High Smile Line Research Articles

Enhancing Gingival Aesthetics: A Case Report on Gingival Depigmentation

Abstract The beauty of a smile is not solely defined by the teeth’s shape, position and colour, but also by the condition of the gingival tissues. While melanin pigmentation of the gingiva poses no medical risk, complaints about ‘black gums’ are common, particularly amongst individuals with a high smile line. Consequently, treatment approaches in periodontal aesthetics aim to establish a harmonious balance between the pink hues of the gums and the white of the teeth, a crucial aspect of all dental procedures. Various methods for gingival depigmentation have been documented, including bur abrasion, scraping, partial thickness flap surgery, cryotherapy, electrosurgery and laser treatment. In this case report, scraping, electrosurgery and diode laser techniques were employed for depigmentation, chosen for their simplicity, effectiveness and ability to deliver satisfactory results, thereby ensuring patient contentment.

Technique for Soft Tissue Modification for Pontic Reception: A Case Report

Background The article discusses a technique for modifying the pontic site when replacing missing maxillary incisors in the anterior esthetic zone. In such cases, patient concern often centres around esthetics, especially considering factors like smile lines and the display of incisors. The esthetic zone may extend to the entire clinical crown and involve the surrounding soft tissue, particularly if the patient has a high smile line.  Case Summary The emergence profile is highlighted as a crucial aspect when dealing with pontics in the esthetic zone. The emergence profile refers to the way the pontic emerges from the gingival tissue, and it significantly influences the overall esthetics of the restoration.  Conclusion The technique described in this case report involves converting a flat gingival contour into a concave receptor site for the desired pontic without soft tissue grafting. This modification aims to enhance the emergence profile, contributing to a more natural and esthetically pleasing outcome when replacing missing maxillary incisors in the anterior esthetic zone.

The Influence of a Single Infrapositioned Anterior Ankylosed Tooth or Implant-Supported Restoration on Smile Attractiveness.

To investigate the influence of a single infrapositioned ankylosed tooth or implant-supported restoration on smile esthetics. A series of 48 digitally modified images that simulated varying degrees of infraposition (from 0.25 to 2.0 mm, with a step of 0.25 mm) were created for each maxillary anterior tooth by altering the full-portrait image of a smiling man, adjusted to show medium and high smile lines. For the model with the high smile line, a series of 24 digitally modified images were created that simulated the infraposition of a single anterior tooth with a restored incisal edge. Smile esthetics for each of the images were evaluated by 160 participants (80 dentists and 80 laypersons), and a visual analog scale (VAS) was implemented. For the images with the high smile line, an infraposition of ≥ 0.25 mm in the central incisor region and ≥ 0.5 mm in the region of the lateral incisor or the canine had a negative effect on the perceived smile esthetics for both the dentists and the laypersons. Regarding the medium smile line, an infraposition of ≥ 0.5 mm in the central and lateral incisor region had a negative effect on the perceived smile esthetics for both groups of observers. In the canine area, an infraposition of ≥ 0.5 mm for the dentists and ≥ 0.75 mm for the laypersons also had a negative impact on the smile esthetics. Even a minor infraposition of a single maxillary anterior ankylosed tooth or implant-supported restoration can reduce the perceived attractiveness of the smile. Infraposition in the canine site can be better tolerated in a medium smile line compared to a high smile line. In patients with a high smile line, prosthetic intervention is needed to restore the incisal edge of an infrapositioned tooth without harmonizing the gingival contour; this can be beneficial for the lateral incisor but ineffective for the central incisor and unfavorable for the canine.

ARE THE GINGIVAL DISPLAY AND THE SMILE ARC IN MALES AND FEMALES DIFFERENT?

Highlights Gingival display and smile arc enhance the aesthetic value of a person's smile and may be influenced through dental treatment. The individual profile photographs taken during social smiles can be used to evaluate dental treatment plans. Abstract Background: An aesthetic smile is part of a person's attraction and affects their level of psychosocial well-being. Gingival display and smile arc belong to smile components that enhance the aesthetic value of a person's smile. Objective: To determine the differences in gingival display and smile arc in social smiles between males and females. Material and method: This analytical observational study was conducted with a cross-sectional design. A total of 110 photographs (55 males and 55 females) of study subjects who fulfilled the inclusion criteria were taken directly by Canon EOS-600D while performing social smile poses. The CorelDraw Graphic Suite 2022 measured gingival appearance and smile curves. The Chi-square test was performed to analyze the differences in gingival display and smile arc between males and females. Result: Based on gingival display, social smiles between genders were categorized into moderate (56.4% males and 58.2% females), low (30.9% males and 20% females), high (9.1% males and 18.2% females), and very high (3.6% males and females) smile lines. Social smiles based on smile arc were categorized into consonant (85.5% males and 96.4% females), straight (10.9% males and 3.6% females), and inverted (3.6% men and 0% women) smiles. No statistical differences were found in gingival display (p=0.397) or smile arc (p=0.113). Conclusion: There were no significant differences in gingival display or smile arc between males and females. Females, on the other hand, had an increased gingival show while smiling and no inverted smile arc.

