Treatment Of Excessive Gingival Display Research Articles

Digital Planning to Enhance Diagnosis and Precision in Correcting Excessive Gingival Display in the Presence of Asymmetrical Maxillary Position: A Case Report.

This case report addresses the treatment of excessive gingival display (EGD) in the context of maxillary asymmetry, zenith irregularities, and occlusal plane inclination. Digital planning was pivotal in formulating a precise treatment strategy by incorporating facial photographs, digital models, and cone-beam computed tomography data. Parameters, including occlusal plane inclination, teeth position, and lip-to-gingival margin relationships, were considered to ensure treatment alignment with the patient's facial characteristics. Notably, during the planning phase, it was evident that the conventional approach using the cementoenamel junction as the apical limit for incisions would result in asymmetry. Consequently, the gingival margin position was defined in accordance with facial and lip features. The chosen treatment, flapless crown lengthening, was tailored to the patient's thin phenotype and guided by measurements derived from digital planning. Postsurgery, the patient experienced a swift and painless recovery. A harmonious smile with a stable gingival margin position was achieved at the 1-year follow-up, seamlessly complementing the patient's facial attributes. This case underscores the importance of personalized EGD treatment and the value of digital planning in enhancing diagnostic accuracy and precise treatment planning, ultimately facilitating optimal treatment strategies.

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.

Use of both the diode and Er: YAG lasers in esthetic crown lengthening with the aid of digitally guided dual technique: 3 years follow-up.

To explore the feasibility of the usage of digital guides in combination with low- and high-power lasers for the treatment of excessive gingival display, also known as "gummy smile". Excessive gingival display due to altered passive eruption can affect patient's perception of their own esthetics and consequently have an impact on self-confidence. Therefore, the management of this condition should offer a predictable and stable long-lasting solution. To attain these objectives, digital planning emerges as a tool in optimizing the outcomes of crown lengthening surgery for this condition by enhancing precision through the use of surgical guides. Additionally, the usage of high- and low-powered lasers can provide a safe approach because of their tissue selective removal properties. The technique described showed satisfactory clinical results in the short- and long-term follow-up, leading to an improvement in patients' self-esteem. This approach integrates digital and laser technologies to deliver a surgical treatment characterized by precision, efficiency, and safety. Digital dentistry has contributed to innovative dental procedures, as personalizing surgical guides for patients, assisting and guiding incisions of the gingival margins, as well as the extension of the osteotomy, during the procedures for increasing the clinical crown. Furthermore, smile esthetics are directly related to an individual's improved emotional and social quality of life.

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.

Clinical advantages of improving the excessive gingival display (EGD) by surgical repositioning of the upper lip

The objective of this study is to minimize gingival display by surgical repositioning of the upper lip and to suggest this technique as an alternative treatment modality to orthognatic surgery for treatment of excessive gingival display. Forty-eight patients were selected with gingival display of more than 2mm during maximal smiling. All patients underwent surgical repositioning of the upper lip, aimed at limiting elevator muscle activity to treat excessive gum exposure. Patients were regathered in 1week for the follow-up postoperative symptoms according to VAS scale to evaluate pain and swelling. Reference values were given to patients. The study has indicated good results and stability especially to patients with skeletal class I classification along with medium and thick biotype of attached gingiva without hypermobile upper lip. Surgical repositioning of the upper lip is an effective way to improve a patient's gingival smile caused by degree I and II VME in combination with HUL as an alternative treatment modality to orthognathic surgery. This method is less invasive and cost-effective, causes minimal postoperative complications, and provides faster recovery. Excessive gingival display (EGD) with various etiologies requires several proper treatment modalities. The proposed modified method of lip repositioning to reduce the degree of gingival display is less aggressive, reliable, and causes fewer postoperative complications compared to orthognathic surgery.

A Standardized Technique for Gummy Smile Treatment Using Repeated Botulinum Toxins: A 1-year Follow-up Study.

