Impact of orthognathic surgery on the treatment of gummy smile: an integrative review

Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study

This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.

Gingival Zenith Correction by Laser Gingivectomy

A healthy gingival structure showcases a knife-edged gingival margin, firmly adherent to the tooth surface, accompanied by a cone-shaped or pointed interdental papilla, mirroring the lowest point in the gingival margin, termed the gingival zenith. Tooth transposition denotes an anomaly in tooth positioning, commonly involving the canine and the first maxillary premolar. It represents a form of ectopic eruption, wherein two adjacent teeth interchange positions within the same quadrant of the dental arch. Laser wavelengths are utilized for precise incision of gingival tissues to address restorative, cosmetic, and periodontal needs. Post-operatively, rapid healing and diminished discomfort are frequently observed, often eliminating the necessity for periodontal packing or sutures. Gingivectomy is the accepted modality for the establishment of esthetics in situations with abnormal gingival contour. This study highlights the use of contemporary technology namely a 940 nm diode laser for correction of gingival zenith to achieve optimal esthetics post orthodontic treatment.

Comparison of Effects between Total Maxillary Setback Osteotomy and Anterior Maxillary Segmental Osteotomy on Nasolabial Morphology

BACKGROUND

The authors aimed to compare the effects of total maxillary setback osteotomy (TMSO) and anterior maxillary segmental osteotomy (AMSO) on nasolabial morphology.

METHODS

This retrospective clinical trial enrolled 130 patients undergoing maxillary surgery using TMSO or AMSO. Ten nasolabial-related parameters and nasal airway volume were measured preoperatively and postoperatively. The soft-tissue digital model was reconstructed using Geomagic Studio and Dolphin image 11.0. Statistical analysis was performed using IBM SPSS Version 27.0.

RESULTS

A total of 75 patients underwent TMSO, and 55 underwent AMSO. Both techniques achieved optimal repositioning of the maxilla. Except for the dorsal nasal length, the dorsal nasal height, the length of the nasal columella, and the upper lip thickness, the remaining parameters were significantly different in the TMSO group. In the AMSO group, only the nasolabial angle, the alar base width, and the greatest alar width showed significant differences. There was a significant difference in the nasal airway volume for the TMSO group. The results of matching maps are consistent with the statistical results.

CONCLUSIONS

TMSO has a more significant impact on both nose and upper lip soft tissues, whereas AMSO has a more significant impact on the upper lip and less on the nasal soft tissue. There is a significant decrease in nasal airway volume after TMSO, whereas AMSO showed less decrease. This retrospective study is helpful for clinicians and patients to understand the different changes in nasolabial morphology caused by the two interventions, which is essential for effective intervention and physician-patient communication.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Orthognathic Surgery for Management of Gummy Smile

Excessive gingival show is mainly caused by hypermobility of the upper lip, altered passive eruption, gingival hyperplasia, and bony maxillary vertical excess. Orthognathic surgery is the optimal treatment option for patients with moderate and severe vertical maxillary excess. Surrounding anatomic structures and soft tissue changes such as alternation in the nasal morphology confine the amount of impaction. Therefore, Le Fort 1 may be performed in conjunction with horseshoe osteotomy or partial turbinectomy. The possible necessity of further mandibular orthognathic surgeries and chin repositioning has to be considered. No common major complication and long-term relapse have been reported for maxillary impaction.

A volumetric study of mandibular condyles in orthognathic patients by semiautomatic segmentation

Purpose

This study was conducted to elucidate volumetric data of mandibular condyles of orthognathic patients by analyzing cone beam computed tomography images based upon semiautomatic segmentation.

Methods

Cone beam computed tomography images of 87 patients with malocclusions were analyzed in this retrospective study. Patients were between 17 and 53 years old and diagnosed with Angle class I, II, or III malocclusion. By using the validated open-source software “ITK-SNAP,” the volumetric measurements of 174 mandibular condyles were performed. Volumetric analysis was performed according to intra-subject side differences by paired Student t test. In accordance to inter-subject side, gender, age and type of malocclusion differences bivariate analysis and ANOVA were applied.

