Gingival Display Research Articles

LIP REPOSITIONING SURGERY ALONG WITH ESTHETIC CROWN LENGTHENING FOR THE TREATMENT OF GUMMY SMILE:A CASE REPORT

Excessive gingival display is an aesthetic concern that may be addressed with a variety of methods. Lip repositioning is a treatment option for people who are concerned about their appearance. Excessive gingival display, commonly known as gummy smile, is characterised by a gingival display of more over 3mm when smiling. A patient with a gummy smile was treated with lip repositioning surgery in the current case report. Our goal was to present lip repositioning as a viable treatment technique for reducing gingival display and asymmetry with a simple and conservative surgical procedure, strong long-term durability, and little recurrence.

Clinical efficacy of lip repositioning technique and its modifications for the treatment of gummy smile: systematic review and meta-analysis.

To systematically review the literature regarding the clinical efficacy of reducing excessive gingival display (EGD) using the surgical lip repositioning technique (LRT) and its modifications. The question to address was: "What is the clinical efficacy of the surgical LRT and its modifications in patients with EGD?" Four databases (MEDLINE-PubMed, Scopus, EMBASE, and CENTRAL) were searched up to December 2021 (PROSPERO-CRD42020205987). Randomized, non-randomized controlled and prospective case series with a minimum of 6-month follow-up were eligible for inclusion. Two meta-analyses were performed using the mean difference (MD) between baseline and different follow-up periods (6 and 12 months). Subgroup analyses were performed using the different modifications of LRT. The electronic research retrieved 783 studies. Only 13 met the inclusion criteria and were included in the statistical analysis. Six modifications of the original LRT were identified. An overall EGD reduction of -3.06 mm (95%CI: -3.71-2.40), -2.91 mm; (95%CI: -3.66-2.15) and -2.76 mm; (95%CI: -3.83--1.70) was achieved after 6, 12, and 36 months, respectively, compared to baseline (P < 0.01). Meta-analysis revealed that the use of LRT with periosteal suturing showed the greatest decrease in EGD with 5.22 mm (95% CI: 4.23-6.21; P < 0.01) at 6 months and 4.94 mm (95% CI: 3.86-6.02; P < 0.01) at 12 months. Both the original LRT and its different modifications reduce EGD and provide good results and overall patient satisfaction at 6, 12, and 36 months of follow-up. Evaluating the different modifications of the LRT can be a guiding aspect for the clinical and surgical approach to be used in patients with EGD.

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.

Creating smiles the lip repositioning way a case report

A beautiful smile comprises a perfect balance of the white and pink. A gummy smile has been a prevalent esthetic disorder with varied etiologies including of skeletal, dento-alveolar, or soft-tissue origin. It can be managed by a variety of treatment modalities after appropriate diagnosis and treatment planning. If it is due to jaw deformities, altered passive eruption or tooth malpositioning, the corrective measures incorporate orthognathic surgery and orthodontic treatment. However, this requires hospitalization and entails significant discomfort. Lip repositioning is a simple and predictable technique that restricts the muscle pull of the elevator lip muscles thereby reducing the gingival display. This case report demonstrates the successful management of a young patient with moderate gummy smile using the conventional LR surgery thereby proving to be a promising alternative that is less invasive in nature and with minimal postop complications. At 6 months, the results were stable.  Â

Evaluation of Effectiveness of Management of Excessive Gingival Display (Gummy Smile) with Lip Reposition Procedure

Background and Aim: Excessive gingival display can be managed by a variety of treatment modalities, depending on the specific diagnosis. Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. The aim of the present study was to minimize gingival display with a lip reposition procedure. Materials and Methods: A total of three patients with a gummy smile were selected for the study. This case report demonstrates the successful management of excessive gingival display with a lip-repositioning procedure. This is accomplished by removing a strip of mucosa from the maxillary buccal vestibule, then suturing the lip mucosa to the mucogingival line. Results: The procedure resulted in a narrower vestibule and restricted muscle pull, thereby reducing gingival display during smiling. Conclusion: The lip repositioning technique to decrease the amount of gingival display proved to be more conservative and provided a good esthetic outcome.

