Lip repositioning with or without myotomy: a systematic review

Abstract

Excessive gingival display is an esthetic issue that is commonly managed by different procedures. Lip repositioning is a modality to address concerns of affected patients. The aim of this review was to investigate the scientific evidence on outcomes and long-term stability of lip repositioning surgery with or without myotomy. The electronic search was conducted in three databases: MEDLINE, Embase, and the Cochrane Library up to October 2019. No publication status, language, or time restrictions were applied. The electronic search was complemented by a manual search of the reference lists. Three hundred thirty-eight studies were screened by title, and 16 articles remained for data extraction. The included studies assessed the lip repositioning procedure in 144 patients aged between 15-59 years (134 females and 10 males). Based on the available data, lip repositioning with myotomy/muscle containment can be a successful treatment for minor discrepancies in gingival display in selected cases. However, further well-organized controlled clinical trials are recommended to derive a conclusion about the long-term stability compared with other alternatives.

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

“…To avoid encountering substantial heterogeneity among studies, the current study is aimed at evaluating various modalities of LRS and comparing them with each other. The previous systematic reviews did not consider this important issue [ 14 – 16 ].…”

“…As expected, the overall findings of the current systematic review and meta-analysis were consistent with previous meta-analyses. However, those studies did not focus on the modalities [ 14 – 16 ]. In our study, the amount of gingival display reduction differed in various modalities.…”

“…In our study, the amount of gingival display reduction differed in various modalities. Furthermore, we excluded those studies with adjunctive treatments to LRS; however, this issue was not considered in the previous meta-analyses [ 14 – 16 ].…”

“…Thus, due to the lack of data, it was not possible to conclude about the success rate of LRS in each modality and to compare between each two modalities. None of the previous systematic reviews considered the success rate of treatment as an outcome [ 14 – 16 ].…”

“…Another systematic review in 2020 evaluated the short- and long-term gingival display reduction and focused on the comparison between LRS with and without myotomy [ 15 ]. Furthermore, the recently published systematic review in 2021 assessed the 6-month gingival display reduction in the patients who undergone LRS with or without myotomy [ 16 ]. Noteworthy, LRS comprises several important tasks including frenectomy (yes/no), flap thickness (full/partial), and myotomy (yes/no), and all these tasks can influence the outcomes of the surgery.…”