A stepwise approach to the correction of excessive gingival display: an integrative review of the literature

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Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine

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VOLUME 36 , ISSUE 2 (November 2020) > List of articles

A stepwise approach to the correction of excessive gingival display: an integrative review of the literature

Yi-Jun Hung / I-Ping Lin / Szu-Han Wang / Eddie Hsiang-Hua Lai *

Citation Information : Australasian Orthodontic Journal. Volume 36, Issue 2, Pages 184-194, DOI: https://doi.org/10.21307/aoj-2020-021

License : (CC BY 4.0)

Published Online: 20-July-2021

ARTICLE

ABSTRACT

Background: Excessive gingival display is an aesthetic concern for patients and a challenge for clinicians. An accurate diagnosis is essential in order to provide effective treatment.

Aim: The aim of the present article is to fill a gap in the current literature by providing clinicians with an overview and a stepwise approach to assessing gingival excess, as well as reviewing possible treatment.

Method: Published articles related to smile aesthetics and excessive gingival display over the last 40 years were identified and analysed through an electronic search.

Results: An examination should be initiated extra-orally to distinguish contributing skeletal factors. The relationships of four aesthetic parameters (LIPG): lip length (L), incisal lines (I), tooth proportions (P), and gingival lines (G), should be examined individually to determine other possible causes of gingival excess. Contributing factors may include a short or hypermobile upper lip, dentoalveolar extrusion, or altered passive eruption. Further investigation to identify patients who might benefit from orthognathic surgery, orthodontic treatment alone, lip repositioning or botulinum injection, or aesthetic crown lengthening procedures, should be conducted to reconfirm a diagnosis and provide the optimal treatment.

Conclusion: Clinicians can have a dental blueprint for anterior tooth reconstruction and are able to provide comprehensive treatment in co-operation with other disciplines. By understanding the principles of an aesthetic smile line, the aetiology of an excessive gingival display and treatment concepts, clinicians may provide alternative treatments to avoid extensive surgical procedures while achieving acceptable outcomes.

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REFERENCES

1. Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000 1996;11:18-28.

2. Hulsey CM. An esthetic evaluation of lip-teeth relationships present in the smile. Am J Orthod 1970;57:132-44.

3. Tjan AH, Miller GD, The JG. Some esthetic factors in a smile. J Prosthet Dent 1984;51:24-8.

4. Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am 1988;32:307-30.

5. Hunt O, Johnston C, Hepper P, Burden D, Stevenson M. The influence of maxillary gingival exposure on dental attractiveness ratings. Eur J Orthod 2002;24:199-204.

6. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod 1992;62:91-100.

7. Bynum J. Treatment of a “Gummy Smile”: understanding etiology is key to success. Compend Contin Educ Dent 2016;37:114-22.

8. Kokich VO Jr, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 1991;11:311-24.

9. Diamond O. Facial esthetics and orthodontics. J Esthetic Dent 1996;8:136-43.

10. Waldrop TC. Gummy smiles: The challenge of gingival excess: Prevalence and guidelines for clinical management. Semin Orthod 2008;14:260-71.

11. Moura D, Lima E, Lins R, Souza R, Martins A, Gurgel B. The treatment of gummy smile: integrative review of literature. Rev Clín Periodoncia Implantol Rehabil Oral 2017;10:26-8.

12. Silberberg N, Goldstein M, Smidt A. Excessive gingival display- -etiology, diagnosis, and treatment modalities. Quintessence Int 2009;40:809-18.

13. Wu H, Lin J, Zhou L, Bai D. Classification and craniofacial features of gummy smile in adolescents. J Craniofac Surg 2010;21:1474-9.

14. Bhola M, Fairbairn P, Kolhatkar S, Chu SJ, Morris T, Campos MD. LipStaT: The lip stabilization technique-indications and guidelines for case selection and classification of excessive gingival display. Int J of Periodontics Restorative Dent 2015;35:549-59.

15. Fradeani M. Evaluation of dentolabial parameters as part of a comprehensive esthetic analysis. Eur J Esthet Dent 2006;1:62-9.

