DR.

PRASANT ET AL: LIP REPOSITIONING April 5, 2020

Case report on Lip Repositioning : A boon for gummy

smile patients
Dr. MC Prasant*, Dr. Abin Varghese**, Dr. Deepa Davis***, Dr. Anuj Vyas**,
Dr. Sandesh Singh Chouhan**, Dr. Akankasha Chaurasia**

*Professor & Head, **Post-graduate Student – Dept. of Oral & Maxillofacial

Surgery, ***Post-graduate Student – Dept. of Conservative Dentistry

RKDF Dental College & Research Centre, Bhopal, MP, India

Abstract

An excessive gingival display during smiling approaches of orthodontics and

will always produce a negative impact on maxillofacial surgery can treat this and but
the society. An individual may even canget this treatment of surgical or orthodontic
depressed for this reason because of their correction or even the combination of both
unpleasant smile. A great concern even has various disadvantages such increased
when smiling to others can produce time duration of treatment, fear of surgery
psychological stress and which may can which leads to creation of psychological
even affect the confidence and thereby the stress, increased hospitalization after the
performance of an individual. These can be surgery, complications of General
due to multiple reasons. Multidisciplinary anaesthesia etc. The technique of surgical

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 DR. PRASANT ET AL: LIP REPOSITIONING April 5, 2020

repositioning of lip for the correction of off from the clinic within 45minutes and
excessive gingival display can be a boon for moreover the fear of surgery under GA
the patients who requires a very small thereby waves off. This case report
correction as it can be well accepted for the emphasizes the treatment of excessive
patient because of the procedure itself is gingival display by conventional lip
carried out under local anesthesia and repositioning technique. In the present case
thereby the reduced postoperative Gummy smile of 5mm was treated with
discomfort, reduced hospitalization and the conventional lip repositioning technique.
immediate result which the patient can walk
Key words

Gummy smile, Lip repositioning, Lip lengthening

Introduction

In the last decade the demand of the Etiological factors contributing in a gummy
minimally invasive cosmetic procedures are smile can be hyperactivity of the muscles of
increased throughout the globe. Cosmetic the upper lip, Vertical maxillary excess6 etc.
surgical procedures, the use of botulinum these factors contribute to the imbalance in
toxin type A (BTX-A) (Botox; Allergan, the gingiva- tooth ratio,inturn produces an
Irvine, Calif) and dermal fillers, orthodontic excessive gingival display. Gingival display
and orthognathic procedures, dental of 1 – 2mm is considered to be normal and
bleaching, and other dental cosmetic when its 4mm or more thenits classified as
procedures are widely requested by adults.(1- unattractive. For patients who are unwilling
4)
An undeniable psychological benefit of for the orthognathic surgery lip
cosmetic procedures is the increase in self- repositioning is an alternative treatment.9
esteem. There two types of lip repositioning
An excessive gingival display during techniques for the treatment of gummy smile
smiling which is called as a gummy smile mentioned in the literature, they are the i)
which can be self-conscious, embarrassed, conventional technique and ii) the modified
or even psychologically affected, and thus technique.10
seek intervention.5

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 DR. PRASANT ET AL: LIP REPOSITIONING April 5, 2020

Case report
A 21 year old female patient reported to premolar of left side).(Figure 1) A diagnosis
Department of Oral and Maxillofacial of moderate vertical maxillary excess with
Surgery, RKDF Dental College and hypermobility of upper lip was made. Since
Research Centre, Bhopal (M.P) with the the patient preferred a minimally invasive
chief complaint of excessive gingival procedure , Conventional lip repositioning
display during smiling. Past medical and technique of treatment modality was
dental history was non contributory. The explained to the patient and the informed
patient was moderately build and nourished. consent was obtained from the patient even
The patient was well oriented. On clinical after discussing the other treatment
examination during smiling 5mm gingival modalities, the benefits and the possible
display was noted from 14(maxillary first complications.
premolar of right side) to 24 (maxillary first

Lip repositioning procedure

Standard painting and draping done was exposed. Great care was taken to
following strict and aseptic prevent the damage of minor salivary glands
protocol.Lignocaine with 2% Adrenaline which are present in the submucosal layer.
was injected to anesthetize the operating The epithelium was excised leaving the
site. (Figure 2) The 2 incision lines were connective tissue exposed. (Figure 3) Local
marked using sterile marker pen. Partial anesthetic with 2% Adrenaline and
thickness incision stared at mucogingival electrocautery was used to arrest the
junction from upper right first premolar bleeding. Dissection was carried out to
extending to the upper left first premolar relive the muscular attachments to a smaller
was given. A second incision, ie, the parallel extent. Tissue tags were removed and the
incision was given 12-14 mm above the first upper flap is advanced and checked for its
incision was given following the marking. adaptation to the new site. Interrupted suture
The two incisions were attached together on placed using 4-0 silk, starting at the
the right and left side which created an midlineof the lip to ensure the proper
elliptical design and the connective tissue alignment of the lip with the midline of

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 DR. PRASANT ET AL: LIP REPOSITIONING April 5, 2020

teeth. Then further 4 more interrupted was adviced. Postoperatively regular

sutures on either side was placed for the antibiotics and analgesics were prescribed
complete closure of the wound. (Figure 4) and the patient was recalled after 10 days for
Intraoral pressure pack was placed using suture removal. Patient reported back on the
gauze piece over the surgical site and 12th day postoperatively for the suture
extraorally pressure pack applied using removal, showed a reduction in the gingival
Dynaplast. (Figure 5)Post operative display during smiling. Healing of the
instructions including the placement of ice tissues were acceptable.(Figure 6)Gingival
packs for several hours, avoiding of display was checked during smiling again
brushing at the surgical site, vigorous and the result was satisfactory. (Figure 7)
gargling and soft gargling with warm saline

Discussion
In patients with excessive gingival display, a effective procedure to reduce gingival
dentist offers multiple non invasive display by positioning the upper lip in a
treatment modalities such as the botox more coronal location.9 This technique is an
injection7, crown lengthening , modify or easy, cost effective, less time consuming,
control the form of teeth, lip repositioning psychologically more acceptable with a
technique etc . Satisfactory result was promising result in selected cases as case
obtained in this case. For an selection plays a major role for the success
excessive gingival display according to of this procedure. Contraindications for this
VME classification degree II, III procedure includes patients with severe
orthognaticsurgey is preferred.8 But for VME, minimal zone of attached gingiva
those patients which are unwilling to go for which inturn creates difficulty in flap
the orthognathic surgery , lip repositioning design, stabilization and suturing.6
technique is the alternative treatment.9 Its an

Conclusion
In cases with excessive gingival display technique is a surgical alternative in selected
during smiling and is unwilling for the patients. Sound diagnosis and careful case
orthognathic correction, lip repositioning selection is the key for the surgical outcome.

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 DR. PRASANT ET AL: LIP REPOSITIONING April 5, 2020

Figure : 1 Figure : 2

Figure 1: Preoperative image showing Figure 2 : Prepared surgical site

excessive gingival display of 5mm from
14 to 24

Figure : 3
Figure : 4

Figure 3 : Elliptical incision with exposed Figure 4: Suturing done using 4-0 silk
connective tissue

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 DR. PRASANT ET AL: LIP REPOSITIONING April 5, 2020

Figure : 5 Figure : 6

Figure 5 : Pressure pack given extraorally Figure 6 :Post operative healing after 12
with Dynaplast days

Figure : 7

Figure 7: Post operative image of the

patient showing reduced gingival display
during smiling

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 DR. PRASANT ET AL: LIP REPOSITIONING April 5, 2020

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