Lip repositioning surgery: A pioneering technique for perio-esthetics

Abstract

In our esthetic conscious society people are now demanding all types of treatments possible to have a pleasing and attractive personality. A dazzling and beautiful smile can work wonders for anyone's personality. Our smile mirrors our persona, our unique being. However, a beautiful smile comprises of a perfect balance of the white and pink. This imbalance of excessive gingival display (EGD) can be managed by a variety of treatment modalities, depending on accurate diagnosis. This case report demonstrates the successful management of EGD with a lip-repositioning procedure in a patient with incompetent short upper lip. This was accomplished by removing a partial thickness strip of mucosa from the maxillary buccal vestibule and suturing the lip mucosa to the mucogingival line. This resulted in a narrower vestibule and restricted muscle pull, thereby resulting in competent lips and reduced gingival display during smiling.

Effectiveness of Different Modalities of Lip Repositioning Surgery for Management of Patients Complaining of Excessive Gingival Display: A Systematic Review and Meta-Analysis

“…Case series and case reports were the most retrieved articles, and there were a limited number of well-designed studies. Some of the case series and most of the case reports reported subjective gingival display reduction without an exact measurement of pre- or postoperative gingival display [ 10 , 30 , 32 , 34 , 36 , 39 , 40 , 42 , 44 , 47 , 49 , 53 , 54 , 58 ]. In the current study, there is lack of sufficient evidence in each modality in order to obtain conclusive results about the gingival display change from baseline to 3, 6, and 12 months after surgery.…”

“…However, we did not find any established definition for complete relapse or stability of the results for each patient who undergone LRS. For a number of studies, the stability of the results was not defined by the authors; nevertheless, in the result section, the treatment outcome was reported as stable [ 12 , 36 , 39 , 40 , 42 , 46 , 51 – 56 , 58 ]. Therefore, stability and complete relapse outcomes in the current study were defined based on the judgment of the experts (NM and SY).…”

“…However, it has not been mentioned in the latter studies [ 23 , 25 , 27 ]. Other methods have been used to prevent the risk of relapse are advancing the flap to remove the flap tension [ 36 , 39 , 40 , 58 ] and using periosteal fenestration and extraoral tissue stabilization tapes to accelerate the process of scar formation during healing phase [ 31 ].…”

Comparison of Two Botulinum Toxin Injection Methods for Treatment of Excessive Gingival Display

“…7 These invasive interventions aim at reducing the gingival display during smiling to 2 mm or less, they are not accompanied with major complications, although there is some frequency of relapse. 8 A less invasive approach is by botulinum toxin (BT) injection, which is reported to be a reliable, reproducible and safe method. 9 Botulinum toxin injection is indicated when the main cause of EGD is muscular hypermobility even in association with other causes as most patients opt for the least invasive procedure, also BT injection can be used as a complement to other definitive treatment methods.…”

“…The upper lip muscular hyperfunction is managed with various surgical techniques that include vestibular mucosa resection, myectomy with levator muscles partial resection and subperiosteal dissection of levator muscles 7 . These invasive interventions aim at reducing the gingival display during smiling to 2 mm or less, they are not accompanied with major complications, although there is some frequency of relapse 8 . A less invasive approach is by botulinum toxin (BT) injection, which is reported to be a reliable, reproducible and safe method 9 …”