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Mundra S, Shetty NJ. A Smile Reimagined: Gummy Smile Resolution with Cutting Edge Method Using Chu's Gauge and Polymethylmethacrylate (PMMA) Bone Cement. Case Rep Dent 2024; 2024:6500762. [PMID: 38884011 PMCID: PMC11178403 DOI: 10.1155/2024/6500762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/11/2024] [Accepted: 05/25/2024] [Indexed: 06/18/2024] Open
Abstract
Excessive gingival display (EGD) is one of the most common aesthetic concerns, and its correction often presents a challenge to periodontists. It has a multifactorial etiology, and this article describes a case involving hypermobile upper lip (HUL), altered passive eruption (APE), and vertical maxillary excess (VME). Upon investigation, a positive collum angle and marked subnasal skeletal depression were observed. In this context, it is noted that during a spontaneous smile, the upper lip retracts and gets lodged in this depression. The rehabilitation plan includes included aesthetic crown lengthening via gingivectomy using Chu's proportional gauge for altered passive eruption and filling the subnasal depression by PMMA (polymethylmethacrylate) bone cement. The entire treatment plan was digitalised using cutting edge methods such as computed tomography (CT), cone beam computed tomography (CBCT), and 3D printers for virtual planning of the defect's position, size, and shape. No postoperative complications were reported. After six months, the patient exhibited a harmonious smile with reduced exposed gingiva.
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Affiliation(s)
- Shalini Mundra
- Department of Periodontology Manipal College of Dental Sciences, Mangalore, India
- Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Neetha J Shetty
- Department of Periodontology Manipal College of Dental Sciences, Mangalore, India
- Manipal Academy of Higher Education (MAHE), Manipal, India
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Martins de Araújo Carneiro V, Roquete MP, Seabra Gomes AM, Marinho MU, Simino de Melo G, Kasabji F, An TL, Nascimento de Sousa D, Meireles Rodrigues JM, Stefani CM, Guimarães MDCM, Rodrigues Ribeiro AC, Soares Andrade CA. Effects of polymethyl methacrylate-based bone cement graft for treating excessive gingival display and its dimensional facial changes: 12-Month clinical study. J Oral Biol Craniofac Res 2024; 14:326-334. [PMID: 38660054 PMCID: PMC11039310 DOI: 10.1016/j.jobcr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/03/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024] Open
Abstract
Objective to present a 12-month follow-up with photographic and tomographic analyses of the effect of polymethyl methacrylate-based bone cement graft (PMMA) in gingival exposure (GE) in patients with excessive gingival display (EGD). Methods Twelve patients with EGD were included. The PMMA was surgically placed. A frontal and lateral photograph protocol was performed at baseline (T0), 3 (T3), 6 (T6), and 12 months (T12) post-operatively. Soft tissue cone-beam computed tomography (ST-CBCT) was performed at T0 and T12. Measures included GE, length of the lip vermilion (LLV), lip shape (LS), nose width (NW), filter width (FW), nasolabial angle (NAS) while smiling, and nasolabial angle at rest (NAR). The height, thickness, and volume of the cement graft were also measured in the ST-CBCT. The comparisons were performed by Kruskal-Wallis test at 5 % of significance (p < 0.05). Results The height, thickness, and volume of the PMMA were respectively 12.84 ± 1.59 mm, 3.83 ± 0.53, and 1532.02 ± 532.52 mm3. PMMA significantly decreased GE from 8.33 ± 1.25 mm (T0) to 6.60 ± 0.93 mm (T12) (p < 0.01). NAR was 98.34 ± 9.28° at T0 and increased to 105.13 ± 7.33° at T12; however, the angle value was not statistically different (p = 0.08). LLV, LS, NW, FW, and NAS did not exhibit statistical differences between the baseline and follow-up periods. Conclusions PMMA significantly decreased GE in a 12-month follow-up without influencing adjacent soft tissue anatomical structures.
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Affiliation(s)
- Valéria Martins de Araújo Carneiro
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Mayra Pereira Roquete
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Andressa Meireles Seabra Gomes
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Mônica Umpierre Marinho
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Gabriel Simino de Melo
- Faculdade de Medicina e Odontologia, Departamento de Periodontia, Faculdade São Leopoldo Mandic, Rua Dr. José Rocha Junqueira 13, Campinas, SP, 13045-755, Brazil
| | - Feras Kasabji
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Kassai Út 26, Debrecen, Hajdú-Bihar, H-4028, Hungary
| | - Tien-Li An
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Dircilei Nascimento de Sousa
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - João Marcelo Meireles Rodrigues
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Cristine Miron Stefani
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Maria do Carmo Machado Guimarães
- Faculdade de Ciências da Saúde, Departamento de Odontologia, Universidade de Brasília - Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Ana Clara Rodrigues Ribeiro
- Departamento de Odontologia, Universidade Católica de Brasília – Campus Taguatinga Sul, Taguatinga, Brasília, DF, 71966-700, Brazil
| | - Carlos Alexandre Soares Andrade
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Kassai Út 26, Debrecen, Hajdú-Bihar, H-4028, Hungary
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