Excessive gingival display: differences in diagnosis and management by periodontists and dermatologists in Saudi Arabia

Background: Excessive gingival display (EGD), commonly known as a \&amp;quot;gummy smile,\&amp;quot; is defined as overexposure of the maxillary gingiva (&amp;gt;3 mm) when smiling. The prevalence of EGD ranges from 10.5% to 29% of the population worldwide. Multiple factors contribute to EGD, including dental, skeletal, and muscular etiologies. Various treatments for EGD include both surgical and nonsurgical approaches. Objectives: This study aimed to identify the similarities and differences in diagnosis and treatment strategies used by periodontists and dermatologists for EGD. Methods: A cross-sectional study was carried out based on the results obtained using a digital survey. A questionnaire focusing on the study objectives was formulated using Google Docs and distributed to specialty practitioners via their institutional email accounts. The first section of the questionnaire collected socio-demographic information from the physician participants. The second section explored their familiarity with EGD, including the different clinical variables, diagnostic measures, and potential treatments. Statistical analysis was carried out using Fisher\&amp;apos;s exact test. Results: Fifty respondents (both male and female) representing various academic levels and institutions in Saudi Arabia participated in this study. Most of the participants from both specialties were familiar with EGD (p = 0.05); however, patient selection varied significantly based on the extent (in mm) of preoperative gingival display (p &amp;lt; 0.001). The participants also differed in their preferred approach to the management of EGD due to different causes. Conclusion: The findings presented in this study revealed the strengths and limitations of the management strategies used by these specialists. Taken together, our findings demonstrated the importance of a shared training program and ongoing collaboration to optimize the treatment of EGD.

Management of gummy smile with an interdisciplinary approach

In this extremely competitive society, esthetic appearance plays an important role in the acceptance and self-esteem of individuals. Facial expressions and smile are the primary constituents of fast and effective nonverbal communication. Gummy smile is a frequent finding that can occur because of various intraoral or extraoral etiologies. Gummy smile is considered unattractive and a major cause of embarrassment. Lip repositioning was first described in 1973 by Rubinstein and Kostianovsky as a conservative surgical method for correcting a gummy smile. This procedure minimizes the gingival display by limiting the retraction of the elevator smile muscles. This case report describes the management of gummy smile using an interdisciplinary approach. Despite other possible alternatives, the present case was treated with minimally invasive perioplastic surgery (crown lengthening and lip repositioning) and cosmetic restorations of maxillary anterior teeth. Surgical lip repositioning is a safe, predictable procedure with minimal risks or side effects.

Modified Lip Repositioning Technique to Improve the Smile Harmony

Excessive gingival display (EGD) is a highly prevalent condition and poses esthetic concerns. Lip repositioning is a simple technique for the treatment of EGD due to vertical maxillary excess (VME) and hypermobility of the upper lip. Various modifications have been proposed to the original technique to improve the predictability and stability of the results over the long term. This article presents the long-term results of the modified lip repositioning technique.

Influence of Gender on Smile Characteristics; Gingival Display and Exposure of Maxillary Central Incisor

Influence of Gender on Smile Characteristics; Gingival Display and Exposure of Maxillary Central Incisor

Lip Surgeries in Periodontics: A Review

Purpose: The goal of this presentation is to describe and assess the many types of operations that can be used to treat excessive gingival display and puffy lips.&#x0D; Methods: Aesthetic dentistry is swiftly becoming as one of dentistry's most innovative and challenging fields. Patients are becoming more conscious of their physical appearance, and the grin has gotten a lot of attention as a result. Lip operations are becoming more popular among the general public. Various lip surgeries and their modifications have been described in this article, as well as their surgical techniques, indications, and post-operative care. Lip repositioning and lip reduction are discussed in this article. Lip repositioning is a less expensive and time-consuming option for excessive gingival show than more expensive and time-consuming procedures. Lip repositioning has psychological benefits, especially when compared to the low risk. Lip reduction surgery, on the other hand, strives to achieve a balanced relationship between the upper and lower lips that is proportional to the rest of the face, as well as typical lip competence and the appearance of lips that are larger or fuller than desired.