Summary:The present study was performed to evaluate the effect of repeated botulinum toxin injections and their long-term effects, using a customized injection point and dosage technique in the treatment of excessive gingival display. Twenty women who had gummy smile due to hypermobility of the upper lip or gingival display, ranging from 4 to 6 mm‚ were included in the study. All patients were injected with Botox injections at different injection points according to the type of smile. Pre- and postoperative measurements were taken by measuring digitally the gingival display at smiling, using Adobe Photoshop software via standardized digital photographs. Patients were followed up at 14 days, 4 months, 8 months, and 12 months. Postoperative measurements showed marked improvement at 14-day follow-up, with a significant reduction in the amount of gingival display. Relapse, however, occurred at 4 months and later. For excessive gingival display, Botox is an effective treatment that lasts for 2–3 months, with almost complete relapse at 4 months. We concluded from the results of our study that, despite repeated Botox injections at two follow-up intervals (4 and 8 months), the theory that repeated Botox injections may offer a permanent effect is still questionable.

Enhanced anterior esthetic using crown lengthening and depigmentation at single visit: Report of two cases and review of literature

Gingival hyper-pigmentation becomes more obvious when it is associated with excessive gingival display. The treatment of excessive gingival display and depigmentation collectively are the key to patient satisfaction. The objective of the present article was to evaluate 6 months' result of surgical protocol that integrated surgical depigmentation, gingivectomy, and an apically positioned flap with osseous resective surgery to correct hyper-pigmentation and excessive gingival display in maxillary anterior teeth among different patients. The author has discussed in detail the selection of surgical techniques in different clinical conditions to achieve pleasant and long-term results. The selected techniques for depigmentation and crown lengthening resulted in excellent color and contour of the gingiva at the 6-month follow-up.

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.

Botulinum Toxin-A in the Treatment of Excessive Gingival Display: A Clinical Study.

The aim of this study was to elucidate the efficiency of BTX-A injections as an alternative approach in patients with excessive gingival display and to observe the patient's satisfaction in order to obtain cosmetically promising results. Fifteen patients of whom ten female and five male with different types of gummy smiles such as anterior (53%), posterior (7%) and mixed (40%) reported to the Department of Oral and Maxillofacial Surgery at Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu from December 2018 to October 2019 those who were willing to undergo corrections using Botulinum Toxin Type A (BTX-A) were selected for the present study using various inclusion and exclusion criteria. The patients were injected with BTX-A on Yonsei triangle accordingly. The clinical evaluation and patient satisfaction evaluation were carried out. A significant decrease in the gingival exposure of about 3.5 ± 1mm at 2weeks after injection was observed and it lasted for 4months. It was also noted that there was no difference in the measurement of gingival display on maximum smile for postinjection during 5th and 6th month when compared with preinjection measurements. This study confirms that the efficacy of BTX A injection lasted for 4months and then gradually reduced resulting in reversal of gingival display during maximum smile. The authors conclude that in the cosmetic correction of gummy smile by BTX-A, it is important to identify the type of smile and the main muscles involved, so that the correct injection technique can be used. It also confirms that BTX-A is a novel, competent, risk-free and minimally invasive nonsurgical therapy that can extensively improve smile aesthetics.

Effectiveness of lip repositioning surgeries in the treatment of excessive gingival display: A systematic review and meta-analysis.

To synthesize the available evidence regarding lip repositioning surgery (LRS) and quantify the short- and long-term reduction in excessive gingival display (EGD) with the procedure. Additionally, evaluate the effect of myotomy on the results. Seven electronic databases were searched up to May 2020 by two independent reviewers. Studies evaluating the exclusive use of LRS to treat EGD were included. After risk of bias assessment, the data were quantitatively evaluated with random-effects meta-analysis. The initial database search yielded 368 studies, of which 16 were selected for full-text review. Finally, eight studies were included. The random effects model exhibited an EGD reduction of 2.87 mm (95% CI: 1.91-3.82) after 3 months of LRS. These results decreased after 6 months (2.71 mm; 95% CI: 1.95-3.47) and 12 months (2.10 mm; 95% CI: 1.48-2.72). Meta-analysis comparing the performance of myotomy showed greater EGD reduction at 6 months than without myotomy (P < 0.02). LRS is an effective approach for treating EGD, and it has satisfactory results up to 6 months. After this period, the effectiveness appears to progressively decrease over time indicating substantial relapse at 12 months. Myotomy seems a suitable alternative to increase the stability of LRS. Lip repositioning surgery is an effective procedure to improve smile esthetics in the short-term (up to 6 months). After this period, the efficacy of LRS seems to decrease progressively, and an approximately 25% relapse may be expected after 12 months. Clinicians should combine the procedure with other approaches, such as plastic periodontal surgeries, restorative procedures, or botulin toxin injections for more predictable and stable outcomes.

