Craft the Gummy Smile with Lip Repositioning

1Gummy smile” is a major concern for a large number of patients visiting the dentist. Esthetics has now become an integral part of periodontal treatment plan. This case is of a of a 26 yr old male who walked into Denty’sVikrampuri with the complaint of excessive gingival display wherein which esthetic correction was achieved through periodontal plastic surgical procedure called Lip repositioning. The patient being singer, esthetics and time were the major factors to be considered.

Possible etiology for the gingival display can be movement of the upper lip in apical direction when the patient smiles exposing the dentition and excessive gingiva. In this condition, surgical lip repositioning treatment was performed to reduce the labial retraction of the elevator smile muscles and minimize excessive gingival displayobjective of lip repositioning surgery is surgical correction of unaesthetic gummy smile by limiting the retraction of the elevator smile muscles (zygomaticus minor, levatoranguli, orbicularis oris and levatorlabiisuperioris) resulting in a narrow vestibule and restricted muscle pull thereby reducing gingival display during smiling.

The surgical area was outlined using an indelible pencil; Markings bilaterally has to be uniformas this might change the smile curve. The procedure was initiated with a 15 no Bard-Parker blade by giving a partial-thickness incision following the mucogingival junction extending from right first premolar (14) to left first premolar (24). Followed by the first incision, another second horizontal incision parallel to first was made in the labial mucosa 10-12 mm apical to mucogingival junction.

These two incisions were connected at each end by creating an elliptical pattern. The partial-thickness flap was excised leaving the underlying connective tissue exposed to the oral cavity. Delicate partial thickness flap to handle during the procedure was a challenge as any negligence could ruin the whole procedure.

The amount of partial-thickness flap excised should be either double the amount of gingival display that needs to be reduced or a maximum of 10-12 mm tissue excision in order to prevent the involvement of labial minor salivary glands severing of which may lead to the formation of mucocele.Parallel incised margins were approximated with an interrupted stabilization suture using Vicryl at the midline to ensure proper alignment of the midline of the lip with that of the teeth. This technique holds importance that dental esthetic procedure has taken Periodontics to a different level other than in the improvement of oral health

Team involved Dr. Priyanka, Dr. Sukhvinder Bindra

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