Analysis of gingival display during static and dynamic smiles in a Turkish sample: A clinical study.

The aim of this study is to determine the prevalence of smile types in spontaneous smiles among a Turkish population aged 18-23 and to compare it with the prevalence of static smiles. This study was carried out with 150 undergraduate students at Başkent University Faculty of Dentistry (75 females, 75 males). For this purpose, photo recordings for static smiles and 20-second video recordings for dynamic smiles were taken 40 cm from the participant's nose. Measurements were made with an electronic ruler. High smile line was found to be the highest prevalence in both static and dynamic smiles (p<0.001). The average soft tissue display is higher in dynamic smiles (p<0.05). In both static and dynamic smiles, the average amount of gingival display was higher in females than in males (p<0.05). When the smile line was evaluated on the photograph recordings while the patient was posing, it was found to be lower than the natural spontaneous smile line obtained from the video recordings. Since the gingival display increases when patients smile naturally instead of posing, clinical evaluations and restorative considerations should be planned according to the dynamic smile.

The Influence of Three Root Canal Irrigation Methods on PostThe Influence of Three Root Canal Irrigation Methods on PostOperative Pain “Randomized Clinical Trial”

Introduction: Facial soft tissue changes in relation to hard tissue movements after orthognathic surgery cases is always of concern to patients , surgical and orthodontics teams. The aim of the present study was to assess facial soft tissue changes and stability using 3D facial laser scanner after orthognathic surgery Le Forte I maxillary impaction in excessive gingival display patients. Methods: The subjects consisted of 12 patients with skeletal vertical maxillary excess (VME) causing an aesthetic concern to the patients in the form of “Gummy smile”, who underwent LeFort I osteotomy with maxillary impaction, Three-dimensional images of the patients were acquired with a 3D laser scanner preoperatively and postoperatively. The changes in facial soft tissue were detected using a colour coded map for analysis. Results: Significant change was recorded in the upper lip, alar base, nasolabial fold and nasal tip areas, without specification of this change in direction. Conclusions: The 3D images captured using the laser scanner in this study can be a useful tool for communication with both patients and professionals but cannot be relied upon solely for accurate analysis of the facial soft tissue changes. The colour coded map analysis cannot be relied upon solely as a method of analysis as it lacks an important aspect of the change which is the direction.

Gummy Smile Treatment by Aesthetic Crown Lengthening on Altered Passive Eruption Case

An attractive smile enhances the appearance and acceptance of an individual in society. Gum exposure more than 3 mm is generally considered unattractive and known as a gummy smile, which is usually considered an aesthetic problem. At present, patients have a greater desire for more aesthetic results that may influence the planning of dental treatments. This case report aimed to describe the surgical sequence of aesthetic crown lengthening to improve smile profile and eliminate gummy smile. We reported a 21-year-old non-smoking woman with no pertinent medical history who presented with a chief complaint of an unattractive smile due to excessive gingival display. The gingival display in the smile was 5 mm, and the width to height ratio of the central incisor was 121%. Neither periodontal problems nor teeth mobility was detected. Assessment for the condition was excessive gingival display due to altered passive eruption. The overall prognosis for this case was good. The primary treatment plan proposed to the patient was an aesthetic crown lengthening. Altered passive eruption class I subtype A was a case conclusion, and aesthetic crown lengthening with gingivectomy without osseous reduction was the selected treatment. In conclusion, aesthetic crown lengthening should be considered as a surgical component of aesthetic therapy to improve smile profile and eliminate gummy smile.

