Gummy Smile Research Articles

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.

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.

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.
 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.

Botox- the wonder poisonous healer

Botulinum toxin A has a wide variety of medical applications, which are related to the blockade of acetylcholine and often are associated with abnormal muscle contractures. The use of botulinum toxins has also revolutionised the treatment of various dental conditions like bruxism, gummy smiles, Frey’s syndrome spastic disorders, hypersalivation, orthodontic relapse, facial dystonias and temporomandibular disorders. The list of possible new indications is rapidly expanding. Many of these conditions are discussed with regard to their treatment with Botox compared to conventional treatments.

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.

Analyses of Youtube Videos on Botox Treatment of Gummy Smile.

The purpose of this study was to determine the content quality and accuracy of the YouTube videos about the Botox application during gummy smile treatment and to analyze the efficacy of these videos in informing the healthcare professionals and the patients. The first 200 videos resulting from the search on YouTube by using the keywords "gummy smile/Botox," which were determined by Google Trends, were evaluated in the study. One hundred fourteen out of these 200 videos were included in the study. The videos were calculated using these descriptive features. A content scale consisting of 8 categories was used to determine the content levels of the videos and the video information and quality index scale was used to determine the quality level. The most mentioned subjects in the videos were "Description" of the gummy smile and Botox treatment (71.9%), "Advantage" of Botox treatment (51.8%), "Procedure" (48.2%), and "Prognosis" (47.4%). The "Contraindication" was mentioned rarely (2.6%). A statistically significant difference was found between the videos with different content levels in terms of Description, Advantage, indication, Procedure, Complication, Prognosis, and Cost. Likewise, there was a statistically significant difference between videos in distinct content level groups in terms of video information and quality index total score. The quality of the YouTube videos about Botox applications in gummy smile treatment was found to be low in general. it is important for the physician who will perform the procedure to explain the procedure to the patients in detail. in addition, YouTube was determinedto be insufficient for accessing high-quality information for students, assistants, and specialist physicians.

Autorotation of the Mandible as Sequelae to Maxillary Intrusion: A Systematic Review.

Background:Autorotation of the mandible is a normally anticipated phenomenon following a surgical superior repositioning of the maxilla in clinical situations where patients have an excessive gummy smile. Prediction of the surgical treatment outcome following a presurgical orthodontic treatment is a critical element in the surgical treatment planning.Materials and Methods:The relevant articles were selected by hand search and electronic media (Google Scholar, PubMed, Science Direct, Medline, Embase, and Cochrane) from 1982 to 2020. All the relevant articles were properly screened, and findings were extracted from the articles.Results:It was observed that, following maxillary intrusion, mandible would eventually autorotate to take a new occlusion. Mandibular autorotation as a result of maxillary intrusion would lead to minimal shortening of the lower lip in the vertical plane. It was observed that the amount of mandibular autorotation correlates with the extent of maxillary impaction. Studies have shown that there is a passive soft-tissue response which may be attributed to the fact that no muscular detachment had been affected in the lower lip and soft-tissue chin region during the maxillary surgery.Conclusion:It is observed that there is a definite influence on the mandibular and chin positions as a result of maxillary intrusion and autorotation of the mandible. Every 1 mm of maxillary superior impaction, the chin moved 0.6 mm vertically and 0.2 mm horizontally. There is an appreciable shortening of the lower lip length.

Full Digital Surgery-First, Skeletal Anchorage and Aligners Approach to Correct a Gummy Smile and Class II Malocclusion with Mandibular Retrusion and Deviation

Background: The demand for interdisciplinary orthodontic treatment has increased significantly in the past few years, especially in adult patients. This kind of treatment requires careful clinical management, as consequence of the possible complications and limits related to adult age. However, the use of skeletal anchorage and three-dimensional (3D) digital technology has deeply revolutionised diagnostic planning and treatment strategies. Methods: A fully digital approach to the treatment of a Class II patient with a gummy smile and mandibular deficiency and deviation, consisting of initial surgery followed by the use of aligners and skeletal anchorage, is described. Results: The 3D, fully digital pre-evaluation enabled clinicians to accurately and reliably plan the surgical procedure and subsequent orthodontics, including the individualised positioning of stabilisation plates and a splint for maxillary and chin surgical movements. This allowed for the improvement of the patient’s facial aesthetics and dental occlusion without the use of visible orthodontic appliances or the occurrence of pre-surgical aesthetic worsening. Conclusions: This approach could be very effective for adult patients seeking aesthetic treatment options for facial and dental aesthetic improvement.

Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression.

The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure. The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models. A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I2 = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks. Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application. The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.

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.

Altered passive eruption: A case report

Altered passive eruption is defined as a developmental abnormality in the passive phase of the eruption. It has an aesthetic impact such as the gummy smile and short teeth. The management of the gingival smile associated with altered passive eruption presents a real challenge for the practitioner, who must know the different signs of this anomaly to make the right diagnosis and to establish an appropriate treatment plan. The purpose of this article is to expose, the therapeutic modalities of management of altered passive eruption through a clinical case.

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.

Botulinum Toxin A in the Management of a Gummy Smile: A Clinical Controlled Preliminary Study.

Botulinum toxin type A (BTX-A) is recent technique for the treatment of gummy smile. The aim of this randomized controlled preliminary clinical trial was to evaluate the effects of BTX-A on excessive gingiva display (EGD) reduction, muscle activity, and patient satisfaction at 2, 8, 12, 16, 21, and 25 weeks. Group 1 (G1) received 4 points of BTX-A application (2 U/point) for relaxation of the levator labii superioris alaeque nasi and levator labii superioris muscles; Group 2 (G2) received 2 points of BTX-A (2 U/point) for relaxation of only the levator labii superioris alaeque nasi muscle. A high dropout of patients from follow-up sessions occurred. Therefore, because of this data limitation, the results were considered a preliminary outcome. At 2 weeks, there was a significant difference between baseline regarding the reduction of EGD in G1 and G2, reduction in muscle activity in G1, and increased satisfaction in G1 and G2. At 2 weeks, there was no difference between the 2 groups. Statistically significant EGD reduction was maintained until 16 weeks in G2 and 25 weeks in G1. After 14 days there was a gradual recovery of muscle activity in both groups until recovery of baseline values by 25 weeks. Patients' satisfaction with treatment lasted 21 weeks in G1 and 16 weeks in G2. Increasing the number of BTX-A injection points resulted in a prolonged effect regarding EGD reduction and patient satisfaction but did not increase the intensity of the outcome. However, due to the high dropout of patients, this is a preliminary conclusion and further studies are necessary to confirm these results.

Role of botulinum toxin A in improving facial erythema and skin quality

Botulinum toxin A (BTX-A) injections have become the most popular noninvasive cosmetic procedures performed worldwide. With growing interest, investigators continue to uncover an expanding array of aesthetic indications for BTX-A. Botulinum toxin A has been used off-label in the management of masseter hypertrophy for facial slimming, platysmal bands, nasal 'bunny' lines, perioral rhytides, gummy smile and scars, to name a few. Interestingly, the injection of multiple microdroplets of dilute BTX-A into the dermis, sometimes referred to as 'microbotox', has been investigated as a tool for facial rejuvenation. A handful of prospective studies and case series have demonstrated the benefit of BTX-A in the treatment of facial erythema and improving skin texture. The aim of this review is to summarize and appraise currently available data on the role of BTX-A in treating facial erythema and skin quality, with a special focus on potential pathophysiologic mechanisms.

The Lip Repositioning Surgery: A Review of the Technique's Evolution

AbstractThe lip repositioning technique (LRT) is considered a safe and predictable gummy smile (GS) treatment. However, since Rubinstein and Kostianovsky introduced it in 1973, it has undergone several modifications. This article aims to review and provide a historical compilation of LRT evolution to help clinicians understand each technique's description and the rationale for its modifications to treat GS.An electronic search was performed in Medline, Scopus, and Cochrane Library up to May 2021 including the terms “lip repositioning,” “lip repositioning technique,” or “lip repositioning surgery” and studies evaluating or discussing the original LRT's modifications in detail. The search had no language or time restrictions. Additionally, a hand-searching of references of all included articles was performed.Modifications described in the literature include muscle severance, subperiosteal dissection of the gingiva, frenectomies, and the use of adjuvant products. They aim to minimize relapse, morbidity, and improve stability. Discomfort, scar formation, and pain were the most frequent complications reported. The choice to use a modification should be analyzed and customized to the individual patient's needs.

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.

Evaluation of Soft Tissue Changes on Lateral Cephalometric X-Ray Associated with Lip Repositioning Surgery and/or Botulinum Toxin Injections in Gummy Smile Cases. Randomized Clinical Study

Evaluation of Soft Tissue Changes on Lateral Cephalometric X-Ray Associated with Lip Repositioning Surgery and/or Botulinum Toxin Injections in Gummy Smile Cases. Randomized Clinical Study

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.