. Accurately recording and considering maximum lip dynamics helps avoid asymmetric, excessive or insufficient gingival architecture, insufficient or excessive tooth length and visible restorative margins.

COMPARISON OF AESTHETIC SMILE PERCEPTIONS BETWEEN DENTISTRY AND ECONOMICS BUSINESS STUDENTS IN LAMBUNG MANGKURAT UNIVERSITY

ABSTRACTBackground: Smile is one of the aesthetic components that contribute to person's attractiveness. The aesthetic smile is obtained from orthodontic treatment. The standard of orthodontic aesthetic smile is from the evaluation between smile arch and lower lip border, number of gaps, and amount of gingival, when smiling. Aesthetic concepts can be different because of perception. The difference in perception may be generated by a variety of variables. One of which is educational background. Purpose: This study aims to analyze the difference in perception of the aesthetic smile between dentistry students and economic business students at Lambung Mangkurat University. Method: This study used an analytic observational method with a cross-sectional approach. The sample was calculated using the Slovin formula and obtained 88 respondents who were taken using a simple random sampling technique. The questionnaire was measured on an ordinal scale using a visual analogue scale from 0-100. Before being distributed to respondents, the questionnaire was first tested for validity and reliability. Then, the results were analyzed using the Mann-Whitney test. Results: The significance of the Mann-Whitney test obtained a consonant smile of 0.000; a narrow buccal corridor of 0,000; a gingival display of a non-gummy smile of 0.006, and a symmetrical smile of 0.000. The four variables had a significance value of less than 0.05. It means that there was a difference between the two groups. Conclusion: There is a difference in perception of an aesthetic smile between dentistry students and economic business students at Lambung Mangkurat University. Keywords: Aesthetic Smile, College Student Perceptions, Smile Perceptions

Perception of discrepancy in the upper midline position in conjunction with the gingival display according to various occupations in Iran.

This study evaluated the influence of various gingival displays on the esthetic perception in the presence of upper dental midline discrepancy. A smiling image of a male subject was altered digitally to produce five image series: normal smile (series A), decreased tooth show (series B), increased gingival show (series C), maxillary cant (series D), and asymmetric upper lip elevation (series E). In each image series, the midline was deviated to the right and left incrementally. A total of 210 raters (four professional groups and laypersons, n = 42 in each group) determined the midline deviation threshold and the attractiveness of midline position in each series. The right and left thresholds were statistically similar for the symmetrical series (A, B, and C), while for series D, the right threshold was significantly lower. In most rater groups, the mean threshold order was: B > A > E > C > D. In all the series, the raters selected the coincident midline as the most attractive series except for series D, for which 1-2-mm deviations to the left were selected as the most attractive by almost all the groups. It is crucial to establish the coincident midline position in a symmetrical smile, especially when a gummy smile exists. In the asymmetrical gingival show, a coincident midline might not be the most esthetic midline position.

Perception of smile esthetics by patients reporting for orthodontic treatment

Objective: The main objective of this study was to evaluate smile esthetics in terms of midline diastema, smile arc and gingival display during smile by patients reporting for orthodontic treatment. Study design: A cross-sectional study. Setting: Out Patient Door, Orthodontic Department Liaquat University of Medical and Health Sciences, Jamshoro Sindh. Duration: The study was conducted within 06 months after the approval of synopsis i-e from Dec 2020, to May 2021. Sample size: Out measures were 1) midline diastema, 2) Gingival Display during smile, 3) smile arc. Sample size calculation was done by using “Openepi” software with 5% margin of error and 95 % confident value, Mean 0.95, Sample size was n= 126. Sample technique: Non-Probability consecutive sampling technique. Data collection method: After approval of this study from Ethical Review Committee of LUMHS study was conducted at Orthodontic Department, Institute of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. There were total of 126 participants in this study, Data was collected showing three different front smiling photographs with various degrees of; Gingival Show During Smile i-e A= 0mm B =0.5mm C=1.5mm D=2mm E=2.5mm Smile Arc i-e A. Convex/Curved B. Plan/Straight C. Inverted/Reverse.

A case report: Surgical esthetic crown lengthening procedure for gummy smile treatment

Background: In modern society, a harmonious smile is considered a symbol of beauty. An attractive smile can improve appearance so that a person is more easily accepted in society. In planning dental treatment to be carried out, aesthetic considerations are very relevant because of the relationship between smile and facial beauty. Purpose: The purpose of writing this article is to describe a crown lengthening accompanied by bone reduction to correct an excessive gingival display in a patient with altered passive eruption (APE) of the maxillary anterior teeth. Case: A 28-year-old female patient came to the Periodontology Specialist Polyclinic at RSGM Airlangga University with complaints that the gums on the upper front teeth looked more dominant. The patient did not have problems with the periodontal tissue and had no history of systemic diseases such as diabetes, high blood pressure, and had no history of allergies to food and drugs. Case Management: After analyzing the periodontal tissue, the choice of crown lengthening with bone reduction was chosen to treat this case. Conclusion: procedures Crown lengthening have been performed as a viable option to facilitate restorative therapy or improve esthetic appearance.

