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OBJECTIVE: This article aims to showcase the implementation of a digital workflow in addressing a case of multifactorial excessive gingival display in a patient with high esthetic demands, incorporating both surgical and restorative interventions in a single session. CLINICAL CONSIDERATIONS: A 28-year-old female patient presented with excessive gingival display, attributed to a combination of short teeth due to altered passive eruption, lip hyperactivity, and a sub-nasal depression that lodged the upper lip during spontaneous smiling. The multidisciplinary treatment strategy encompassed surgical crown lengthening, the placement of a biovolume in the maxillary concavity, and the rehabilitation of the six anterior teeth with direct composite resin, all done in a single session. Smilecloud Biometrics was used to digitally plan the smile, and the final wax-up/mock-up was approved by the patient prior to any irreversible procedure. A digital planning center (GuiderLab) enabled the materialization of the virtual planning and the printing of the periodontal surgical guide, the biovolume, and the resin layering guides for the restorative technique. CONCLUSIONS: Adopting a digital workflow in multidisciplinary cases with excessive gingival display leads to predictable and more expedited outcomes, ensuring a favorable result between soft and hard tissues. CLINICAL SIGNIFICANCE: Excessive gingival display is a condition with multifactorial etiologies, including dentoalveolar, periodontal, skeletal, or muscular origins, or a combination of these factors. The diagnoses of altered passive eruption and a hypermobile upper lip are common in daily clinical practice and can be successfully managed through surgical crown lengthening and filling of the maxillary concavity, respectively. To achieve the desired outcome, restorative procedures often complement these surgical interventions.

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Background: The objective of this systematic review and meta-analysis was to answer the questions ''Does lip repositioning surgery reduce the amount of gingiva exposed in the smile in individuals with excessive gingival display EGD (excessive gingival display)?'' and ''Is the reduction of the amount of gingiva exposed when smiling obtained with lip repositioning surgery stable over time?'' to evaluate the effectiveness of lip repositioning surgery for correcting EGD on smiling. Materials and Methods: A systematic structured search was carried out in five databases without data restriction. Studies reporting the degree of reduction in gingival ex-posure after lip repositioning surgery were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate Results: One hundred sixty-four references were retrieved and eleven studies met the eligibility criteria. Meta-analysis demonstrated that lip repositioning surgery results in a significant reduction in the amount of exposed gingival tissue (mean difference = -3.03; confidence interval = -3.55; -2.52). In addition, the results remained stable in the evaluated follow-up periods (1, 3, 6 and 12 months). Included studies had a low risk of bias. Conclusions: Lip repositioning surgery is effective for the treatment of EGD on smiling and exhibits stable results in the evaluated periods. The study was registered (CRD42020184866) in the international prospective register of systematic reviews (PROSPERO)

Antecedentes: el objetivo de esta revisión sistemática y metanálisis fue responder a las preguntas "¿La cirugía de reposicionamiento de labios reduce la cantidad de encía expuesta en la sonrisa en personas con exposición gingival excesiva (EGE)?" y "¿La reducción de la cantidad de encía expuesto al sonreír obtenido con cirugía de reposicionamiento de labios estable en el tiempo?" para evaluar la efectividad de la cirugía de reposicionamiento de labios para corregir la EGE al sonreír. Materiales y Métodos: Se realizó una búsqueda sistemática estructurada en cinco bases de datos sin restricción de datos. Se incluyeron los estudios que informaron el grado de reducción de la exposición gingival después de la cirugía de reposición de labios. La selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo se realizaron por duplicado. Resultados: Se recuperaron ciento sesenta y cuatro referencias y once estudios cumplieron con los criterios de elegibilidad. El metanálisis demostró que la cirugía de reposicionamiento de labios da como resultado una reducción significativa en la cantidad de tejido gingival expuesto (diferencia de medias = -3,03; intervalo de confianza = -3,55; -2,52). Además, los resultados se mantuvieron estables en los periodos de seguimiento evaluados (1, 3, 6 y 12 meses). Los estudios incluidos tenían un bajo riesgo de sesgo. Conclusión: La cirugía de reposicionamiento de labios es efectiva para el tratamiento de la EGE al sonreír y presenta resultados estables en los períodos evaluados. El estudio fue registrado (CRD42020184866) en el registro prospectivo internacional de revisiones sistemáticas (PROSPERO).

