Management Of Excessive Gingival Display Research Articles

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

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

Clinical and psychological impact of lip repositioning surgery in the management of excessive gingival display

BackgroundExcessive gingival display (EGD), also known as a gummy smile, is characterized by overexposure of the maxillary gingiva on smiling. EGD can cause embarrassment and reduce patient satisfaction. This study aimed to evaluate the clinical and psychological effects of lip repositioning surgery on the management of EGD. MethodologyThis experimental study enrolled 14 patients with EGD who had undergone a modified lip repositioning technique, which comprised moving two strips of mucosa bilaterally to the maxillary labial frenum and repositioning the new mucosal margin coronally. The extent of gingival display (GD), lip mobility (LM), total lip length (TLL), lip length (LL), and internal lip length (ILL) was measured at baseline and 6 months postoperatively. The pre-operative psychological assessment was conducted using the social appearance anxiety scale (SAAS) scores, whereas the postoperative assessment was conducted using SAAS and visual analog scale (VAS) scores at 1 week, 3 months, and 6 months postoperatively. ResultsAmong the clinical parameters, TLL increased by 2.0 ± 1.038, LL increased by 2.28 ± 0.99, ILL reduced by 2.78 ± 1.36, LM reduced by 3.21 ± 1.12, and GD reduced by 3.14 ± 0.77 at 6 months postoperatively. Among the psychological parameters, SAAS reduced by 31.42 ± 1.907 from the baseline to 6 months, whereas the VAS score reduced to 3.14 ± 0.27 at 6 months postoperatively. ConclusionA significant reduction in GD, which is largely dependent on strict case selection, pain, and social anxiety was observed in this study, indicating that lip repositioning surgery is effective in managing EGD.

Evaluation of effectiveness of management of excessive gingival display (Gummy Smile) with lip reposition procedure: A case series

Evaluation of effectiveness of management of excessive gingival display (Gummy Smile) with lip reposition procedure: A case series

Mucosal coronally positioned flap technique for management of excessive gingival display

Improvement of smile esthetics is a major goal of modern dentistry. Various treatment modalities have been proposed to correct excessive gingival display, depending on intraoral or extraoral etiologies. This report aimed to document the use of mucosal coronally positioned flap called surgical lip repositioning technique for the management of a gummy smile associated with vertical maxillary excess. The procedure restricts the muscle pull of the elevator lip muscles by shortening the vestibule, thus reducing the gingival display when smiling. Rapid surgical healing with minimal postoperative sequelae was observed. The follow up examinations showed esthetic satisfaction up to 6 months postoperatively, at the end of one year a partial relapse was observed. Although the short-term stable results of lip repositioning surgery appear satisfying postoperatively, its utility as a long-term treatment option remains questionable. More studies with larger sample size and long-term follow-up are necessary to establish the level of scientific evidence of this procedure.

Evaluation of a Neurotoxin as an Adjunctive Treatment Modality for the Management of Gummy Smile.

Introduction:Excessive gingival display while smiling mars facial aesthetics, this condition is referred to as “gummy smile” (GS). Available literature suggests that Botulinum toxin type A (BTX-A) is effective in the management of excessive gingival display by denervating hyperfunctional muscles. This study was conducted to statistically assess the effects of BTX-A for the management of GS.Materials and Methods:A total of 10 patients between the ages of 18–27 years were selected for this study, they received BTX-A (Botox; Allergan, Irvine, CA, USA) injections for reduction of excessive gingival display at “Yonsei point” on both sides. Gingival display was measured as the vertical distance from the zenith of the gingiva of the upper right central incisor to the inferior border of the upper lip before beginning treatment (T0). The patients were then recalled after 15 days to measure the gingival display (T1). Standardized photographs to document changes were obtained at T0 and T1.Results:A statistically significant reduction in gingival display, while smiling was observed from T0 (7.5 ± 1.35 mm) to T1 (3.2 ± 0.91 mm) in all 10 patients (t = 16.5168, P value = 4.87, P < 0.05).Conclusions:Administration of BTX-A is recommended as an adjuvant to orthodontic treatment where the GS is caused due to hyperfunctional upper lip elevator muscles.

Lip repositioning, an alternative treatment of gummy smile – A case report

The aim of present case report is to discuss surgical lip repositioning technique for the management of excessive gingival display related with vertical maxillary excess and increase mobility of the upper lip. By restricting the muscle pull by elevator lip muscles, this procedure reduces excessive gingival display during smiling. For patient, this procedure is safe, less invasive with minimal side effects and an alternative to orthognathic surgery in the correction of gummy smile.

Botox as an adjunct to lip repositioning for the management of excessive gingival display in the presence of hypermobility of upper lip and vertical maxillary excess.

