Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2018, vol. 55, nr 3, July-September, p. 241–246

doi: 10.17219/dmp/92317

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Lip repositioning with a myotomy of the elevator muscles for the management of a gummy smile

Repozycja wargi przez przecięcie przyczepów mięśni dźwigacza w leczeniu uśmiechu dziąsłowego

Asmaa Mohammad Alammar1,D, Omar Ahmad Heshmeh2,D

1 Faculty of Dentistry, Damascus University, Syria

2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, Syria


Background. Excessive gingival display ≥4 mm is commonly referred to as a “gummy smile”, which is caused by several different etiologies and can be corrected using various techniques. Therefore, the etiology of a gummy smile dictates the most appropriate treatment approach.
Objectives. The aim of this study was to evaluate the surgical lip repositioning technique (a full-thickness flap with a myotomy of the elevator muscles) in the management of a gummy smile in the range of 4–6 mm, caused by soft tissue disorders (short upper lip, hyperactive lip elevator muscles).
Material and Methods. A prospective study was conducted between April 2016 and May 2017. Fourteen adult patients, aged 18–38 years, with a gummy smile of 4–6 mm, caused by soft tissue disorders were included in the study. All patients were treated by the surgical lip repositioning technique (a full-thickness flap with a myotomy of the elevator muscles) in the Department of Oral and Maxillofacial Surgery at Damascus University, Syria. The amount of gingival display in a full smile and complications after surgery were evaluated in the current study.
Results. The results were as follows: the mean amount of gingival display in a full smile was 6.36 mm preoperatively, after 1 month postoperatively – 0.91 mm, after 3 months – 2.27 mm, after 6 months – 2.45 mm. The post-surgery complications were as follows: the infection did not appear in any patient, flap dehiscence appeared in 2 patients (14.2%), numbness appeared in 9 patients (64.2%). Pain recurrences varied between mild pain in 5 patients (35.7%) and moderate pain in 3 patients (21.4%).
Conclusion. The proposed surgical lip repositioning technique showed effectiveness in reducing the amount of gingival display in a full smile through postoperative follow-up periods. All the postoperative complications are temporary and fade within a short period after the surgical procedure, making lip repositioning a safe surgical technique.

Key words

gingival display, gummy smile, lip repositioning, myotomy of elevator muscles

Słowa kluczowe

ekspozycja dziąseł, uśmiech dziąsłowy, repozycja wargi, przecięcie przyczepów mięśni dźwigacza

References (17)

  1. Iqbal C, Nandakumar K, Padmakumar TP. Laser assisted treatment of excessive gingival display along with modified lip re-positioning. IOSR J Dent Med Sci. 2015;14(7):28–33.
  2. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod. 1992;62(2):91–100.
  3. Levine RA, McGuire M. The diagnosis and treatment of the gummy smile. Compend Contin Educ Dent. 1997;18(8):757–762,764,quiz 766.
  4. Abdullah W, Khalil H, Alhindi M, Marzook H. Modifying gummy smile: A minimally invasive approach. J Contemp Dent Pract. 2014;15(6):821–826.
  5. Martins AT, Sakakura CE, Correcirc BE, et al. A modified technique that decreases the height of the upper lip in the treatment of gummy smile patients: A case series study. J Dent Oral Hyg. 2012;10:21–28.
  6. Pandurić DG, Blašković M, Brozović J, Sušić M. Surgical treatment of excessive gingival display using lip repositioning technique and laser gingivectomy as an alternative to orthognathic surgery. J Oral Maxillofac Surg. 2014;72(2):404.e1–11.
  7. Miron H, Calderon S, Allon D. Upper lip changes and gingival exposure on smiling: Vertical dimension analysis. Am J Orthod Dentofacial Orthop. 2012;141(1):87–93.
  8. Hwang W-S, Hur M-S, Hu K-S, et al. Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod. 2009;79(1):70–77.
  9. Livada R, Shiloah J. Gummy smile: Could it be genetic? Hereditary gingival fibromatosis. J Tenn Dent Assoc. 2012;92(1):23–26.
  10. Garber DA, Salama MA. The aesthetic smile: Diagnosis and treatment. Periodontol 2000. 1996;11:18–28.
  11. Monaco A, Streni O, Marci MC, Marzo G, Gatto R, Giannoni M. Gummy smile: Clinical parameters useful for diagnosis and therapeutical approach. J Clin Pediatr Dent. 2005;29(1):19–25.
  12. Simon Z, Rosenblatt A, Dorfman W. Eliminating a gummy smile with surgical lip repositioning. J Cosmet Dent. 2007;23(1):100–108.
  13. Wei J, Herrler T, Xu H, Li Q, Dai C. Treatment of gummy smile: Nasal septum dysplasia as etiologic factor and therapeutic target. J Plast Reconstr Aesthet Surg. 2015;68(10):1338–1343.
  14. Ishida LH, Ishida LC, Ishida J, Grynglas J, Alonso N, Ferreira MC. Myotomy of the levator labii superioris muscle and lip repositioning: A combined approach for the correction of gummy smile. Plast Reconstr Surg. 2010;126(3):1014–1019.
  15. Ellenbogen R, Swara N. The improvement of the gummy smile using the implant spacer technique. Ann Plast Surg. 1984;12(1):16–24.
  16. Silva CO, Ribeiro‐Júnior NV, Campos TV, Rodrigues JG, Tatakis DN. Excessive gingival display: Treatment by a modified lip repositioning technique. J Clin Periodontol. 2013;40(3):260–265.
  17. Benlier E, Top H, Aygit AC. A new approach to smiling deformity: Cutting of the superior part of the orbicularis oris. Aesthetic Plast Surg. 2005;29(5):373–377.