Is lip repositioning operation actually effective in treatment of gummy smile?

Year 2019, Volume: 16 Issue: 2, 284 - 289, 29.08.2019

Bozan Serhat İzol , Devrim Deniz Üner

https://doi.org/10.35440/hutfd.586541

Abstract

Background: Modified lip repositioning operation (MLR) are being used very
frequently in recent times for treating Gummy Smile (GS) caused by hyperactive
upper lip as they are easily applicable, have very few side effects and high
patient satisfaction. The purpose of this study is to assess whether or not the
effects of MLR operation that is used in GS treatment is temporary.

Methods:
In this study, 16 female patients who had complaints of excessive visibility of
their gums while smiling were treated by MLR operations. The amounts of
visibility of the gums were measured before the operation and in the 3rd and
6th months following the operation.

Results:
According to the measurements that were made and analysis that was carried out,
the mean amounts of visible gums before the operation, 3 months after the
operation and 6 months after the operation among the 16 patients were
respectively 4.93±0.85 mm, 1.06±0.98 mm and 2.87±0.8 mm. The mean amount of
reduction in the amounts of the visible gums after the operation were respectively
3.75±0.93
mm and 2.06±0.68
mm for the 3rd and 6th months after the operation.

Conclusions: Based on the results of this study, we may state that the effects of
the MLR operation on the amount of visible gums while smiling decrease in time.
However, the fact that the study was carried out on a few patients prevents us
from reaching precise conclusions about this topic. As the authors, we
recommend that similar studies are carried out with larger samples, and for the
purpose of restricting lip movements, Botulinum Toxin is applied 2 weeks before
the operation.

Keywords

Gummy Smile, modified lip repositioning operation

Dudağın Yeniden Konumlandırılması Operasyonu Dişeti Gülümsemesi Tedavisinde Gerçekten Etkili Mi?

Abstract

Amaç: Modifiye dudağın yeniden konumlandırılması (MDYK) operasyonu kolay
uygulanabilir olması, çok az yan etkisinin olması ve yüksek hasta memnuniyeti
nedeniyle hiperaktif üst dudağın sebep olduğu Gummy
Smile’ın  (GS) tedavisinde son zamanlarda çok sık kullanılmaktadır. Bu
çalışmanın amacı GS tedavisinde kullanılan MDYK operasyonunun 6 aylık dönemde
etkisinin geçip geçmediğini değerlendirmektir. 

Materyal ve
Metot: Bu çalışmada gülümseme
esnasında dişetinin fazla görünmesinden şikayetçi olan 16 bayan hasta MDYK
operasyonu ile tedavi edildi. Operasyon öncesi ve operasyondan 3-6 ay sonra
gülümseme esnasında görünen dişeti miktarları ölçüldü. 

Bulgular: Yapılan ölçüm ve analize göre operasyondan önce ve operasyondan
sonraki 3-6. ayda 16 hastada gülme esnasında ortalama görünen dişeti miktarı
sırasıyla 4.93±0.85 mm, 1.06±0,98 mm ve 2.87±0.8 mm olarak hesaplandı.
Operasyon sonrası dişetindeki ortalama azalma miktarı ise operasyondan sonraki
3. ve 6. ayda sırasıyla 3.75±0.93 ve 2.06±0.68 mm olarak tespit edildi. 

Sonuç: Bu çalışmanın sonucuna dayanarak; MDYK operasyonunun gülme esnasında
görünen dişeti miktarı üzerine etkisinin zamanla azaldığını
söyleyebiliriz. Ancak araştırmanın az sayıda hasta üzerinde yapılmış
olması, bu konu hakkında kesin sonuçlara varmamızı engellemektedir. Biz
yazarlar olarak buna benzer çalışmaların hasta sayısının fazla olduğu gruplar
üzerinde yapılmasını ve operasyonun daha etkili olması için, dudak
hareketlerinin kısıtlanması amacıyla operasyondan 2 hafta önce üst dudağı
yukarı kaldıran kaslara Botulinum Toksin uygulayarak yeni çalışmalar
yapılmasını önermekteyiz.

Keywords

Dişeti gülümsemesi, modifiye dudağın yeniden konumlandırılması operasyonu, , dişetinin aşırı derecede görünmesi

