Maxillary exostoses as contributing etiology to lip hypermobility and associated excessive gingival display: A...

Several etiologies may contribute to the development of excessive gingival display (EGD). However, little, if any, consideration has been given to the potentially significant role of prominent buccal maxillary exostoses (BMEs) in EGD etiology. Therefore, the aim of this report was to highlight the contribution of BMEs to EGD. Two patients complaining of EGD were evaluated, and BMEs were found associated with a hypermobile upper lip, vertical maxillary excess, and altered passive eruption. Both patients received esthetic crown lengthening (ECL) as the first surgical intervention. The BMEs were removed by osteoplasty performed during ECL. The resulting smile and EGD changes were evaluated 3 to 6 months postoperatively. An extraordinary amount of gingival display reduction was found in both patients (8 mm and 6 mm), a highly atypical outcome for ECL alone. BME removal on its own represented 75% and 67% of the EGD decrease, respectively. The exostoses removal-associated EGD decreases corresponded to observed reductions in lip mobility during smile. Sizeable BMEs can contribute significantly to the etiology of EGD, in part through an effect on lip mobility during smile. Proper management of such BMEs through osteoplasty provides meaningful EGD reduction, resulting in improvements of smile esthetics and patient satisfaction.