Avoiding radiation risks from dental cone-beam computed tomography imaging in orthodontic patients

Although CBCT has several advantages, it has a huge disadvantage regarding the amount of exposure dose associated with its diagnostic assessment. The risks associated from using CBCT can be avoided by using another safe technique which is the Digital Smile Design (DSD). DSD is a globally procedure depending on definite photographs and software analysis. In the present study, DSD had been used as a substituted technique instead of CBCT to avoid radiation hazards accompanied by using CBCT and get a full understanding of smile features helping in diagnosis and treatment planning for maximum patient satisfaction. This study was carried out on patient adults from Class III and Class I. Two frontal digital photographs were taken for each subject, one at rest and the other in the posed smile position. Photographs were uploaded on Photoshop software for standardization and a reading for the incisogingival height of the right maxillary central incisor was done. The ratio of 7:5 was found to provide the most accurate image guided by the actual clinical height of the central incisor. The new standardized photos were uploaded on the DSD to be calibrated and measure all linear variables. It is found that Class III patients tended to have wider smile widths, less gingival display, longer chin heights, shorter lower vertical dimensions and a higher percentage of non-consonant and flat smile arcs than Class I subjects. We concluded that the smile components estimated from DSD are almost typical to those obtained from CBCT, without exposure to radiation doses.

A Modified Approach in Lip Repositioning Surgery: A Prospective Study in a Twin Population with a 3-Year Follow-up.

This study evaluated long-term clinical and patient satisfaction outcomes following a modified lip repositioning technique that utilized periosteal sutures in a twin population. Twin sisters diagnosed with maxillary lip hypermobility were randomly assigned to either the control group (original LipStaT technique) or test group (addition of periosteal sutures). The participants (n = 12; 6 per group) were evaluated at intervals for up to 3 years postoperative. Clinical measurements, digital images, and patient satisfaction surveys were collected. Descriptive statistics were used to assess outcome variables: average lip width at rest (ALW), vertical lip translation (VLT), and average gingival display (AGD). Student t test, one-way analysis of variance, and Spearman rank correlation tests were used to compare mean values of variables at five time points for both groups. The level of significance was α = .05. In the control group, mean VLT and AGD values showed statistically significant decreases from baseline (14.8 mm and 7.0 mm, respectively) to 2 years (5.7 mm and 2.4 mm, respectively), but a slight increase was seen at 3 years (7.5 mm and 5.0 mm, respectively; P < .0001). In the test group, mean VLT and AGD values showed statistically significant decreases from baseline (14.8 mm and 6.9 mm, respectively) to 3 years (5.5 mm and 3.5 mm, respectively; P < .0001). A higher participant satisfaction score at 3-year follow-up was observed in the test group. The modified lip repositioning technique in a population of twins resulted in more stable outcomes that lasted up to 3 years postoperatively.

Effectiveness of Different Modalities of Lip Repositioning Surgery for Management of Patients Complaining of Excessive Gingival Display: A Systematic Review and Meta-Analysis.

Purpose This study is aimed at synthesizing the available evidence regarding effectiveness of various modalities (combinations of LRS tasks) and comparison between each two modalities in terms of gingival display reduction, success rate, stability of the results, patient's satisfaction, and postoperative morbidity. Materials and Methods The electronic databases including PubMed, Scopus, Web of Science Cochrane Library, Google Scholar databases, ClinicalTrials.gov, and WHO International Clinical Trial Registry Platform were searched up to 27th June 2020 regarding lip repositioning surgery. The modalities were defined as the combinations of the following tasks: frenectomy (yes/no), flap thickness (full/partial), and myotomy (yes/no). Meta-analyses were performed on gingival display change from baseline to months 3, 6, and 12 in each modalities using Stata (v.16). Results 38 studies (including three clinical trials, two quasiexperimental studies, seven case series, and 26 case reports) met the criteria for final inclusion. The mean gingival display reduced from baseline to 6 months (WMD = −2.90, 95% CI: -4.85 to -0.95) in the patients undergoing the “frenectomy + full-thickness flap + myotomy” modality. This parameter decreased from baseline to 6 and 12 months, respectively (WMD = −2.68, 95% CI: -3.49 to -1.86; WMD = −2.52, 95% CI: -4.40 to -0.64), in patients undergoing the “frenectomy + partial-thickness flap + without myotomy” modality. In patients who undergone the “without frenectomy + partial-thickness flap + without myotomy” modality, gingival display reduced from baseline to 6 months (WMD = −3.22, 95% CI: -5.61 to -0.84). Almost 83% of patients with modality 1 had satisfaction. Conclusions Gingival display within the 6 months after LRS could be reduced with all modalities. Descriptively, the greatest reduction was observed in patients with the modality not including the frenulum.

