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Adel N. Modified Lip Repositioning Surgery with and without Dual-layered Suturing for Treatment of Gummy Smile Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5521. [PMID: 38264443 PMCID: PMC10805458 DOI: 10.1097/gox.0000000000005521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/07/2023] [Indexed: 01/25/2024]
Abstract
Background The present study was performed to evaluate the differences in the efficacy of treating excessive gingival display with the standard modified lip repositioning surgery or the modified lip repositioning surgery with dual-layered suturing. Methods This study included 20 female patients who had a gummy smile resulting from upper lip hypermobility or short upper lip. Preoperative measurements of the amount of gum exposure were taken during involuntary smiling. The patients were randomly divided into two groups; the first group was treated with the standard technique, whereas the second group was treated with the double-layered suturing method. All patients were followed up at 14 days, 3 months, and 6 months; postoperative assessment was done by measuring the changes in the gingival display during spontaneous smiling. Results Postoperative measurements at 14 days follow-up showed a significant reduction in the amount of gingival exposure in both groups. However, at 3 months, there was a complete relapse for the first group of patients, whereas the second group showed a slight regain in the amount of gum exposure, though the latter group showed a complete relapse at 6 months postoperative. Conclusions The dual-layered suturing for the modified lip repositioning surgery did not provide any long-term improvement for treating gummy smile patients; however, it did delay the relapse to a certain extent for the first 3 months postoperative in some of the patients.
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Affiliation(s)
- Noury Adel
- Oral and Maxillofacial Surgery Specialist, Private Practice, Cairo, Egypt
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Rizzi RI, Portes MIP, Ertty E, Meloti F, An TL, Cardoso MDA. Aesthetic perception of smile in long face pattern patients who underwent maxillary impaction with miniplates or orthognathic surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:498-504. [PMID: 35577305 DOI: 10.1016/j.jormas.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The gummy smile is perceived in 10% of the population aged 20 to 30 years old, and it causes an aesthetic imbalance in the smile. This study investigated the existence of differences in the aesthetic perception of the smile after correcting the gummy smile using two different techniques: orthognathic surgery for maxillary impaction and miniplate-aided orthodontic impaction. METHODS Photographs of 16 Long Face Pattern female patients were evaluated by 56 oral and maxillofacial surgeons, 56 orthodontists, and 56 laypeople before and after the treatment with one of the two techniques. These photographs were standardized using the Photoshop program, randomly organized, and then presented to the evaluators via the Google Meeting® application in the PowerPoint® program. To evaluate the attractiveness of the smile, the Visual Analogue Scale (VAS) was used. To analyze the intra and inter-examiner concordances, Spearman's correlation and Kendall's concordance tests were used, respectively. For intergroup comparison, the Friedman test was used, with a 5% significance level. RESULTS For all three groups of evaluators, the post-treatment evaluation results were superior to the results before the treatment: surgeons and orthodontists assigned higher scores for surgical cases and laypeople for orthodontic cases. CONCLUSION From a clinical point of view, there was no difference between the results of both techniques with regard to the aesthetic perception of smiles. A gingival exposure ranging from zero to two millimeters was considered the most aesthetic for all evaluators.
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Affiliation(s)
- Ricardo Ideny Rizzi
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto São Leopoldo Mandic, 230-Apt 164, Cambuí, Campinas, São Paulo, SP 13024-490, Brazil
| | - Maila Izabela Pêsso Portes
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto São Leopoldo Mandic, 230-Apt 164, Cambuí, Campinas, São Paulo, SP 13024-490, Brazil.
