Surgical Procedures Reducing Excessive Gingival Display in Gummy Smile Patients With Various Etiologic Backgrounds

Gummy smile (GS) is an esthetic issue which causes a person to show a larger than average amount of gum tissue when smiling. Lip repositioning procedure is a surgical treatment option performed by removing a partial thickness strip from the maxillary buccal vestibular mucosa and suturing back the lip mucosa to the mucogingival line. High rate of relapse has been recorded with this procedure. In this study, different treatment options were applied according to the etiology and clinical background of each individual case in an attempt to overcome relapse. Furthermore, modification of the conventional lip repositioning procedure and the clinical outcome of this technique will be demonstrated in this report.

Among the four selected patients who requested correction of their GS, the amounts of gingival display (GD) measured using digital Vernier were from 5 to 7 mm. Clinical examination revealed variation in the length of the clinical crowns, and vestibular depth and width of keratinized gingiva. Since the causes of their GS were different, different surgical modalities were applied to address GS in this case series. The procedures were gingivectomy, osteoplasty, and modification of lip repositioning procedure performed by removing a partial thickness ribbon of the keratinized attached gingiva and then suturing the labial alveolar mucosa to the attached gingiva at a level more coronal to its previous position.

One-year follow-up showed that all these surgical procedures reduced excessive GD by 2 mm without relapse and the patients were satisfied with the esthetic outcome.