Intrusion of Maxillary Incisors Using Orthodontic Mini-Implants in an Adult Patient with Deep Bite and Excessive Gingival Display

Intrusion of Maxillary Incisors Using Orthodontic Mini-Implants in an Adult Patient with Deep Bite and Excessive Gingival Display

Therapeutic effects of botulinum toxin type A in subjects with gummy smile: A longitudinal sEMG approach

To evaluate the response of the myoelectric activity of levator labii superioris (LLS), levator labii superioris alaeque nasi (LLSAN), and minor zygomatic (Zm) muscles in individuals with gummy smile, volunteers to botulinum toxin type A (BTX-A) application, with a follow-up of 6 months. Thirteen individuals were submitted to clinical evaluation and photographic records to monitor the variations of the gingival display (GD) during posed smile. The recording of the surface electromyography (sEMG) signal of muscles studied was performed in three tasks: posed smile (PS), upper lip elevation (ULE) and nose wing elevation (NWE). The root-mean-square value, an amplitude sEMG signal parameter, was extracted from the sEMG signals. One and three-way ANOVA were applied, and the level of significance set at 5%. There were significant differences (P<0.05) in the sEMG signal activity from the control condition (before BTX-A application - T0) to the 8th week of follow up, which was accompanied by clinical evaluation for the gingival display (P<0.05). The peak of the reduction in sEMG signals occurred 2 weeks after T0 for all the studied tasks, with the exception of the left hemiface in the PS, which showed a peak of reduction 4 weeks after T0. BTX-A led to a decrease in the sEMG signal amplitude over 2 to 4 weeks after application in the muscles, although differently concerning each hemiface when recruited to perform other mouth tasks. During the PS, the recruitment level of the upper lip elevator muscles was compatible with the clinical response obtained in the follow-up period in this study, which corroborates the sEMG assessment to clinical data.

Comparison of Two Botulinum Toxin Injection Methods for Treatment of Excessive Gingival Display.

Hyperfunction of the muscles of the upper lip is considered as the most common cause of excessive gingival display (EGD). The aim of this study was to demonstrate the effectiveness of botulinum toxin (BT) injection as a conservative treatment for EGD due to muscular hyperfunction and to compare the outcome of 2 injection methods. This study included 40 participants who were randomly assigned into 2 groups of 20 each, The first group received 2.5IU BT injection at 1 point per side (2-points group), while the second group received a total of 5 IU of BT at 2 points per side (4-points group). The outcome variables were the reduction in the central and lateral gingival display expressed as the difference between the pre- and post-injection measurements and the degree of satisfaction of the participants. The follow up visits were at 2- and 12-weeks postinjection. The study variables were statistically analyzed and probability values of <0.05 were considered significant. There was a significant improvement (P < 0.0001) in both groups throughout the follow up period, but the improvement achieved by 4-points group was significantly better than that of the 2-points group with respect to the gingival display and the degree of satisfaction (P < 0.0001). Botulinum toxin injection represents a safe and less invasive modality for treatment of EGD, the 4-points method results in better outcome in terms of clinical measurements and degree of satisfaction over the 2-points method.

Gingival depigmentation: A therapeutic modality for pink esthetics: A case series

Hyperpigmentation is a condition where melanin is present in excess quantity which can cause significant esthetic problems. Pigmentation of gingiva is considered to be unaesthetic by patients, and it may have a psychological impact on them. This impact is aggravated in patients with “gummy smile” or excessive gingival display while smiling (high smile line). Variety of treatment modalities have been promulgated for depigmentation of gingival such as scraping, bur abrasion, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, techniques such as scalpel and diode laser have been tried for treatment of hyperpigmentation, which are simple, effective, and yielded good results, along with good patient satisfaction.