| | - Ertty Ertty
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto São Leopoldo Mandic, 230-Apt 164, Cambuí, Campinas, São Paulo, SP 13024-490, Brazil
| | - Fernanda Meloti
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto São Leopoldo Mandic, 230-Apt 164, Cambuí, Campinas, São Paulo, SP 13024-490, Brazil
| | - Tien-Li An
- Department of Dentistry, School of Health Sciences, Brasilia, Brazil
| | - Mauricio de Almeida Cardoso
- Department of Orthodontics, Faculdade São Leopoldo Mandic, Instituto São Leopoldo Mandic, 230-Apt 164, Cambuí, Campinas, São Paulo, SP 13024-490, Brazil
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Hakobyan G, Boyadjian A, Boyadjian M, Harutyunyan A, Tunyan G, Khachatryan G. Clinical advantages of improving the excessive gingival display (EGD) by surgical repositioning of the upper lip. Clin Oral Investig 2022; 26:7265-7275. [DOI: 10.1007/s00784-022-04687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
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Silva CO, Rezende RI, Mazuquini AC, Leal VC, Amaral GSA, Guo X, Tatakis DN. Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness. J Clin Periodontol 2021; 48:826-833. [PMID: 33745186 DOI: 10.1111/jcpe.13461] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 12/20/2022]
Abstract
AIM To assess the effect of aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) on perception of smile attractiveness. MATERIALS AND METHODS Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender and group) and case (gingival display and GD) on smile attractiveness rating. RESULTS Average preoperative and postoperative VAS scores for ACL patients were 3.8 ± 2.0 and 6.2 ± 1.9, respectively. Corresponding LRS patient values were 4.8 ± 2.0 and 6.4 ± 1.9. Treatment, baseline GD and rater age were significant determinants (p < .001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p < .032) only for ACL. Procedure (p < .001), baseline VAS (p < .001), change in GD (p ≤ .002) and rater age (p ≤ .017) were significant determinants of smile attractiveness change from preoperative to postoperative. CONCLUSIONS ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.
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Affiliation(s)
- Cléverson O Silva
- School of Dentistry, State University of Maringá (UEM), Maringá, Brazil
| | - Robson I Rezende
- School of Dentistry, State University of Maringá (UEM), Maringá, Brazil
| | | | - Vinicius C Leal
- School of Dentistry, Ingá University (UNINGÁ), Maringá, Brazil
| | | | - Xiaohan Guo
- Department of Statistics, College of Arts and Sciences, The Ohio State University, Columbus, OH, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
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5
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Abstract
The delineation of excessive gingival display and review of current treatment options. Discussion over periodontal and prosthetic treatments, mucosal stripping procedures, myotomies, Botox therapy, and orthognathic procedures for correction of the "gummy smile."
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Affiliation(s)
- Jairo A Bastidas
- Oral and Maxillofacial Surgery, Department of Dentistry, Montefiore Medical Center, Albert Einstein School of Medicine, 3332 Rochambeau Avenue, Second Floor, Bronx, NY 10467, USA.
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6
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Ardakani MT, Moscowchi A, Valian NK, Zakerzadeh E. Lip repositioning with or without myotomy: a systematic review. J Korean Assoc Oral Maxillofac Surg 2021; 47:3-14. [PMID: 33632971 PMCID: PMC7925163 DOI: 10.5125/jkaoms.2021.47.1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/22/2020] [Accepted: 11/02/2020] [Indexed: 11/07/2022] Open
Abstract
Excessive gingival display is an esthetic issue that is commonly managed by different procedures. Lip repositioning is a modality to address concerns of affected patients. The aim of this review was to investigate the scientific evidence on outcomes and long-term stability of lip repositioning surgery with or without myotomy. The electronic search was conducted in three databases: MEDLINE, Embase, and the Cochrane Library up to October 2019. No publication status, language, or time restrictions were applied. The electronic search was complemented by a manual search of the reference lists. Three hundred thirty-eight studies were screened by title, and 16 articles remained for data extraction. The included studies assessed the lip repositioning procedure in 144 patients aged between 15-59 years (134 females and 10 males). Based on the available data, lip repositioning with myotomy/muscle containment can be a successful treatment for minor discrepancies in gingival display in selected cases. However, further well-organized controlled clinical trials are recommended to derive a conclusion about the long-term stability compared with other alternatives.