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Introduction: The lip repositioning surgical technique arose with the objective of correcting and harmonizing the act of smiling. Since the conventional technique was published, some modifications of the technique have been proposed in order to counteract postoperative recurrence and to achieve the best esthetic appearance of the smile. The objective of this paper was to describe the laser-assisted lip repositioning technique (laser-assisted LRS) with a 940nm diode laser and 2780nm Er,Cr: YSGG, as a modification to the conventional lip repositioning technique, for the treatment of a gummy smile. Case Report: The proposed technique consists in achieving the descent of the upper lip by removing the intraoral mucosal band through the laser peeling of oral mucosa, preserving the connective tissue intact for healing by secondary intention. The technique was implemented in two patients with a diagnosis of a gummy smile caused by a short and hyperactive upper lip; the healing process was satisfactory, and there was no bleeding or postoperative edema. Postoperative controls were performed at 3 and 10 months, and no recurrence was found. Conclusion: the 940nm Diode laser or 2780nm Er,Cr: YSGG laser-assisted lip repositioning technique described here is less invasive than that performed with a conventional scalpel, offers aesthetic results, lower risk of infection and recurrence of the gummy smile in the long term.

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OBJECTIVE: To systematically review the literature regarding the clinical efficacy of reducing excessive gingival display (EGD) using the surgical lip repositioning technique (LRT) and its modifications. The question to address was: "What is the clinical efficacy of the surgical LRT and its modifications in patients with EGD?" MATERIAL AND METHODS: Four databases (MEDLINE-PubMed, Scopus, EMBASE, and CENTRAL) were searched up to December 2021 (PROSPERO-CRD42020205987). Randomized, non-randomized controlled and prospective case series with a minimum of 6-month follow-up were eligible for inclusion. Two meta-analyses were performed using the mean difference (MD) between baseline and different follow-up periods (6 and 12 months). Subgroup analyses were performed using the different modifications of LRT. RESULTS: The electronic research retrieved 783 studies. Only 13 met the inclusion criteria and were included in the statistical analysis. Six modifications of the original LRT were identified. An overall EGD reduction of -3.06 mm (95%CI: -3.71-2.40), -2.91 mm; (95%CI: -3.66-2.15) and -2.76 mm; (95%CI: -3.83--1.70) was achieved after 6, 12, and 36 months, respectively, compared to baseline (P < 0.01). Meta-analysis revealed that the use of LRT with periosteal suturing showed the greatest decrease in EGD with 5.22 mm (95% CI: 4.23-6.21; P < 0.01) at 6 months and 4.94 mm (95% CI: 3.86-6.02; P < 0.01) at 12 months. CONCLUSIONS: Both the original LRT and its different modifications reduce EGD and provide good results and overall patient satisfaction at 6, 12, and 36 months of follow-up. CLINICAL RELEVANCE: Evaluating the different modifications of the LRT can be a guiding aspect for the clinical and surgical approach to be used in patients with EGD.

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Introdução:O sorriso gengival tem mostrado ser um fator de desconforto estético e psicológico, além de afetar as relações interpessoais e a autoestima dos pacientes. Di-ante disso, procedimentos estéticos têm sido desenvolvidos com o intuito de melhorar a qualidade de vida de quem os procuram. Objetivo:Analisar qual o impacto que os procedimentos odontológicos estéticos possuem na recuperação da autoestima e satis-fação dos pacientes com sorriso gengival. Metodologia:A temática é abordada por meio da revisão integrativa da literatura. Para a seleção dos artigos utilizou-se as bases dedados: MEDLINE, LILACS, SciELO, BBO e PubMed, publicações escritas em in-glês, português ou espanholno período de 2010 a 2020. A amostra desta revisão cons-tituiu-se de 06 artigos. Resultados:Foi observado que o sorriso gengival causa descon-forto estético e psicológico ao indivíduo. As prevalências das etiologias relacionadas foram erupção passiva ou tardia dos dentes, extrusão dentoalveolar anterior, excesso maxilar e lábio superior curto. Os procedimentos mais utilizados foram a aplicação de toxina botulínica, a qual mostrou-se ser promissora para a correção do sorriso gen-gival assim como o reposicionamento labial. Conclusões:Os estudos mostraram que os procedimentos odontológicos estéticos para correção do sorriso gengival contri-buem para satisfação do paciente e melhora da autoestima e as técnicas menos invasi-vas e com melhor pós-operatório apontadas, são a aplicação da toxina botulínica e o reposicionamento labial (AU).