Results

The mean volume for the right condyle was 1.378 ± 0.447 cm³, with a maximum of 2.379 cm³ and a minimum of 0.121 cm³. The mean volume for the left side was 1.435 ± 0.474 cm³, with a maximum of 3.264 cm³ and a minimum of 0.109 cm³. Bivariate analysis indicated a highly significant inter-subject difference between the volume of the left and right mandibular condyles (p < 0.01). Females had a significantly smaller condyle volume than males (p < 0.05 left condyle; p < 0.01 right condyle).

Conclusion

The fact that shape and volume of mandibular condyles show a high susceptibility to pathological alterations and particularly malocclusions makes a precise knowledge about volumetric changes indispensable. Our results show that significant inter-subject differences in condyle volume could be found with respect to the side and gender. Larger volumes could be assessed for the left condyle and for male patients.

Orthognathic surgery and orthodontics associated with orofacial harmonization: Case report

Introduction and importance

Orthognathic surgery aims to restore the functional and esthetic standards of the face and non-surgical or minimally invasive procedures have been optimizing the results of facial orthosurgical treatments. This case report aimed to show the use of minimally invasive techniques that, associated with orthognathic surgery, represent a trend in current oral and maxillofacial rehabilitation.

Case presentation

A female patient, 28 years old, white, sought care from the Dentistry team of the São Vicente de Paulo Hospital, in Passo Fundo, Brazil, complaining of mandibular prognathism, anteroposterior maxillary deficiency, dental crowding, malocclusion, functional and esthetic changes that negatively affected her psychosocial interactions and stomatognathic function. The treatment involved orthodontics, orthognathic surgery, and orofacial harmonization with dermal fillers.

Clinical discussion

The multidisciplinarity among the specialties of Oral and Maxillofacial Surgery and Traumatology, Orthodontics, and Orofacial Harmonization add and contribute to the process of planning and implementing the treatment proposed, as well as the prognosis toward patient satisfaction.

Conclusion

The surgical procedure associated with minimally invasive facial harmonization not only corrected the functional complaint of the patient but also played an important role in improving facial harmony, contributing significantly to self-esteem.

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Minimally invasive facial harmonization refines orthognathic surgery techniques.

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The integration of several disciplines helps to improve facial harmony.

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Injectable fillers represent important allies in orthosurgical treatments.

The effect of botulinum toxin A in patients with excessive gingival display with and without zinc supplementation: randomized clinical trial

OBJECTIVE

The objective is to determine the effect of oral zinc supplement intake on the clinical efficacy and sustained effect of BTXA injection, in patients with excessive gingival display (EGD).

MATERIALS AND METHODS

Twenty-five participants with excessive gingival display (EGD) were included in this parallel-group RCT, treated with BTXA with and without Zinc supplementation prior to treatment. Participants were assessed for excessive gingival display reduction and results of stability at 2, 6, 12, 18, and 24 weeks. Patient satisfaction questionnaires were filled at 2, 12, and 24 weeks.

RESULTS

The results of this study revealed that after 6, 12, 18, as well as 24 weeks; The control group (BTXA) showed statistically significantly higher median gingival display than the intervention (Zinc supplement with BTXA). In the intervention group, the median gingival display after 24 weeks showed statistically significantly lower median value compared to the baseline measurement CONCLUSIONS: The use of zinc supplementation prior to BTXA injection prolonged its effect and maintained long-term decreased amount of gingival display, and it did not return to baseline measurements. Patients reported high satisfaction levels and self-confidence.

CLINICAL RELEVANCE

Botulinum Toxin A (BTXA) is used to correct gummy smile; however, its main drawback is its short-lasting effect. Oral zinc supplement intake prior to BTXA injection could maintain the effect of BTXA and enhance its clinical efficacy.