engleski

Laser-assisted surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognathic surgery

INTRODUCTION Excessive gingival display (EGD), commonly termed gummy smile, is a condition when there is an overexposure of the maxillary gingiva during smile, in severe cases the overexposure is present in repose of mouth and lips. The etiology of EGD is various. In the literature, different techniques have been reported for the treatment of the hyperactive upper lip. AIM The aim of presented clinical study was to evaluate the laser-assisted lip repositioning technique (LRS) in combination with laser gingivectomy for treatment of EGD in patients who refused orthognathic surgery. MATERIALS AND METHODS Three young female patients, with the chief complaint of „gummy smile“, reported dissatisfaction with the amount of gingiva exposed while smiling. During clinical evaluation, it was verified that up to 10 mm of gingiva was displayed during smile and normal upper lip lenght was found. The final diagnosis was excessive gingival display due to a combination of altered passive eruption, vertical maxillary excess and hyperactive upper lip. After the patient refused orthognathic surgical treatment, a modified lip repositioning technique and concomitant gingivectomy was proposed. The treatment plan consisted of reversible lip repositioning and definitive surgical repositioning. To begin the reversible lip repositioning, the proposed surgical incision lines was marked with the high power diode laser (LaserHF, Hager&Werken, Duisburg, Germany) set to a power of 1.5W, using a continuous (CW) mode and fiber with active diameter (core) of 320 µm. Finally, partial- thickness incisions using scalpel were made first across the superior border, then the inferior, connecting in the posterior molar area bilaterally. Frenectomy using high power diode laser (975µm, 4W, CW) was performed. Two strips of outlined mucosa were removed by a superficial split thickness dissection. After probing and marking using Crane- Kaplan pocket marker, gingivectomy in intercanine area was performed with high power diode laser (975µm, 3W, 10 ms, 1:2). Soft tissue bandage was applied over the whole surgical site. Periodic follow-ups were scheduled on 3., 5., 10. and 14. postoperative days, 3 months, and finally 6 months postoperatively. Gingival display at baseline was 5.5-10 mm and decreased significantly to 2 mm in medial line and zero in canine and molar region bilaterally. Patient’s postoperative satisfaction was evaluate using VAS. DISCUSSION AND CONCLUSION The lip repositioning technique is an excellent alternative to the more costly procedures with higher morbidity rate. Laser-assisted LRS might be a valid alternative for reduction of EGD caused by hyperactive or short upper lip.

oral surgery ; gummy smile ; laser ; treatment ; esthetics

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