Excessive gingival display: addressing multiple etiologies for optimal esthetic outcomes

Welcome Dear Guest

To create a new topic please register on the forums. For help contact : discussdentistry@hotmail.com

This topic has 2 replies, 1 voice, and was last updated 19/09/2012 at 9:33 am by drsushant.

Currently, there are 0 users and 1 guest visiting this topic.

Viewing 2 posts - 1 through 2 (of 2 total)

Author

Posts
19/09/2012 at 9:30 am #15935

drsushant
Offline
Registered On: 14/05/2011
Topics: 253
Replies: 277
Has thanked: 0 times
Been thanked: 0 times

In the case of the 25-year-old Asian (Filipina) woman pictured in Figs. 1 through 8, the primary etiologies were APE, HUL, and VME.

Fig. 1: Preoperative full-smile view showing excessive gingival display.

Fig. 2: Measurement of gingival display in smile showing 6.75 mm of visible attached gingiva.

For this patient, CL via a gingivectomy only was necessary to expose the cementoenamel junction (CEJ) as the osseous crest is 2 mm to 3 mm apical to the facial CEJ (Figs. 3 and 4).

Fig. 3: Intraoperative view after gingivectomy/-plasty, teeth Nos. 3 through 8.

Fig. 4: Post-gingivectomy/-plasty view, teeth Nos. 3 through 14.

An elliptical incision removes a partial-thickness segment of vestibular mucosa and contiguous attached gingiva in a 2:1 ratio (Figs. 5 and 6).

Fig. 5: Planned mucogingival incision outlined with marking pen.

Fig. 6: Mucogingival incision after excision of combined full and split-thickness flap.

19/09/2012 at 9:33 am #15936

drsushant
Offline
Registered On: 14/05/2011
Topics: 253
Replies: 277
Has thanked: 0 times
Been thanked: 0 times

The apical margin of the mucosa is advanced coronally and sutured to the coronal margin of the attached gingiva, reestablishing the mucogingival junction at a more coronal level (Fig. 7), and effecting a pronounced reduction in gingival display during smile (Fig. 8).

Fig. 7: Postoperative view (three weeks) after coronal advancement of mucosal flap margin.

Fig. 8: Three weeks postoperative smile view demonstrating pronounced reduction in gingival display (compare with Fig. 1).

When APE coexists with HUL and/or VME, combining this procedure with CL produces optimal results.

GS correction heralds significant esthetic dentistry milestones, allowing restorative dentists, periodontists, orthodontists, and oral surgeons to collaborate optimally in improving gummy smiles and changing people’s lives for the better.
Author

Posts