Aesthetic crown lengthening: periodontal and patient‐centred outcomes

Silva, Cléverson O.; Soumaille, Jéssica M. S.; Marson, Fabiano Carlos; Progiante, Patrícia Saram; Tatakis, Dimitris N.

doi:10.1111/jcpe.12482

Cited by 31 publications

(31 citation statements)

References 19 publications

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“…The latter could vary significantly from patient to patient because EGD may be caused by several etiologies including altered passive eruption (APE), plaque‐/drug‐induced gingival enlargement, anterior dentoalveolar extrusion, vertical maxillary excess, hypermobile upper lip (HUL), short upper lip, and asymmetric upper lip . The treatment modalities indicated comprise a wide range of less or more invasive procedures, including aesthetic crown lengthening, lip repositioning, orthognathic surgery and orthodontics, and other surgical and nonsurgical options – …”

Section: Introductionmentioning

confidence: 99%

Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile

Andijani

Tatakis

2018

Journal of Periodontology

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Background Excessive gingival display (EGD), or a gummy smile (GS), is a mucogingival deformity that can be of concern to patients. The prevalence of GS etiologies, such as altered passive eruption (APE) and hypermobile upper lip (HUL), has not been reported. The aim of this study was to assess the prevalence of APE and HUL in patients seeking to correct their GS, and to determine possible prevalence differences among patients with different gingival display (GD) levels. Methods During clinical screening of patients interested in participating in a GS treatment study, GD diagnosis, GD level, and presence of APE and/or HUL were determined. Descriptive statistics were calculated for APE, HUL, and GD group prevalence. Fisher's exact test was used to determine difference in frequency of etiologies between GD groups. Results Fifty‐six patients were clinically screened (27.2 ± 7.2 years old; 85.7% females; 94.6% with GD, 5.4% without GD). Among patients having GD, 75.5% presented with GD≥4 mm and 24.5% with GD<4 mm. Prevalence of etiologies was: 20.8% APE alone, 45.3% HUL alone, and 34% APE and HUL. The prevalence difference between GD≥4 mm and GD<4 mm groups was statistically significant (p<0.0001); for ≥4 mm GD: 5% presented with APE alone, 50% HUL alone, and 45% APE and HUL; for <4 mm GD: 69.2% presented with APE alone and 30.8% HUL alone. Conclusion Among patients seeking GS treatment, HUL is the most predominant etiology and it is often present in combination with APE.

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Section: Introductionmentioning

confidence: 99%

Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile

Andijani

Tatakis

2018

Journal of Periodontology

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“…The second area, “aesthetic effect” includes three items (items 1, 3, 4), actually involving aesthetic concerns. Patients with periodontal aesthetic problems have lower satisfaction scores (Silva, Soumaille, Marson, Progiante, & Tatakis, ). There is a positive relationship between periodontal aesthetics and satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with periodontal aesthetic problems have lower satisfaction scores (Silva, Soumaille, Marson, Progiante, & Tatakis, 2015).…”

Section: Discussionmentioning

confidence: 99%

Development and validation of the periodontal aesthetic perception scale in patients with periodontal problems

Göktürk

Yarkac

Başol

2018

J Clinic Periodontology

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“…Esthetic CLS, to correct dentogingival discrepancies arising from altered passive eruption, and LRS, to address upper lip hyperactivity, were performed sequentially. Sequencing of these procedures is important, because it is possible to reduce or completely resolve EGD by CLS alone; 5 therefore, in cases of altered passive eruption, the potentially remaining need for LRS should be reassessed after CLS. Although possible in select cases, performing both procedures simultaneously could result in technical difficulties (lack of fixed gingival tissue for anchorage of LRS flap).…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Altered passive eruption, often a cause of EGD, can be corrected by crown lengthening surgery (CLS), achieved through gingivectomy or an apically positioned flap with or without ostectomy depending on gingival width and alveolar bone crest location relative to the cemento-enamel junction (CEJ). 2,5 When hyperactive upper lip is the underlying EGD etiology, 2 either non-surgical (botulinum toxin injections) 6 or surgical approaches can be used for treatment. Among surgical approaches, lip repositioning surgery (LRS) can reduce lip mobility during smiling and minimize gingival exposure.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Gummy Smile of Multifactorial Etiology: A Case Report

Gibson

Tatakis

2017

Clin Adv Periodontics

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Introduction: This case report describes the management of a patient diagnosed with excessive gingival display caused by altered passive eruption and hyperactive lip. Treatment for this patient was staged and included esthetic crown lengthening and a subsequent lip repositioning procedure. Case Presentation: A 17‐year‐old female was referred for assessment of a “gummy smile.” The patient reported a history of mouth breathing and a sports injury causing a non‐vital tooth #9, which had been temporarily restored. After periodontal evaluation, the patient was diagnosed with plaque‐induced gingivitis and excessive gingival display due to hyperactive lip and altered passive eruption. After initial therapy, an esthetic crown lengthening procedure was performed on the maxillary anterior sextant, resulting in ideal maxillary anterior crown contours. Six weeks after esthetic crown lengthening, the patient was treated for hyperactive lip by a modified lip repositioning surgery. Subsequently, the patient received a permanent restoration on tooth #9. During the 1.5‐year follow‐up time the patient repeatedly expressed her satisfaction with the improvement of her smile. Persistent mouth breathing and associated recurrent gingival inflammation remained a challenge. Conclusions: The presented case illustrates results of sequentially applied techniques for management of a gummy smile of multifactorial etiology and limitations imposed by unresolved factors. Excessive gingival display can be a significant esthetic concern for patients. Understanding the etiology can be challenging due to multiple factors that may be concomitantly involved. Accurate diagnosis and treatment planning are critical for proper management. When multifactorial etiology is present, multiple treatment modalities, including various surgical approaches, are necessary to obtain positive outcomes in such patients.

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Aesthetic crown lengthening: periodontal and patient‐centred outcomes

Abstract: Aesthetic crown lengthening surgery results in high levels of patient satisfaction and predictable and stable outcomes in the short term.

Cited by 31 publications

References 19 publications

Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile

Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile

Development and validation of the periodontal aesthetic perception scale in patients with periodontal problems

Treatment of Gummy Smile of Multifactorial Etiology: A Case Report

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