Introduction:The gingival smile currently is a factor of aesthetic and psychological discomfort and affects interpersonal relationships and self-esteem of patients. There-fore, aesthetic procedures have been developed in order to improve the quality of life of those who seek it. Objective:To analyze the impact that aesthetic dental procedures have on the recovery of self-esteem and satisfaction of patients with a gingival smile. Methodology:The theme is addressed through an integrative literature review. The followingdatabases were used for the selection of articles: Medline via VHL, Lilacs, SciElo, BBOand PubMed, publications written in English, Portuguese or Spanish, from 2010 to 2020. The sample of this review consisted of 06 articles. Results: It was observed that the gingival smile causes aesthetic and psychological discomfort to the individual. The most used procedures are applying botulinum toxin, which has shown to be promising for the correction of the gingival smile and lip repositioning. The prev-alence of related etiologies was passive or delayed tooth eruption, anterior dentoalve-olar extrusion, maxillary excess, and short upper lip. Conclusions:Studies have shown that aesthetic dental procedures to correct gingival smile contribute to patient satisfactionand improve self-esteem. Less invasive techniques with better post-oper-ative results are the application of botulinum toxin and lip repositioning (AU).

Introducción: La sonrisa gingival ha demostrado ser un factor de incomodidad esté-tica y psicológica, además de afectar las relaciones interpersonales y la autoestima de los pacientes. Por lo tanto, se han desarrollado procedimientos estéticos con el fin demejorar la calidad de vida de quienes los buscan. Objetivo: Analizar el impacto que los procedimientos dentales estéticos tienen en la recuperación de la autoestima y la satisfacción de los pacientes con sonrisa gingiva . Metodología: El tema se aborda a través de la revisión integrativa de la literatura. Para la selección de artículos, se utili-zaron las siguientes bases de datos: MEDLINE, LILACS, SciELO ,BBO y PubMed, pu-blicaciones escritas en inglés, portugués o español, de 2010 a 2020. La muestra de esta revisión consistió en 06 artículos.Resultados:Se observó que la sonrisa gingival causa molestias estéticas y psicológicas al individuo. La prevalencia de etiologías relaciona-das fue erupción pasiva o tardía de los dientes, extrusión dentoalveolar anterior, ex-ceso maxilar y labio superior corto. Los procedimientos más utilizados fueron la apli-cación de toxina botulínica, que resultó ser prometedora para la corrección de la son-risa gingival, así como el reposicionamiento de labios.Conclusiones: Se observó que la sonrisa gingival causa molestias estéticas y psicológicas al individuo. La prevalencia de etiologías relacionadas fue erupción pasiva o tardía de los dientes, extrusión den-toalveolar anterior, exceso maxilar y labio superior corto. Los procedimientos más utilizados fueron la aplicación de toxina botulínica, que resultó ser prometedora para la corrección de la sonrisa gingival, así como el reposicionamiento de labios (AU).