References

• 1. Gill DS, Naini FB, Tredwin CJ. Smile aesthetics. SADJ [Internet]. 2008;63(5):270, 272–5.
• 2. Tjan AHL, Miller GD, The JGP. Some esthetic factors in a smile. J Prosthet Dent. 1984;51(1):24–8.
• 3. Kokich VO, Asuman Kiyak H, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Restor Dent.1999;11(6):311–24. 4. Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am. 1988;32(2):307–30.
• 5. Humayun N, Kolhatkar S, Souiyas J, Bhola M. 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. J Periodontol. 2010;81(12):1858–63.
• 6. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod. 1992; 62(2):91-100
• 7. Silberberg N, Goldstein M, Smidt A. Excessive gingival display--etiology, diagnosis, and treatment modalities. Quintessence Int. 2009;40(10):809–18.
• 8. Rosenblatt A, Simon Z. Lip repositioning for reduction of excessive gingival display: a clinical report. Int J Periodontics Restorative Dent. 2006;26(5):433–7.
• 9. Robbins JW. Differential diagnosis and treatment of excess gingival display. Pract Periodontics Aesthet Dent [Internet]. 1999;11(2):265–72.
• 10. Pereira J, Furtado A, Ghizoni J, Molina G, Oliveira M. Gummy smile: A contemporary and multidisciplinary overview. Dent Hypotheses. 2014;4(2):55.
• 11. Chagas TF, Almeida NV de, Lisboa CO, Ferreira DMTP, Mattos CT, Mucha JN. Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis. Braz Oral Res. 2018;32(0).
• 12. Ishida LH, Ishida LC, Ishida J, Grynglas J, Alonso N, Ferreira MC. Myotomy of the levator labii superioris muscle and lip repositioning: A combined approach for the correction of gummy smile. Plast Reconstr Surg. 2010;126(3):1014–9.
• 13. Mollabashi V, Abolvardi M, Akhlaghian M, Ghaffari MI. Smile attractiveness perception regarding buccal corridor size among different facial types. Dent Med Probl [Internet]. 2018;55(3):305–12.
• 14. Mostafa D. A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: A case report. Int J Surg Case Rep. 2018;42:169-74.
• 15. Gupta S, Shivananda H, Dayakar M. Lip repositioning: An alternative cosmetic treatment for gummy smile. J Indian Soc Periodontol. 2014;18(4):520.
• 16. Rao A, Koganti V, Prabhakar A, Soni S. Modified lip repositioning: A surgical approach to treat the gummy smile. J Indian Soc Periodontol. 2015;19(3):356.
• 17. Aly LA, Hammouda N. 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. Dent Res J (Isfahan). 2017;13(6):478.
• 18. Andijani RI, Tatakis DN. Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile. J Periodontol. 2019;90(3):256–62.
• 19. Rubinstein AM KA. Cosmetic surgery for the malformation of the laugh: Original technique in Spanish. Prensa Med Argent. 1973;60:952. 20. Iqbal C, Nandakumar K, Padmakumar TP. Laser assisted treatment of excessive gingival display along with modified lip re-positioning. IOSR J Dent Med Sci Ver I. 2015;14(7):28–33.
• 21. Silva CO, Ribeiro-Júnior N V., Campos TVS, Rodrigues JG, Tatakis DN. Excessive gingival display: Treatment by a modified lip repositioning technique. J Clin Periodontol. 2013;40(3):260–5.
• 22. Ambrosio F, Gadalla H, Kapoor N, Neely AL, Kinaia BM. Lip Repositioning Procedure to Correct Excessive Gingival Display: A Case Report of Identical Twins. Clin Adv Periodontics. 2017;1–21.
• 23. Balasubramaniam AS, Reddy SR, Thomas LJ, Ramakrishnan T, Ambalavanan N. Surgical Lip Repositioning in Two Patients Undergoing Orthodontic Treatment, With Degree I Vertical Maxillary Excess and Short Hypermobile Upper Lip. Clin Adv Periodontics [Internet]. 2014;4(1):19–24.
• 24. Sánchez I, Gaud-Quintana S, Stern J. Modified Lip Repositioning with Esthetic Crown Lengthening: A Combined Approach to Treating Excessive Gingival Display. Int J Periodontics Restorative Dent. 2016;37(1):130–4.
• 25. Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofac Orthop. 2008;133(2):195–203.
• 26. Abdullah WA, Khalil HS, Alhindi MM, Marzook H. Modifying gummy smile: A minimally invasive approach. J Contemp Dent Pract. 2015;15(6):821–6.
• 27. 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. 2018;30(2):101-12
• 28. Üner DD, İzol BS, İpek F, Elbir M, Tosun B. Treatment Gummy Smile With A Lip Repositıoning Technique And Gingivectomy: A Case Report. J Dent Fac Atatürk Uni. 2015;10:25–9.
• 29. Sarver DM. The importance of incisor positioning in the esthetic smile: The smile arc. Am J Orthod Dentofac Orthop. 2001;120(2):98–111.
• 30. Hulsey CM. An esthetic evaluation of lip-teeth relationships present in the smile. Am J Orthod. 1970;57(2):132–44.
• 31. Fowler P. Orthodontics and orthognathic surgery in the combined treatment of an excessively “gummy smile”. N Z Dent J. 1999;95(420):53–4.
• 32. Simon Z, Sc M, Rosenblatt A, Dorfman W. Eliminating a Gummy Smile with Surgical Lip Repositioning. J Cosmet Dent. 2007;23:100–8.
• 33. Gabrić Pandurić D, Blašković M, Brozović J, Sušić M. Surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognathic surgery. J Oral Maxillofac Surg. 2014;72(2):404-11.
• 34. Ashtaputre V. Smile Enhancement by Lip Repositioning Surgery: A case report. Am J Esthet Dent. 2012;2(4):162–70.