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

Abstract

Soft tissue cephalometric profile of patients with gingival smile associated or not with vertical maxillary excess Gummy smile (GS) is defined by the excessive exposure of gingiva (≥3 mm) during smile. Its etiology may be related to varying factors, including inflammatory gingival hyperplasia, altered passive or active eruption (APE/AAE), vertical maxillary excess (VME), short upper lip length or hypermobility of upper lip. Treatment is related to the cause and can vary from orthognathic surgery to esthetic crown lengthening and application of botulinic toxin. In spite of that, there is no well-defined clinical protocol for the diagnosis of GS in literature. The aim of this study is to investigate the clinical and tomographic parameters associated to the etiology of GS, aiming at the establishment of a clinical diagnostic protocol. Twenty five patients aged 18-42 (28,77 ± 6,56) years, 23 women and 2 men, systemically healthy, diagnosed with GS were included. All participants have answered health questionnaire and were periodontally examined according to probing depth (PD), clinical attachment level (CAL), gingival thickness (GT), width of keratinized gingiva (WKG), gingival bleeding index (GBI) and plaque index (Pl). Extra and intra-oral photographs were obtained for digital analysis of the smile and soft tissue cephalometric analysis. Cone-beam computerized tomography (CTCB) were obtained from upper anterior region to investigate distance from gingival margin (GM) to cementum-enamel junction (JCE), JCE to alveolar crest (AC), osseous thickness at 1 (OT1), 3 (OT3) and 5 (OT5) mm from alveolar crest (AC) and gingival thickness (CBCT_GT). Participants were divided in groups according to GS etiology: APE/AAE (n= 12), VME (n= 8) or combination (COMB; n= 5). Mean gingival exposure on smile was 4,2 ± 2,44mm. Seventeen (68%) participants showed >3mm of gingival exposition, and in 22 cases (88%) there was a continuous band of gingiva exposed during smile. Patients with VME associated or not to APE/AAE showed greater height of middle and inferior facial thirds, length of upper lip in rest (ULR) or during smile (UPS), thickness of vermillion and height of anterior maxillae