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AIM: To compare oral health-related quality of life (OHRQoL) between individuals with and without excessive gingival display (EGD). MATERIALS AND METHODS: A cross-sectional study was conducted in 53 individuals with EGD and 53 controls matched for sex and age. The outcome was OHRQoL, determined using the Oral Health Impact Profile (OHIP-14) and self-perceptions of satisfaction with smile aesthetics. A clinical examination was conducted to evaluate the smile line, colour of the teeth, tooth wear and malocclusion. Poisson regression was used to model the association between excessive gingival display and OHRQoL. RESULTS: Participants with EGD had higher total OHIP-14 score (4.81 ± 4.76) in comparison with the controls (1.85 ± 3.77; p < .001). The percentage of satisfied with smile individuals without and with EGD was 78.9% and 21.1%, respectively (p = .005). In the multivariate analysis, total OHIP-14 scores were 2.10-fold higher individuals with EGD, independently of the other variables analysed. Impacts were evident on the functional limitation, psychological discomfort, psychological disability and social handicap. CONCLUSIONS: The occurrence of EGD exerted a negative impact on OHRQoL independently of confounding variables in this specific population. The present findings justify the planning of treatment for individuals with EGD that impacts quality of life.

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O objetivo dessa revisão foi buscar na literatura o que há de mais relevante e atual sobre o tema Excessiva Mostra Gengival (EMG). Foram incluídos os aspectos de como identificar a condição do que é a EMG, de como avaliar cada paciente portador da EMG e suas características e manifestações, como classificar cada caso e como essa classificação vai influenciar no desenrolar do tratamento. Para esse estudo, foi realizada uma pesquisa bibliográfica no Banco de dados PUBMED, utilizando as palavras-chave: excessive gingival display, lip reposition, smile line, smile design, gummy smile, smile, aesthetic factors in a smile, aesthetic smile. Foram pesquisados 90 trabalhos relacionados a esse tema e também 4 livros foram envolvidos na busca. Destes 90 Artigos, 40 foram utilizados, tendo maior relevância para essa obra. Também foi feita uma busca utilizando palavras em Língua Portuguesa, com as palavras-chave: reposicionamento do lábio superior, excessiva mostra gengival, sorriso gengival, linha do sorriso. Após esse estudo, as conclusões foram: as EMG são classificadas em cinco tipos, com diferentes etiologias. Para cada tipo de EMG existe um tratamento indicado, sendo na maioria das vezes cirúrgico. A EMG quando associada a alterações periodontais são tratadas com cirurgias de menor complexidade e com alta previsibilidade de sucesso. A técnica de mudança de posicionamento do lábio superior (LipStat) mostra ser uma forma bastante promissora para o tratamento de EMG complexa e, finalmente, pesquisas futuras são necessárias para avaliar resultados a longo prazo.(AU)

The objective of this review is to search in the literature the most relevant and updated regarding to the theme Excessive Gingival Display ( EGD ). This search has dealt with the aspects regarding the identification of this condition , what exactly it is that condition , how to evaluate each patient who portrait this situation and identify all relevant characters of the condition EGD . And how this character will influence upon the treatment. For this piece, a search was performed through the database PUBMED, utilizing the key-words: excessive gingival display, lip repositioning, smile line, smile design , gummy smile, smile, aesthetic factors in a smile , aesthetic smile. Searches gathered 90 Articles which were related to the matter and 4 books were involved, too. From these 90 Articles, 40 Articles were utilized, having more relevance. Some words in Portuguese Language were used to perform a search, too. After this search in the literature, conclusions were made: the EDG is classified in five different types, with different etiologies. For every kind of EDG, there is a different kind of treatment, most of them through surgery. The EDG, when associated to periodontal problems are treated by minor complex surgeries, having highly visibility of success. The technique of upper lip repositioning (lipStat) has shown to be a good way to solve the EGD complex cases and finally, future researches are necessary to evaluate long term outcomes.(AU)

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Excessive gingival display during smile can result in compromised esthetics. This study aims to report a case of excessive gingival display with multiple etiologies treated by means of modified lip repositioning technique associated with esthetic crown lengthening. A 23-year-old female patient, with 5-mm gingival display during smile caused by altered passive eruption and hypermobility of the upper lip, underwent the modified lip repositioning technique associated with gingivectomy followed by flap elevation and ostectomy/osteoplasty. Seven months after the second procedure, the patient had her esthetic complaint solved appearing stable in the observation period. The modified lip repositioning technique is an effective procedure employed to reduce gingival display and when associated with esthetic clinical crown lengthening, can appropriately treat cases of gummy smile.