Evaluating smile aesthetic satisfaction and related smile characteristics in dental students

AimThis study aimed to assess the association between self-rated smile satisfaction and the smile dimensions among dental students. MethodAn analytical cross-sectional study was conducted on 216 Vietnamese dental students. A standardized photograph was taken of each student with their frontal social smiles to assess aesthetic dimensions. A single-session self-administered questionnaire containing five questions about smile aesthetic satisfaction related to various aspects was administered to all students. Differences in smile characteristics and satisfaction scores between the two genders were evaluated. The impact of smile characteristics on satisfaction scores was assessed using multiple linear regression models. ResultsMost dental students had a high smile line, parallel smile arcs, an upward upper lip curvature, a non-touching labiodental relationship, a dental midline that coincided with the midline of the face, and eight teeth displayed during smile. Most participants were satisfied with their smiles, and the self-rated satisfaction score was 67 out of 100. Self-perceived overall smile satisfaction was associated with the "smile arc”, the "upper lip curvature”, the "number of teeth displayed during smile”, and the "dental midline”. Female students had a statistically significant correlation between self-perception and smile characteristics, such as upper lip curvature, dental midline shift, and smile line. ConclusionsThe smile arc, upper lip curvature, and dental midline shift affected self-perceived satisfaction among dental students. Female students showed an association between the smile parameters and self-perceived satisfaction.

Multidisciplinary Aesthetic Management of a Dentition in a Patient with Cleft Lip and Palate with a High Smile Line: A Clinical Report

The aesthetic management of a case involving a high smile line in a patient with a cleft lip and palate can be difficult. In this report, we look at a complex case of a patient with a unilateral cleft lip and palate which required a multidisciplinary approach involving crown lengthening, extraction of a maxillary right central incisor and fabrication of a 4-unit fixed partial denture to replace this tooth and the adjacent absent maxillary right lateral incisor with use of gingival porcelain in order to improve the aesthetics of the patient's smile.

Gingival Depigmentation

A pretty smile enhances an individual’s self-confidence. A smile express joy, success, affection and or even say hello and reveals self-confidence and kindness. Gingival melanin pigmentation is one of the factors which determine the smile of an individual. Excessive gingival pigmentation is a major esthetic concern for many individuals. Gingival pigmentation occurs in all races of man and it varies from one race to another. It may vary depending on whether it is physiological or pathological. Melanin pigmentation of the gingiva is completely benign and it does not present a medical problem, complaints of ‘black gums’ are commonly seen in patients having high smile line (gummy smile). Different treatment modalities are reported for depigmentation of gingiva; which includes cryosurgery, electrosurgery, laser and scalpel surgical technique.

The relationship between different levels of facial attractiveness and malocclusion perception: an eye tracking and survey study

IntroductionThe aim of this study was to investigate the relationship between levels of facial attractiveness and the perception of different types of malocclusion.MethodsA preliminary questionnaire was used to assign photographs of three female patients to low, moderate, and high facial attractiveness designations. Seven modified photographs for each smile photograph of each of these three patients were created. The evaluated photographs were as follows: P0: at rest position, P1: ideal smile, P2: − 2-mm (low) smile line, P3: + 4-mm gummy smile, P4: + 6-mm gummy smile, P5: maxillary anterior crowding, P6: median diastema, P7: polydiastema. An eye tracking device and a questionnaire were used to collect data from orthodontists, dentists, orthodontic patients, and laypeople.ResultsTotal fixation duration varied depending on the type of malocclusion, the level of facial attraction, and the participants’ occupations. In general, orthodontists and dentists had higher total fixation duration scores than orthodontic patients and laypersons. The maxillary anterior crowding photograph had the lowest visual analysis scale score at each attractiveness level (low, medium, and high). Visual analysis scale scores became similar at each attractiveness level only in the P4 photographs, and thus the difference in facial attractiveness disappeared.ConclusionWhile a worsening of the ideal smile had a smaller impact on aesthetic perceptions in an individual with low facial attractiveness, it had a significant negative impact on a person with high facial attractiveness. Anterior crowding and diastema had a more negative impact on facial attractiveness than low or high smile lines.