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Affiliation(s)
| | - Anahita Moscowchi
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Keshavarz Valian
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Manzur Villalobos I, Tovío Martínez EG, Guzmán Menco EM, Martínez Martínez A. LipStaT® Surgery, A Novel Technique for the Treatment of Gummy Smile: Case Report. ACTA ODONTOLÓGICA COLOMBIANA 2020. [DOI: 10.15446/aoc.v10n2.84452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The lip stabilization technique (LipStaT®) is a novel surgical approach for the management of gummy smile. It is an outpatient technique, minimally invasive, with low risk of morbidity and low incidence of complications. The goal of the technique is to reduce the excessive gingival display during smile. Objective: to describe the LipStaT® technique including its indications, preoperative evaluation, surgical approach and patient post procedure care instructions. Clinical Cases: the authors present two female patients, aged 20 and 31 years, with excessive gingival display (over 3mm) and with experiences of failures with other procedures. The LipStaT® technique allowed to achieve aesthetic, harmonic and functional results. Conclusion: The LipStaT® technique is a safe outpatient procedure that allows to obtain predictable results, which are well accepted by patients.
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Tawfik OK, Naiem SN, Tawfik LK, Yussif N, Meghil MM, Cutler CW, Darhous M, El-Nahass HE. Lip repositioning with or without myotomy: A randomized clinical trial. J Periodontol 2019; 89:815-823. [PMID: 30006937 DOI: 10.1002/jper.17-0598] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lip repositioning is a conservative surgical method for the correction of excess gingival display (EGD) by limiting the upward retraction of the lips. Lip repositioning presents a simple method for the treatment of gummy smile. The aim of this randomized clinical trial (RCT) was to assess lip repositioning, compared to lip repositioning with muscle severance for efficacy in treatment of EGD and resultant stability. METHODS A single-blinded, controlled, parallel-group RCT was performed. Twenty patients with EGD were enrolled in the study, treated with lip repositioning with and without muscle severance. Participants were assessed for EGD reduction, changes in lip length and result stability at 3, 6 and 12 months. Additionally, pain, swelling and satisfaction, were assessed. RESULTS Classic lip repositioning was found capable of reducing EGD by 2.73 mm (SD ± 1.281), while lip repositioning with muscle severance offered an improved reduction in EGD with a mean reduction of 3.57mm (SD ± 1.62). Lip length, swelling and pain scores were found comparable between the two techniques. CONCLUSION Lip repositioning is an effective method for treating EGD, however, muscle severance provides a more stable result at 12 months when compared to the classical technique. More studies are necessary to fully assess this procedure.