Excessive gingival display (GD) is a frequent finding that can occur because of various intraoral or extraoral etiologies. This work describes the use of a mucosal repositioned flap for the management of a gummy smile associated with vertical maxillary excess (VME) and hypermobility of the upper lip followed by injection of Botox. Seven female patients in the age range of 17-25 years presented with a gummy smile. At full smile, the average GD ranged from 6 to 8 mm. A clinical examination revealed hypermobility of the upper lip. A cephalometric analysis pointed to the presence of VME. The mucosal repositioned flap surgery was conducted followed by injection with botulinum toxin type A (Botox) 2 weeks postsurgically. After 4 weeks, results were definitely observed with a decrease from 8 mm gingival exposure to 3 mm, which was considered as normal GD for an adult during smiling. For patients desiring a less invasive alternative to orthognathic surgery, the mucosal repositioned flap is a viable alternative. Moreover, Botox is a useful adjunct to enhance the esthetics and improve patient satisfaction where surgery alone may prove inadequately in moderate VME.

Esthetic Crown Lengthening Involving Dental Implants and Natural Teeth: A Case Study

Objective: This paper presents a rare management of excessive gingival display around dental implants and natural teeth using a minimally invasive approach to reduce peri-implant soft tissue with limited osseous reduction around natural teeth. It highlights esthetic crown lengthening procedure creating symmetrical gingival margins in the maxillary anterior region around dental implants and natural teeth. Clinical considerations: Excessive gingival display or gummy smile may adversely impact patient's appearance leading to esthetic concerns. Careful management of soft tissues around dental implants differs than that around teeth to achieve esthetic results. A technique is presented to esthetically and biologically align the gingival margins in areas of implants and natural teeth. It combines soft tissue reduction for implants with limited osseous and soft tissue reduction around natural teeth to achieve symmetrical results. Conclusion: Based on objectively evaluating the results using PES and WES parameters, esthetic results can be achieved around natural teeth and implants with excessive gingival display, through establishing a natural harmonious smile with stable outcomes at 24 months follow up

DUDAĞIN YENIDEN KONUMLANDIRILMASI VE GINGIVEKTOMI YAPILARAK GUMMY SMILE TEDAVISI BIR OLGU SUNUMU (GUMMY SMILE)

Excessive gingival display can be managed by variety of treatment modalities, depending on specific diagnosis. This case report demonstrates the successful management of excessive gingival display with a lip-repositioning and gingivectomy. A female patient aged 26 years reported with a chief complaint of gummy smile and was treated with this technique performed under local anesthesia with the main objective to reduce gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). The technique is fulfilled by removing a strip of mucosa from maxillary vestibule and creating a partial thickness flap between mucogingival junction and upperlip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display

Management of excessive gingival display: Lip repositioning technique

The lips form the frame of a smile and define the esthetic zone. Excessive gingival display during smile is often referred to as gummy smile. A successful management of excessive gingival display with lip repositioning procedure has shown excellent results. The procedure involves removing a strip of partial thickness mucosa from maxillary vestibule, then suturing it back to the lip mucosa at the level of mucogingival junction. This technique results in restricted muscle pull and a narrow vestibule, thereby reducing the gingival display. In this case gummy smile was treated by modification of Rubinstein and Kostianovsky's surgical lip repositioning technique which resulted in a harmonious smile.

Lip Repositioning with Reversible Trial for the Management of Excessive Gingival Display: A Case Series

Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. It involves precise resection of maxillary mucosal tissues with reattachment of the lip in a more coronal position. This limits lip elevation on smiling and increases lip fullness. While this is an elective treatment, no reported cases have yet offered patients the ability to preview the outcome in a reversible manner. This case series presents seven patients who were successfully managed with trial, and then definitive, lip repositioning.

Solution for gummy smile: An esthetic outlook

Changes in the anterior region of the mouth may lead to low self-esteem or a lack of self-confidence. The appearance of anterior teeth has a significant psychological and emotional impact on a patient. A gummy smile or an excessive gingival display is a common esthetic problem. This problem can be resolved by simply removing the gingiva via precisely planned incisions that often produces satisfactory esthetic results. This technique is known as crown lengthening. Crown lengthening has been traditionally utilized as an adjunct to restorative dentistry in cases where the prosthetic crown margins lie subgingivally. This is a case report describing successful management of excessive gingival display with crown lengthening procedure. In this case, the excess of gingival tissues were removed by gingivectomy, which resulted in a very acceptable and pleasing smile.

Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report

Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. A 24-year-old female presented for consultation regarding a gummy smile. At full smile the average gingival display ranged from 2 to 4 mm. A clinical examination revealed hypermobility of the upper lip and absence of generalized altered passive eruption. A cephalometric analysis pointed to the presence of vertical maxillary excess. The surgical procedure consisted of an elliptical mucosal excision followed by coronal advancement of the flap. This procedure aimed to limit the activity of the elevator muscles and reestablish the depth of the vestibule. Rapid surgical healing with minimal postoperative sequelae was observed. The patient reported significant reduction of gingival display at 1 week, which was maintained at the 1-year postoperative visit. Reduction in the amount of gingival display at the 1-year follow-up visit was stable. For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results.