Assessment of Prevalent Gingival Shades in the South Indian Population: An Observational Study.

Gingival shade matching, often overlooked, plays an integral role in designing prostheses for patients with high smile lines, gingival defects, and cases where the acrylic flange of removable dentures extends into the aesthetic zone.The purpose of this study was to find the most prevalent gingival shade in a sample of the South Indian population. A total of 110 participants were included in the study based on the inclusion and exclusion criteria. The standard daylight method of shade matching was used for this study. The participants were seated in a dental chair in the vertical position with their heads supported, their mouths open, and cheek retractors in place. The study area, gingiva, and vestibular region in relation to maxillary and mandibular right central incisors were dried with a three-way syringe, 15cm away, for 3 seconds before shade matching for 5 seconds at each reference point with an Ivoclar Vivadent IPS Dsign shade guide. The most prevalent shade in the marginal and vestibular regions of the gingiva of the South Indian population was found to be GM2 shade, while the most prevalent shade of the attached gingiva was found to be G2 shade. A good percentage of the attached gingival shade was not matched with the tabs available in this shade guide.

Aesthetic Rehabilitation of a Patient with Maxillary Protrusion and High Smile Line Using Flangeless Tooth Supported Overdenture

Aesthetic Rehabilitation of a Patient with Maxillary Protrusion and High Smile Line Using Flangeless Tooth Supported Overdenture

RECONSTRUCTION OF PINK ESTHETICS USING SCALPEL TECHNIQUE : A CASE REPORT

Gingival pigmentation in anterior region alongwith high smile line often causes esthetic concern. Twenty-one years old sytemically healthy, nonsmoker female patient was reported in the department with chief complaint of brown gums in front teeth region. Gingival depigmentaion using scalpel technique was planned and patient-based evaluation of statisfaction in terms of esthetics was recorded using visual analogue scale. After one month of surgery patient reported visual analogue score of 10. This study suggests that scalpel technique is simple and effective in terms of achieving acceptable esthetics.

ESTHETIC MANAGEMENT OF GINGIVAL HYPERPIGMENTATION WITH ELECTROSURGERY TECHNIQUE: A CASE REPORT

The colour of gingiva is usually considered as “coral pink” which is determined by thickness and degree of keratinization, vascular supply, pigmentation like melanin, and various exogenous substances like tobacco, colouring agents in foods, etc. Gingival hyperpigmentation may be a pathological condition but it is usually a physiological condition that is a major esthetic problem for a patient with a high smile line. Gingival depigmentation is a periodontal plastic surgical procedure that reduces or eliminates the degree of pigmentation. Different treatment modalities for gingival depigmentation have been documented, such as scalpel, electrosurgery, diamond burs, chemical methods, cryosurgery, lasers, and micro-needling with ascorbic acid. This article reports the depigmentation procedure of hyperpigmented gingiva with electrocautery in 25 years old male patient.

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.

Management of a partially edentulous patient with idiopathic root resorption by using digital and conventional implant planning technologies

This clinical report describes the rehabilitation of the maxillary arch of a partially edentulous patient with idiopathic root resorption, limited interarch distance, and a high smile line. Four implants were placed to provide a screw-retained fixed partial denture. The esthetic and functional challenges of a high smile line and limited interarch distance were addressed by using a combination of conventional and digital implant treatment technologies.

ESTHETIC MANAGEMENT OF GINGIVAL HYPERPIGMENTATION USING LASER AND SCALPEL TECHNIQUE – CASE SERIES

The complaint of darkly pigmented gums is common particularly in patients having a very high smile line and possess esthetic problems for them. The degree of gingival pigmentation depends on melanoblast activity. Various treatment options are in practice for depigmentation which include scalpel gingivectomy, free gingival graft surgery, use of chemicals, such as 90% phenol and 95% alcohol, bur abrasion, electrosurgery, cryosurgery, and lasers. Among the various techniques, lasers offer a promising therapeutic option since it is simple, painless, and predictable. The laser has been recognized as the most effective and reliable technique having many advantages as compared to other conventional treatment modalities. It provides a bloodless and painless surgery. KEYWORDS: Scalpel, LASER, depigmentation, esthetics.

Dentogingival Smile Analysis of Young Adults of Al Qassim Province, Saudi Arabia: A Cross-Sectional Study.