A Modified Approach in Lip Repositioning Surgery for Excessive Gingival Display to Minimize Post-Surgical Relapse: A Randomized Controlled Clinical Trial.

Lip repositioning surgeries are performed to treat patients with excessive GD (EGD). This study aimed to explore and compare the long-term clinical results and stability following the modified lip repositioning surgical technique (MLRS) with the addition of periosteal sutures compared to the conventional lip repositioning surgery (LipStaT®) in order to address EGD. A controlled clinical trial with female participants (n = 200) intended to improve their gummy smile were divided into control (n = 100) and test (n = 100) groups. The gingival display (GD), maxillary lip length at rest (MLLR), and maxillary lip length at maximum smile (MLLS) were measured at four time intervals (Baseline; 1 Month; 6 Months, and 1 Year) in millimeters (mm). Data were analyzed by t-tests, Bonferroni-test, and regression analysis using SPSS software. At the one-year follow-up, GD for the control and test groups were 3.77 + 1.76 mm and 2.48 + 0.86 mm, respectively, and their comparisons showed that GD was considerably lower (p = 0.000) in the test group compared to the control group. The MLLS measurements taken at baseline, one-month, six-month, and one-year follow-up showed no significant differences (p > 0.05) between the control and test groups. At baseline, one-month, and six-month follow-up, the mean and standard deviation for the MLLR were almost similar, with no statistically significant difference (p = 0.675). The MLRS is a successful and viable treatment option for the treatment of patients with EGD. The current study showed stable results and no recurrence with MLRS until the one-year follow-up compared to LipStaT®. With the MLRS, a 2 to 3 mm decline in EGD is usually to be expected.

Lip repositioning and guided gingivectomy combined treatment for excessive gingival display by using 940-nm diode laser: a case report

Lip repositioning and guided gingivectomy combined treatment for excessive gingival display by using 940-nm diode laser: a case report

The Frequency of Varying Degrees of Gingival Display and Biometric Measurements of Anterior Teeth

Aim: To find out the frequency of gingival display in dentate individuals while smiling and evaluate the biometric measurements of anterior teeth at varying degrees of display. Study design: Cross sectional observational study. Place and duration: Prosthodontic Department of Lahore Medical and Dental College Lahore, from 5-6-2022 to 05-09-2022 Methodology: Selected subjects comfortably seated in dental chair. Digital vernier caliper was used for recording of measurements. Each individual was asked for maximum smile and gingival display noted as visible or not. Biometric measurements e.g.; over jet, over bite were recorded for gingival displayedand non -displayed group. Results: A total of 260 subjects including 49.2% males and 50.8% females were selected. The mean age of the subjects was 22.81±SD 2.087 years. 65.4% of individuals had gingival display whereas 34.6 % did not show gingiva while posed smiling. Gender distribution showed more display of gingiva in females 72.7% as compared to males 57.8%. Statistically significant results were obtained when compared i.e.; p<0.05. The over bite values showed significant difference with respect to gender however the over jet had insignificant difference with respect to gender. The comparison of means of biometric measurements with gingival display and non-display group showed significance. The values of over jet obtained in gingival display and non-display group were 3.30±0.728 and 2.34±0.829 whereas the mean values of over bite obtained in both groups were 2.97± 0.625 and 2.78±0.625. Conclusion: Gingival display is frequently observed in our region. Gender based difference exists with respect to gingival display level where females displaying more gingival tissue and significant variation is seen in the biometric measurements of displayed and non -displayed group.These findings would help in placing margins of fixed and removable prosthesis in best esthetic zone. Key words: Anterior teeth, Dentate, Esthetics, Gingiva, Gingival display, Over jet, Over bite, Smile,

Is There a Correlation between Gingival Display and Incisal Inclination in a Gummy Smile? Study on Cephalometric Parameters.

Excessive gingival display or "gummy smile" is a clinical condition where a maxillary gum shows between the inferior line of the superior lip and the gingival line of the incisive superior during a spontaneous smile. The aim of this research was to understand the various skeletal and dentoalveolar components contributing to a gummy smile in a sample of 120 patients. This retrospective case-control study had the primary objectives of analyzing the existence of a correlation between the presence of gingival exposure and the alteration of the inclination of the upper incisors with respect to the Frankfurt plane, the Palatine plane (bi-spinal) and to the NA line in a sample of orthodontic patients, and also evaluating the association with skeletal, dental, and aesthetic cephalometric parameters. In our study, it's emerged a correlation between the gingival exposure and the presence of alterations to incisal torque in the vestibular direction and the quantity of maxillary gingiva evident during the smile, which is correlated in particular to the Is-Sts distance, overjet and overbite. The major indicative data, therefore, are related to the vertical position of the upper incisors, in particular with respect to the upper lip and to the sagittal position.

