Creating smile aesthetics by using crown lengthening and upper lip repositioning surgical operations together in a gingival smile case: a case report

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When the distance between the gingival margin and the lower border of the upper lip is more than 3 mm while smiling, it is called a gummy smile. The etiology of excessive gingival visibility is varied: delayed passive eruption, anterior dento-alveolar extrusion, vertical maxillary overhang, short upper lip, hypermobile upper lip, or a combination of multiple factors. The aim of our study is to diagnose gingival smile and explain the treatment of excessive gingival appearance due to vertical maxillary excess and hypermobile upper lip with crown lengthening and upper lip repositioning surgeries. A 27-year-old female patient presented to our clinic with the complaint of excessive gingival exposure while smiling. In the intraoral examination, it was determined that the patient had good oral hygiene, the upper lip was hypermobile, and the crown lengths of the upper central teeth were shorter than normal due to passive eruption. Gingivectomy, crown lengthening, and lip repositioning operations were planned for gummy smile treatment. For lip repositioning, the first incision was made from the mucogingival line of teeth numbered 14-24, the second incision was made 8-10 mm apically; and the tissue in between was excised. The wound edges were closed with 5.0 nylon mono sutures. Postoperative antibiotics, analgesics, and mouthwash were prescribed. The patient stated that he did not have any postoperative problems. The 6-month follow-up showed an uneventful recovery. In this case, the excessive gingival appearance was reduced by restricting the muscle traction of the elevator lip muscles, and the tooth length was increased with the crown length operation, providing aesthetic satisfaction for both the patient and the physician. As a result of our study, this procedure is safe for patients, less invasive, has minimal side effects, and may be an alternative to orthognathic surgery in appropriate cases for the correction of gingival smiles.