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Affiliation(s)
- Omnia K Tawfik
- Department of Oral medicine and Periodontology, Faculty of Oral and Dental Medicine-Cairo University, Manial, Cairo, Egypt.,Department of Periodontics, Dental College of Georgia-Augusta University, Augusta, Georgia
| | - Suzi N Naiem
- Department of Oral medicine and Periodontology, Faculty of Oral and Dental Medicine-Cairo University, Manial, Cairo, Egypt
| | | | - Nermin Yussif
- October University of Modern Sciences and Arts (MSA university), Cairo, Egypt
| | - Mohamed M Meghil
- Department of Periodontics, Dental College of Georgia-Augusta University, Augusta, Georgia
| | - Christopher W Cutler
- Department of Periodontics, Dental College of Georgia-Augusta University, Augusta, Georgia
| | - Mona Darhous
- Department of Oral medicine and Periodontology, Faculty of Oral and Dental Medicine-Cairo University, Manial, Cairo, Egypt
| | - Hani E El-Nahass
- Department of Oral medicine and Periodontology, Faculty of Oral and Dental Medicine-Cairo University, Manial, Cairo, Egypt
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Boeira PO, De Rossi A, Caporossi LS, Lima GDS. Periodontal esthetic surgery to improve a natural smile: Report case with 2-year follow-up. J Indian Soc Periodontol 2019; 24:87-91. [PMID: 31983852 PMCID: PMC6961458 DOI: 10.4103/jisp.jisp_477_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/25/2019] [Accepted: 05/04/2019] [Indexed: 11/05/2022] Open
Abstract
The objective in this case report is to present a correction of excessive gingival exposure performed through periodontal esthetic surgery, using clinical crown lengthening and lip repositioning. The patient reported discomfort when smiling due to excessive gingival exposure, and clinical and photographic examinations of the patient showed vertical maxillary growth as the main diagnosis. In the digital smile design, the possibility of crown lengthening observed for teeth – upper left and right central incisors and upper left lateral incisor. A lip-repositioning procedure was also planned. An incision was performed at the mucogingival junction, and a parallel incision was realized at the top of the alveolar mucosa. Afterward, the incised gingival band was removed through vertical incisions in the planned border area. The muscular area was preserved. A simple suture was made, with the approach of the gingival margins around the surgical area. The crown-lengthening procedure was performed with the flapless technique. After 2-year follow-up, the periodontal esthetic surgery, comprising crown lengthening and lip repositioning, was noninvasive and can thus serve as an interesting alternative treatment for excessive exposure of the gingival smile, as it results in a harmonious and natural smile.
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Affiliation(s)
- Peterson Oliveira Boeira
- Department of Operative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Alexandre De Rossi
- Department of Operative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Leonardo Stephan Caporossi
- Department of Operative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Giana da Silveira Lima
- Department of Operative Dentistry, Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
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10
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Arcuri T, da Costa MFP, Ribeiro IM, Barreto BD, Lyra eSilva JP. Labial repositioning using polymethylmethracylate (PMMA)-based cement for esthetic smile rehabilitation-A case report. Int J Surg Case Rep 2018; 49:194-204. [PMID: 30029078 PMCID: PMC6077168 DOI: 10.1016/j.ijscr.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022] Open
Abstract
PMMA-based bone cement proved effective in esthetic smile rehabilitation. The technique is operator-sensitive. The thickness of the PMMA implant is also paramount. PMMA is non-toxic, biocompatible with human tissues.
Introduction One of the most common esthetic complaints among dental patients is a gingival smile, which may be of multifactorial etiology, e.g. gingival hyperplasia, skeletal deformities featuring overgrowth of the anterior maxilla, altered passive eruption, maxillary alveolar tooth extrusion, fine lip and hypermobility of lip elevator muscles, which must be diagnosed prior to treatment so that the appropriate management approach can be selected. Maxillary overgrowth may give rise to subnasal skeletal depression where the upper lip retracts to during smiling, causing gingival exposure. The objective of this case report was to describe a lip repositioning technique using polymethylmethacrylate (PMMA)-based bone cement for esthetic smile rehabilitation. Case report A 23-year-old female attended the Esthetic Dentistry Clinic of our institute, reporting dissatisfaction with her smile, due to the size of her teeth and the amount of gingiva exposed when smiling. A rehabilitation planning was designed, which was performed with periodontal surgical intervention to fill the subnasal depression with PMMA-based bone cement. After crown lengthening, the PMMA-based bone cement was prepared with gentamicin in a sterile surgical bowl. When the mixture stopped sticking to the surgical gloves, it was then positioned into the subnasal pit, under constant and copious saline irrigation. With the cement in place, the prosthesis was shaped in a maximum thickness of 7-mm. After complete polymerization and under abundant cooling, refinement and finishing of the PMMA prosthesis was performed. The prosthesis was fixed onto the bone with two titanium-based bone graft fixation screws. The smile aesthetic rehabilitation was complemented using 10 lithium disilicate-based ceramic veneers. Discussion and conclusion PMMA-based bone cement proved effective when combined to clinical crown lengthening for esthetic smile rehabilitation, acting as a filling material for subnasal depression, providing new lip support.
