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Case Reports
. 2014 Sep;18(5):656-60.
doi: 10.4103/0972-124X.142468.

Treatment of gummy smile: Gingival recontouring with the containment of the elevator muscle of the upper lip and wing of nose. A surgery innovation technique

Carmen Lucia Mueller Storrer  1 , Fabiane Kristine Bochenek Valverde  2 , Felipe Rychuv Santos  3 , Tatiana Miranda Deliberador  1
Affiliations
Case Reports

Treatment of gummy smile: Gingival recontouring with the containment of the elevator muscle of the upper lip and wing of nose. A surgery innovation technique

Carmen Lucia Mueller Storrer et al. J Indian Soc Periodontol. 2014 Sep.

Abstract

The containment of the elevator muscle of the upper lip and wing of nose was used for the treatment of patients with gummy smile. This technique had corrected esthetic alterations of smile, reducing the upper lip elevation, which results in a smaller gingival display. An upper lip lengthening as well as a reduction in the upper lip shortening when the patient smiled could be observed. The high smile line was corrected without compromising the labial harmony. This study presents an innovative and effective therapeutic option to obtain a natural and harmonious smile. The patient expressed a high degree of satisfaction.

Keywords: Esthetics; gingival recontouring; gummy smile; smile esthetics.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Photo illustrating the vestibule of the upper arch in a human corpse (MARC). Anatomical details of the anterior third of the arch (keratinized gingiva and alveolar mucosa). Vertical incision on the labial frenum and horizontal incisions on a superficial layer of the mucogingival line up to the height of the canines
Figure 2
Figure 2
Image after the divulsion and separation of the external epithelium from the mucosa with the use of Goldman-Fox scissors, exposing and pulling the lateral bundle of the elevator muscle of the upper lip and wing of nose bilaterally
Figure 3
Figure 3
Containment of the muscle bundles with an absorbable suture thread in the highest portion of the inserted gingiva on both sides
Figure 4
Figure 4
Sutures made with a 4-0 silk thread in the horizontal incisions and in the vertical incision on the labial frenum
Figure 5
Figure 5
Initial photo of the smile before the surgery
Figure 6
Figure 6
Measurement of the gummy smile, with the help of a periodontal probe, with 7 mm of gingival display
Figure 7
Figure 7
Markings of the depth of gingival sulcus with a periodontal probe or a Crane Kaplan probe. Union of these markings with an internal bevel incision
Figure 8
Figure 8
The excess of gingival tissue is removed with the use of an Orban knife. Note the significant increase of the dental crowns
Figure 9
Figure 9
Traction of the elevator muscle of the upper lip and wing of nose with an absorbable suture thread. Sutures in a deep layer between the muscle and the upper portion of the keratinized gingiva
Figure 10
Figure 10
Continuous suture made with a 4-0 silk thread on the labial frenum and in between the mucosa and the keratinized gingiva
Figure 11
Figure 11
After 12 months of post-operative control. The patient's lip was repositioned closer to the teeth. It was brought down to show less gingiva
Figure 12
Figure 12
View profile after 12 months of post-operative control. The patient's lip was still closer to the teeth. She can smile with confidence
See this image and copyright information in PMC

References

    1. Garber DA, Salama MA. The aesthetic smile: Diagnosis and treatment. Periodontol 2000. 1996;11:18–28. - PubMed
    1. Kokich VO, Jr, Kiyak HA, Shapiro PA. Comparing the perception of dentists and laypeople to altered dental esthetics. J Esthet Dent. 1999;11:311–24. - PubMed
    1. Levine RA, McGuire M. The diagnosis and treatment of the gummy smile. Compend Contin Educ Dent. 1997;18:757–62. - PubMed
    1. Wennström JL, Zucchelli G, Pini Prato GP. Clinical Periodontology and Implant Dentistry. 5th ed. Oxford: Blackwell Munksgaard; 2008. Mucogingival Therapy – Periodontal Plastic Surgery; pp. 955–1028.
    1. Dong JK, Jin TH, Cho HW, Oh SC. The esthetics of the smile: A review of some recent studies. Int J Prosthodont. 1999;12:9–19. - PubMed

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