Predictability in Lip Repositioning with Botulinum Toxin for Gummy Smile Treatment: A 3-Year Follow-up Case Series.

The aim of this case series was to describe the successful treatment of excessive gingival display (EGD) using a lip repositioning technique (LRT) and botulinum toxin injections (BTIs) for long-term stability. Eight patients diagnosed with EGD were enrolled. A partial-thickness horizontal incision was made from the right first molar to the left first molar along the mucogingival line, leaving the midline frenum intact. The next day, all patients received BTIs. Mean reductions in gingival display between baseline and 3, 6, 12, 18, 24, and 36 months after surgery were considered. BTIs prevent movement of the upper lip during the healing phase of the LRT, improving the results and offering long-term outcomes with a follow-up period of 3 years.

Assessment of surgical lip repositioning for treatment of excessive gingival display – a one year follow up study

Assessment of surgical lip repositioning for treatment of excessive gingival display – a one year follow up study

Minimal Invasive Surgical Approach for Treatment of Excessive Gingival Display: A Case Report

Minimal Invasive Surgical Approach for Treatment of Excessive Gingival Display: A Case Report

Interdisciplinary management of a patient with a gummy smile

This article describes the novel use of cone-beam computed tomography (CBCT) to predictably plan a crown-lengthening procedure without osseous contouring. The method aimed to achieve maximum incisal tooth reduction while avoiding endodontic treatment as a method for conservative management of a patient with excessive gingival display. Managing the case involved performing gingivoplasty without osseous recontouring. Prosthetic reconstruction was also performed to replace the missing canines and adjust the incorrect position of the maxillary incisors. A CBCT was used to precisely locate the alveolar bone level and pulp chamber level to avoid the risk of pulp exposure during tooth preparation. Laser was used to perform gingivoplasty. Computer-aided design/Computer-aided manufacturing technology was used to construct all-ceramic restorations making the use of smile design and virtual articulator features in the software. The patient's excessive gingival display was conservatively treated without osseous surgery or root canal treatment. Six monthly checks were performed for 5 years to check pulp vitality, and all teeth responded normally to vitality tests. The patient expressed great satisfaction with the result with minimal postoperative pain. With careful preoperative planning and novel use of CBCT, esthetic, and conservative treatment of excessive gingival display was made possible, while avoiding osseous resective surgery and root canal treatment. This made the treatment prompt with little need for a recovery period, more appealing to the patient, and longevity of treatment was ensured.

Treatment of excessive gingival display using modified lip repositioning technique with esthetic crown lengthening: Case reports

Treatment of excessive gingival display using modified lip repositioning technique with esthetic crown lengthening: Case reports

Lip Repositioning with Vestibular Shallowing Technique for Treatment of Excessive Gingival Display with Various Etiologies.

Improvement of smile esthetics is a major goal of modern dentistry. Various treatment modalities have been proposed to correct excessive gingival display (EGD), depending on the identified etiologies. This study reports on the clinical and patient-centered outcomes of a novel lip repositioning technique with vestibular shallowing approach in the treatment of three types of EGD with varying etiologies. Periosteal fenestration with cicatrization (scarification) was performed at the mucogingival junction to ensure the stability of esthetic outcomes. Suspensory triangular sutures and extraoral tissue stabilization tapes were used to facilitate the cicatrization process during the healing phase of this novel technique. Postoperative clinical examination revealed 84% reduction in gingival display that remained stable for 13 to 16 months with a high level of patient satisfaction.