Objectives The present study aims to analyse the smiling components among young adults within Al Qassim region by evaluating typical smile parameters. Methodology. A cross-sectional study was conducted among 324 female and male participants between 18 and 35 years, within Al Qassim Province of Saudi Arabia. The dentogingival macro-aesthetic elements of the smile, the parallelism between the incisal curve and lower lip line, midline, and buccal corridors were determined by using Canon Rebel t7i (Canon, Melville, NY, USA) and evaluated by photo editing software Adobe Photoshop CC2019. The data were analysed using a chi-square test and Spearman's correlation test for nonparametric data. Results 62.5% of young adults had no buccal corridors. The nonparallel smile was found in 53.2% of young adults. A high smile line was observed in 33% of participants. 59.3% of young adults lacked a coinciding dental and facial midline. There was a statistically significant difference in the parallelism of the incisal curve and lower lip line as well as in the position of the upper lip line across genders (P < 0.05). Conclusion Understanding macro-aesthetic elements of teeth and their interrelation with the surrounding oral structures can be a guide in creating natural and aesthetically pleasing restorative treatment.

The Influence of Varying Gingival Display of Maxillary Anterior Teeth on the Perceptions of Smile Aesthetics

ObjectivesThe aim of the study was to investigate the influence of gingival display on perceived smile aesthetics and to compare aesthetic gingival display preference amongst dental professionals and lay people. MethodsThis cross-sectional study was based on the analysis of quantitative data collected via questionnaires. Two sets of digitally altered smile images with variations of gingival amount and architecture displays were produced. Ranking order scale was used to record aesthetic preferences, from the most attractive to the least attractive. ResultsThere were 124 respondents (60 lay people, 32 general dentists [GDPs] and 32 orthodontists). Average smile line, tangent to the zeniths of maxillary anterior teeth, was found to be the most attractive gingival amount (53.2%, χ2 = 144.15, p < 0.045) amongst lay people, GDPs and orthodontists. High smile line was ranked as the least attractive amount amongst all respondents (88.7%, χ2 = 359.37 p < 0.002). Class III gingival outline, where all gingival levels are symmetrical and in line, was found as the most attractive gingival architecture (65.3%, χ2 = 10.87 p < 0.001). ConclusionNo particular amount of gingival display is universally perceived as attractive although high smile lines are generally disliked. Class III gingival architecture is the most preferred gingival archetype when excessive amount of maxillary gingiva is exposed. Clinical significanceA general acceptance to smile line variations demonstrates that the harmony amongst all smile components is more important than merely focusing on a single ideal smile constituent. However, when designing the smile with an inherent high lip line, a Class III gingival architecture might be more preferable since it reduces the negative impact of excessive gingival display.

Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: journey from splinted metalloceramic prosthesis to all-ceramic crowns

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible.

Rehabilitation Challenge in Patient With a High Smile Line: Case Report and Review of Surgical Protocols

Defects in the maxillary anterior teeth are delicate and difficult to solve because of the esthetic, functional, and psychological impairment that may arise if the rehabilitation treatment does not return the damaged tissues to the naturalness. Esthetic predictability and reduced surgical interventions are some great reasons to simplify dental treatments. During the presurgical evaluation, the clinician should review the implant esthetic risk profile, considering the patient's smile line, the esthetic demands, the hard and soft tissue thickness and width, and the gingival biotype. Thus, achieving long-term esthetic results initiates with a detailed case planning before surgical intervention. The present report described a complex esthetic clinical case involving teeth and dental implant related to a high smile line. The clinical case was solved through immediate implant placement and immediate loading using a personalized prosthetic abutment and finalized with the installation of metal-free prosthetic restorations. The use of a personalized prosthetic abutment helped to achieve a better emergence of the prosthesis under the periodontal tissues. Although it was a challenging esthetic case, especially because of the high smile line, the result was a natural smile while the adjacent soft tissues maintained their esthetics and health.

Gingival Depigmentation Techniques for Pink Aesthetics: Case Series

Introduction: Aesthetics has become a significant aspect of dentistry. Clinicians are facing challenges in achieving acceptable gingival aesthetics. The colour of the gingiva plays an important role in overall aesthetics. Melanin hyper-pigmented gingiva is a benign condition; however it is an aesthetic concern in individuals with high smile line and excessive gingival display. Gingival depigmentation is a periodontal plastic surgical procedure. The depigmentation procedure aims at removing or reducing this hyperpigmentation by various techniques. Aim: To discuss the different techniques for gingival depigmentation. Methodology: Individuals with melanin hyperpigmentation of gingiva were treated by different depigmentation techniques namely Scalpel technique (Conventional technique), Bur Abrasion, Diode Laser, Electrosurgery, Cryosurgery and injection of Vitamin C. All the individuals reported comparable post operative healing. Conclusion: Different gingival depigmentation techniques provide comparable postoperative healing resulting in an aesthetic smile.