Introduction:The case report presents a new possibility of treatment for a gummy smile in a patient with multiple etiologies, such as altered passive eruption and hypermobility upper lip. At first, crown lengthening was not sufficient to achieve the desired aesthetic result, being necessary its combination with lip repositioning. Case Presentation: Crown lengthening surgery (CLS) was performed in a 20year-old woman, with a gingival display of 7.5 mm, having her gingival exposure reduced to 5.5 mm. Because the patient continued unsatisfied after 6 months, a new procedure was adopted. To reduce even more her gingival exposure, lip repositioning technique was performed associated with myotomy and the insertion of polyester threads as a physical barrier to prevent relapse. Conclusion:The result of the gingival display was reduced to 2.5 mm, removing the condition of a gummy smile after the combination of both techniques: crown lengthening, and lip repositioning.
A new technique is proposed in this study to correct the gummy smile (GS) with myotomy, combining lip repositioning with the insertion of polyester threads at the surgical site to act as a physical barrier and control relapse. 11 patients were clinically assessed (30.2 ± 7.43 years old, 90.9% females and 9.10% males). All patients presented gingival display (GD) greater than 4 mm. Hypermobile upper lip (HUL), vertical maxillary excess (VME) + HUL, altered passive eruption (APE) + HUL, and VME + APE were the etiologies identified. Three polyester threads were inserted in each patient one month after the surgery. The GS was measured before, 6 months, and 12 months after the surgery. The results showed a reduction in the mean GD of the patients, 4.42 mm after 6 months ( p value = 0.000) and 4.13 mm after 12 months ( p value = 0.000). The largest relapse was 0.29 mm and was not statistically significant ( p value = 0.07). The Friedman test with pairwise comparisons was used to determine the existence of statistically significant differences in GD between the periods analyzed. The results showed that the proposed technique was successful in treating GS, presenting significant reductions in the GD 12 months after surgery and controlling the relapse.
Introdução: O sorriso gengival é caracterizado pela excessiva exposição de gengiva durante o sorriso, podendo comprometer a harmonia da face. A técnica de reposicionamento labial cirúrgico, um método consagrado na cirurgia plástica reconstrutiva no campo médico, foi proposta para reduzir a parte interna da mucosa do lábio superior, limitando o livre movimento muscular, que é responsável pela exposição. Diante da instabilidade e morbidade da técnica tradicional da miectomia, surgiram os espaçadores aloplásticos (silicone) ou autógenos (cartilagem), para melhorar a estabilidade pós-cirúrgica. Para a abordagem do reposicionamento labial, destaca-se o fio de poliéster, um multifilamento trançado disponível em formas planas e revestidas. Objetivo: O objetivo do presente relato clínico foi apresentar uma nova técnica de reposicionamento labial com a utilização de fio de poliéster como barreira física para sustentar a estabilidade tecidual do procedimento combinado de reposicionamento com a miectomia. Conclusão: Os resultados e os benefícios clínicos alcançados permitem afirmar que a abordagem proposta se mostrou menos invasiva, com resultados estéticos satisfatórios e sem complicações ou recidiva pós-operatória.
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