16. Ahmad I. Anterior dental aesthetics: dentofacial perspective. Br Dent J 2005;199:81-8.

17. Silva CO, Ribeiro-Júnior NV, Campos TV, Rodrigues JG, Tatakis DN. Excessive gingival display: treatment by a modified lip repositioning technique. J Clin Periodontol 2013;40:260-5.

18. Robbins JW. Differential diagnosis and treatment of excess gingival display. Pract Periodontics Aesthet Dent 1999;11:265-72.

19. Foley TF, Sandhu HS, Athanasopoulos C. Esthetic periodontal considerations in orthodontic treatment--the management of excessive gingival display. J Can Dent Assoc 2003;69:368-72.

20. Brindis MA, Block MS. Orthodontic tooth extrusion to enhance soft tissue implant esthetics. J Maxillofac Oral Surg 2009;67:49-59.

21. Desai S, Upadhyay M, Nanda R. Dynamic smile analysis: changes with age. Am J Orthod Dentofacial Orthop 2009;136:310.e1-10.

22. Vig RG, Brundo GC. The kinetics of anterior tooth display. J Prosthet Dent 1978;39:502-4.

23. Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973;29:358-82.

24. Magne P, Gallucci GO, Belser UC. Anatomic crown width/length ratios of unworn and worn maxillary teeth in white subjects. J Prosthet Dent 2003;89:453-61.

25. Rossi R, Benedetti R, Santos-Morales RI. Treatment of altered passive eruption: periodontal plastic surgery of the dentogingival junction. Eur J Esthet Dent 2008;3:212-23.

26. Black GV. Descriptive anatomy of the human teeth. 4thedn. Wilmington Dental Manufacturing Co, 1897.

27. Sterett JD, Oliver T, Robinson F, Fortson W, Knaak B, Russell CM. Width/length ratios of normal clinical crowns of the maxillary anterior dentition in man. J Clin Periodontol 1999;26:153-7.

28. Chu SJ. Range and mean distribution frequency of individual tooth width of the maxillary anterior dentition. Pract Proced Aesthet Dent 2007;19:209-15.

29. Wheeler RC. Wheeler’s atlas of tooth form. 5th ed. Philadelphia: WB Saunders, 1984;136-8.

30. Chu SJ, Tan JH, Stappert CF, Tarnow DP. Gingival zenith positions and levels of the maxillary anterior dentition. J Esthet Restor Dent 2009;21:113-20.

31. Levine RA, McGuire M. The diagnosis and treatment of the gummy smile. Compend Contin Educ Dent 1997;18:757-62, 764.

32. Townsend CL. Resective surgery: An esthetic application. Quintessence Int 1993;24:535-42.

33. Hichijo N, Furutani M, Kuroda S, Tanaka E. Excessive gingival display treated with 2-piece segmental Le Fort I osteotomy: A case report. J Am Dent Asso 2019;150:58-68.

34. Ambrosio F, Gadalla H, Kapoor N, Neely NL, Kinaia BM. Surgical lip repositioning procedure to correct excessive gingival display: a case report of identical twins. Clin Adv Periodontics 2018;8:48-53.

35. Dolt AH 3rd, Robbins JW. Altered passive eruption: an etiology of short clinical crowns. Quintessence Int 1997;28:363-72.

36. Camargo PM, Melnick PR, Camargo LM. Clinical crown lengthening in the esthetic zone. J Calif Dent Assoc 2007;35:487- 98.

37. Rubinstein A, Kostianovsky A. Cosmetic surgery for the malformation of the laugh: original technique. Prensa Med Argent 1973;60:952-4.

38. Simon Z, Rosenblatt A, Dorfman W. Eliminating a gummy smile with surgical lip repositioning. The Journal of Cosmetic Dentistry 2007;23:102-9.

39. Jacobs PJ, Jacobs BP. Lip repositioning with reversible trial for the management of excessive gingival display. Int J of Periodontics Restorative Dent 2013;33:169-75.