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Affiliation(s)
- Toni Arcuri
- Department of Dentistry, Paulista University, UNIP, Brasília, Brazil.
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11
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Uzuka S, Chae JM, Tai K, Tsuchimochi T, Park JH. Adult gummy smile correction with temporary skeletal anchorage devices. J World Fed Orthod 2018. [DOI: 10.1016/j.ejwf.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Tawfik OK, El-Nahass HE, Shipman P, Looney SW, Cutler CW, Brunner M. Lip repositioning for the treatment of excess gingival display: A systematic review. J ESTHET RESTOR DENT 2017; 30:101-112. [PMID: 29193632 DOI: 10.1111/jerd.12352] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lip repositioning is a conservative surgical technique used to treat excess gingival display. An array of modifications has been introduced to the technique over time and as studies show the technique and its modifications to be successful, there is little standardized information for clinicians to make informed decisions when choosing this technique for the treatment of patients with excessive gingival display (EGD). OBJECTIVES To review the current literature on the topic of lip repositioning for the treatment of excessive EGD, exploring outcome, and result longevity. METHODS A structured systematic search was carried out using the Ovid database and Web of Science to identify published studies on lip repositioning technique. Search was restricted to studies in the English language, describing a surgical intervention. Case reports were included as the number of published studies was limited. RESULTS The electronic search identified 93 articles, hand search identified 1 article, and reference search identified 1 article. After excluding duplicates and screening articles, a total of 22 articles met the inclusion criteria. An estimated mean improvement of 3.4 mm (95% confidence interval, 3.0-3.8 mm) was found possible with lip repositioning. Data analysis was performed using only 4 studies, amounting to a total of 33 patients. Potential risk of bias was identified in some of the studies included. CONCLUSIONS Despite the limited available studies on lip repositioning, an estimated mean improvement of 3.4 mm was found to be possible with surgical lip repositioning, suggesting that the technique could be used successfully to treat EGD. However, more studies are necessary to properly evaluate the treatment approach and stability of the technique. CLINICAL SIGNIFICANCE Recently, the demand for esthetics has significantly increased, driven by increased patient awareness and the search for an ideal smile. Creating the perfect smile is an intricate process that requires a multidisciplinary approach, with careful consideration of the lips and the gingival outline. Excess gingival display results in an unaesthetic smile, lip repositioning offers a comparatively simple solution for this problem. While the quality literature on this topic is limited statistical analysis of collected studies show that an estimated mean improvement of 3.4 mm can be achieved with surgical lip repositioning.
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Affiliation(s)
- Omnia K Tawfik
- Department of Periodontology and Oral Medicine, Faculty of dentistry, Cairo University, Cairo, Egypt.,Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Hani E El-Nahass
- Department of Periodontology and Oral Medicine, Faculty of dentistry, Cairo University, Cairo, Egypt
| | | | - Stephen W Looney
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Christopher W Cutler
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Mark Brunner
- Department of Periodontics, Dental College of Georgia at Augusta University, Augusta, Georgia
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Sharma A, Sharma S, Garg H, Singhal V, Mishra P. Lip Repositioning: A Boon in Smile Enhancement. J Cutan Aesthet Surg 2017; 10:219-222. [PMID: 29491658 PMCID: PMC5820840 DOI: 10.4103/jcas.jcas_50_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This clinical report describes the successful use of lip repositioning technique for the reduction of excessive gingival display. The lip repositioning technique was performed with the main objective of reducing gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). This technique includes removing a strip of mucosa from the maxillary buccal vestibule, creating a partial-thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display.
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Affiliation(s)
- Anamika Sharma
- Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Shatakshi Sharma
- Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Harshita Garg
- Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Vineeta Singhal
- Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Pooja Mishra
- Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
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