Treatment of excessive gingival display with lip repositioning technique

Treatment of excessive gingival display with lip repositioning technique

Botulinum Toxin for the Treatment of Excessive Gingival Display: A Systematic Review.

To date, no standardized minimally invasive approach for the treatment of excessive gingival display exists. This systematic review aims to assess the evidence in the literature regarding the role of botulinum toxin injection in the management of gummy smile. All publications through December 2014 and pertaining to the subject were electronically searched in PubMed, Embase, Scopus, and Web of Science, and the bibliographies of retrieved articles were manually screened. Out of 33 articles, 29 were discarded based on exclusion criteria. Although all 4 selected articles were in line with a role for botulinum toxin injection in the treatment of gummy smiles and the importance of targeting the levator labii superioris alaeque nasi muscle, studies differed in the type and the dose of toxin administered and the technique adopted. Injection with botulinum toxin is a novel, safe, and cosmetically effective treatment for gummy smile when performed by experienced practitioners. However, further randomized controlled trials are warranted. LEVEL OF EVIDENCE 4: Therapeutic.

Case series of laser-assisted treatment of excessive gingival display: an alternative treatment.

The objective of this study was to investigate the stable and significant outcomes of laser-assisted lip repositioning technique for the treatment of excessive gingival display. "Gummy smile" is a major concern for a large number of patients visiting the dentist. The hyperactivity of the upper lip is one of the main causes of a gummy smile, and several techniques have been proposed for its treatment. Ten patients with excessive gingival display were treated with laser-assisted lip repositioning technique. The technique is composed of removing a strip of mucosa by laser incisions from the maxillary buccal vestibule, and coronal repositioning of the new mucosal margin. The clinical dimensions of gingival display were measured from the left, right posterior, and anterior sides at baseline, 6 and 12 months postoperatively. Subjects completed surveys to evaluate satisfaction with outcomes. Clinical and patient-centered parameters [visual analog scale for pain and aesthetics (VAS)] were measured at 7 days and again at 12 months after the surgery. The baseline anterior gingival display of 4.3±1.8 mm significantly decreased to 1.1±1.0 mm at 6 months (p<0.0001) and was maintained at 12 months (1.2±1.5 mm). The baseline left, right gingival display (4.9±2.2 mm; 5.0±1.4 mm) significantly decreased (1.2±1.4 mm; 1.3±1.1 mm) at 12 months (p<0.0001). Patients were satisfied with their smile after surgery and would likely choose to undergo the procedure again. The treatment of gummy smile with laser-assisted lip repositioning successfully reduced the preoperative gingival display without postoperative complications, in all cases.

Excessive gingival display: treatment by a modified lip repositioning technique

The objective of this prospective study was to investigate outcomes of a lip repositioning technique for the treatment of excessive gingival display. Thirteen consecutively treated patients with excessive gingival display were treated with a modified lip repositioning technique. Treatment consisted of the removal of two strips of mucosa, bilaterally to the maxillary labial frenum and coronal repositioning of the new mucosal margin. The clinical dimensions of gingival display, upper lip and vermillion length were measured at baseline, 3 and 6months post-operatively. Subjects completed surveys to evaluate satisfaction with outcomes. The baseline gingival display of 5.8±2.1mm significantly decreased to 1.4±1.0mm at 3months (p<0.0001) and was maintained until 6months (1.3±1.6mm). The reduction in gingival display strongly correlated to the combined change in upper lip and vermillion length (r(2) =0.60, p=0.0018). Subjects were satisfied with their smile after surgery and would likely choose to undergo the procedure again (92%). The worst part of undergoing the procedure was the discomfort or the inability to move the lip during the early healing (69%). Treatment of excessive gingival display by means of a modified lip repositioning technique results in high level of patient satisfaction and predictable outcomes that are stable in the short term.