40. Ishida HL, 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;126:1014-9.

41. Miskinyar SA. A new method for correcting a gummy smile. Plast Reconstr Surg 1983;72:397-400.

42. Alammar A, Heshmeh O, Mounajjed R, Goodson M, Hamadah O. A comparison between modified and conventional surgical techniques for surgical lip repositioning in the management of the gummy smile. J Esthet Restor Dent 2018;30:523-31.

43. Jananni M, Sivaramakrishnan M, Lobby TJ. Surgical correction of excessive gingival display in class I vertical maxillary excess: mucosal strip technique. J Nat Sci Biol Med 2014;5:494-8.

44. Polo M. Commentary on: Botulinum toxin for the treatment of excessive gingival display: a systemic review. Aesthet Surg J 2016;36:89-92.

45. Suber JS, Dinh TP, Prince MD, Smith PD. OnabotulinumtoxinA for the treatment of a “Gummy Smile”. Aesthet Surg J 2014;34:432-7.

46. Al-Fouzan AF, Mokeem LS, Al-Saqat RT, Alfalah MA, Alharbi MA, Al-Samary AE. Botulinum Toxin for the Treatment of Gummy Smile. J Contemp Dent Pract 2017;18:474-8.

47. Klein AW, Mantell A. Electromyographic guidance in injecting Botulinum Toxin. Dermatol Surg 1998;24:1184-6.

48. Nasr MW, Jabbour SF, Sidaoui JA, Haber RN, Kechichian EG. Botulinum toxin for the treatment of excessive gingival display: a systematic review. Aesthet Surg J 2016;36:82-8.

49. Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS et al. Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle orthod 2009;79:70-7.

50. Mostafa D. A successful management of severe gummy smile using gingivectomy and Botulin toxin injection: A case report. Int J Surg Case Rep 2018;42:169-74.

51. Patel DP, Mehta F, Thakkar SA, Suthar JR, Verma S. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Indian Journal of Basic and Applied Medical Research 2014;3:237-44.

52. Kane MA. The effect of botulinum toxin injections on the nasolabial fold. Plast Reconstr Surg 2003;112:66-72S.

53. Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan 1977;70:24-8.

54. Cairo F, Graziani F, Franchi L, Defraia E, Pini Prato GP. Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. Int J Dent 2012;2012:837658.

55. Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontol 2000 2018;77:65-83.

56. Zucchelli G. Altered passive eruption. In: Mucogingival esthetic surgery. 1st edn. Quintessence Publishing 2013;29:749-93.

57. Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dentogingival junction in humans. J Periodontol 1961;32:261-7.

58. Nevins M, Skurow HM. The intracrevicular restorative margin, the biologic width, and the maintenance of the gingival margin. Int J Periodontics Restorative Dent 1984;4:30-49.

59. Lanning SK, Waldrop TC, Gunsolley JC, Maynard JG. Surgical crown lengthening: evaluation of the biological width. J Periodontol 2003;74:468-74.

60. Perez JR, Smukler H, Nunn ME. Clinical evaluation of the supraosseous gingivae before and after crown lengthening. J Periodontol 2007;78:1023-30.

61. Pavone AF, Ghassemian M, Verardi S. Gummy smile and short tooth syndrome––Part 1: etiopathogenesis, classification, and diagnostic guidelines. Compend Contin Educ Dent 2016;37:102-7.

62. Marzadori M, Stefanini M, Sangiorgi M, Mounssif I, Monaco C, Zucchelli G. Crown lengthening and restorative procedures in the esthetic zone. Periodontol 2000 2018;77: 84-92.

63. Claman L, Alfaro MA, Mercado A. An interdisciplinary approach for improved esthetic result in the anterior maxilla. J Prosthet Dent 2003;89:1-5.

64. Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M et al. Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol 2014;85:536-44.

65. Brägger U, Lauchenauer D, Lang NP. Surgical lengthening of the clinical crown. J Clin Periodontol 1992;19:58-63.

66. Volchansky A, Cleaton-Jones P. The position of the gingival margin as expressed by clinical crown height in children aged 6-16 years. J Dent 1976;4:116-22.

67. Morrow LA, Robbins JW, Jones DL, Wilson NH. Clinical crown length changes from age 12-19 years: a longitudinal study. J Dent 2000;28:469-73.

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