Optimal gingival display on smiling based on different facial vertical patterns in Iranians

This study aimed to determine the optimal gingival display on smiling on the basis of different facial vertical patterns in Iranians from the perspective of laypeople, maxillofacial surgeons, and orthodontists. Photographs were obtained from short-faced, normal-faced, and long-faced males and females (1 male and 1 female from each group) aged 18-30 years. The original photographs were then modified to have 6, 4, 2, 0, -2, -4, and -6 mm gingival display. Three groups of raters (n= 40), including laypeople, orthodontists, and maxillofacial surgeons, were requested to score each photograph regarding smile attractiveness using a 5-point Likert scale. Data were analyzed using analysis of variance and the Kruskal-Wallis test. Regarding the photographs of the normal-faced female model, all 3 rater groups gave the highest score to a 2 gingival display. In the normal-faced male model, all 3 rater groups gave the highest and lowest scores to 0 and 6 mm gingival display, respectively. In the long-faced female model, all 3 rater groups gave the same score to 0, 4, and 6 gingival display. In the long-faced male model, the 3 rater groups gave the same score to 0, 2, 4, and 6 gingival display. In the short-faced female model, all 3 rater groups gave the highest score to 0 gingival display. In the short-faced male model, the 3 rater groups gave the same score to all values of gingival display except -4 mm. The laypeople, maxillofacial surgeons, and orthodontists all gave the highest score to the photograph of a short-faced Iranian female model with 0 gingival display.

Comparative cone-beam computed tomographic evaluation of maxillary incisor intrusion and associated root resorption: Intrusion arch vs mini-implants

Various literature has verified that apical root resorption is a common adverse effect of orthodontic treatment, particularly intrusion. Conventional radiographic techniques underestimated root lengths and overestimated tooth lengths. Cone-beam computed tomography (CBCT) is a useful diagnostic tool to detect orthodontically induced external apical root resorption. This prospective study aimed to compare maxillary incisor intrusion and associated root resorption via CBCT. Thirty patients aged 16-23 years, having a deepbite of 6-8 mm and excessive gingival display on smiling, were divided into 2 groups: group 1, with 15 patients who were treated with Burstone intrusion arch, and group 2 with 15 patients who were treated with mini-implants applying 100 g of intrusive force for 4 months with activation done every 4 weeks. During this 4-month study period, no treatment was performed other than the intrusion of incisors. CBCT scans were obtained before and after the intrusion phase of treatment to compare the amount of intrusion and associated root resorption among both groups. No significant difference was found in mean incisor intrusion between groups 1 and 2 (P= 0.772), with slightly more proclination of incisors in group 1, resulting in a significant (P= 0.018) increase in the vertical change of incisal edge in group 1. A statistically significant difference was found in root resorption among both groups (P= 0.004), with more root resorption in group2. The results of this study indicate intrusion with both the intrusion systems using appropriate intrusive forces is effective in opening the bite with slightly more external apical root resorption in the mini-implant group.

Simultaneous Esthetic Crown Lengthening and Frenotomy Procedure for Smile Rejuvenation


 Introduction: Gingival tissue plays an important role in smile aesthetics, especially in the anterior maxillary region. A gummy smile (GS) is a gingival condition that appears excessive when the patient smiles. The prevalence of gummy smile in individuals aged from 20 to 30 is 10% of population. It is more common in women and can cause aesthetic problems. Gummy smile aetiology is multifactorial. This case report discusses gummy smile case caused by altered passive eruption (APE) and associated with the presence of aberrant frenum. Case Report: A 19-year-old female patient with chief complaints of the excessive gingival display. The diagnosis of the case was confirmed by clinically healthy gingiva in an intact periodontium with gummy smile due to the presence of altered passive eruption type I-B accompanied by an aberrant frenum. The final surgical plan was aesthetic crown lengthening (CL) with flap surgery and osteotomy simultaneous with a frenotomy. Conclusion: The aesthetic crown lengthening surgery and frenotomy can be performed simultaneously to correct the gummy condition and improve the patient’s smile profile. Appropriate examination, diagnosis, and treatment planning help achieve optimal patient outcomes.

Laser Assisted Modified Lip Repositioning Surgery for the Treatment of Excessive Gingival Display Using Y V Plasty

Excessive gingival display is matter of concern for a lot of patients and affects their psychological well-being. Various methods have been employed to reduce excessive gingival display but with variable results. Modified Lip repositioning is a surgical way to correct gummy smile by limiting the retraction of the elevator smile muscles and yet preserve the labial frenum using Y-V plasty using a method that gives long term results along with being non-invasive and has high patient compliance. After thorough disinfection and achieving adequate anaesthesia, the strip of mucosa which had to ablated was marked with a laser, which was twice the amount of gingival display seen in the patient. After carrying out laser ablation of the marked tissue, and performing Y-V plasty, the surgical area was evaluated and the wound margins were approximated with multiple interrupted sutures. The patient was put on a regular follow-up. The results revealed a marked reduction in gingival display at the 3-month follow-up. Overall gingival display reduced from 6 mm to 2 mm.