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

Abstract

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.

Lip Repositioning with Myotomy- A Surgical Approach to Treat Gummy Smile

“…And it is often present in combination with other etiological factors. 26 In the present case HUL along with a moderate amount of vertical maxillary excess resulted in excessive display of the gingiva during smiling.…”

Dudağın Yeniden Konumlandırılması Operasyonu Dişeti Gülümsemesi Tedavisinde Gerçekten Etkili Mi?

“…(9) Orthognathic surgery (10), botulinum toxin application on the muscles that regulate smiling (11), myotomy (12,13), gingivectomy (14) and lip repositioning (15)(16)(17) are methods that are used in GS treatment. A study on patients with complaints of GS reported that hypermobile upper lip syndrome was the most dominant etiological factor that led to GS by itself in approximately 45.3% of the patients and alongside passive eruption in approximately 34% of patients (18). Lip repositioning (LR) operation, which aims to reduce the amount of gingival visibility by restricting the movements of the muscles that lift the lip in treatment of GS caused by hypermobile upper lip, was performed for the first time in 1973 by Rubinstein (19).…”

Perfil cefalométrico de tecido mole de pacientes portadores de sorriso gengival associado e não associado a excesso vertical de maxila

“…Uma das principais queixas estéticas dos pacientes é o chamado sorriso gengival, que se caracteriza especialmente por exposição excessiva de gengiva no sorriso. Diferentes fatores estão envolvidos na etiologia do SG, sendo os principais: excesso vertical de maxila, erupção passiva e/ou ativa alterada, comprimento curto do lábio superior, hipermobilidade do lábio superior e, em alguns casos, hiperplasia gengival inflamatória e/ou hereditária (WU et al 2010;HUMAYUN 2010;CHU et al 2012;MIRON et al 2012;BHOLA et al 2015, BYNUM 2016ANDIJANI et al 2018). Embora os estudos reconheçam que a etiologia do sorriso gengival é multifatorial e apresentem propostas para a realização do diagnóstico e plano de tratamento associado à causa (TJAN et al 1984;GARBER, SALAMA 1996;DONG et al 1999;CHU et al 2004;MONACO et al 2004;AHMAD 2005;SABRI 2005;ZACHRISSON 2008;MIRON et al 2012;BHOLA et al 2015;BYNUM 2016;PAVONE et al 2016), nenhum deles apresenta um protocolo clínico e/ou de diagnóstico por imagens que seja capaz de identificar o principal fator etiológico do sorriso gengival, sendo este o objetivo primário deste estudo visto que, para se atingir resultados de tratamento satisfatórios para o paciente e para o profissional, é necessário primeiramente determinar a causa (BHOLA et al 2015;BYNUM 2016;PAVONE et al 2016).…”

“…A exposição de mais de 3mm de gengiva é apontada como pouco atrativa pela maioria dos profissionais e pacientes (KERNS et al 1997;KOKICH et al 1999;FLORES-MIR et al 2004;GERON, ATALIA 2005;IOI et al 2010). A exposição gengival excessiva durante o sorriso ("gummy smile" ou "sorriso gengival") é um problema estético que afeta mais mulheres do que homens, com prevalência de aproximadamente 10,5% da população na faixa etária de 20 a 30 anos, sendo 2 vezes mais frequente em mulheres do que em homens (TJAN et al 1984;RISGBEE et al 1988;PECK et al 1992;DONG et al 1999;ANDIJANI et al 2018 ).…”

“…erupção passiva e ativa alteradas (EPA/EAA), excesso vertical de maxila (EVM), comprimento curto do lábio superior, hipermobilidade do lábio superior, hiperplasia gengival inflamatória e extrusão dentoalveolar anterior (EVIAN et al 1993;GARBER, SALAMA 1996;DOLT, ROBBIN 1997;SABRI 2005;SILBERBERG et al 2009;MIRON et al 2012;BHOLA et al 2015;PAVONE et al 2016;ANDIJANI et al 2018).…”