Gummy Smile Management Using Diode Laser Gingivectomy Versus Botulinum Toxin Injection - A Prospective Study

Intraoral Applications of Lasers in the Prosthetic Rehabilitation with Fixed Partial Dentures-A Narrative Review

Laser, an acronym for Light Amplification by Stimulated Emission of Radiation, is a powerful tool with diverse applications in modern dentistry. It emits monochromatic, coherent light resulting from photon-induced chain reactions. Available dental lasers include diode, argon, Er,Cr:YSGG, Er:YAG, Nd:YAG, and CO2. The unique property of these lasers, allowing them to be effectively used on both soft and hard tissues based on the operational parameters, positions them as particularly suited for a wide range of dental procedures. Compared to traditional methods, lasers offer advantages such as improved hemostasis and quicker wound healing. Such benefits stress the shift towards laser technology in dental treatment. In the realm of dental prosthodontics, which focuses on esthetics, functionality, and the physiological aspects of dental prostheses, lasers provide promising outcomes. Among the prosthetic options, fixed partial dentures stand out for their ability to mimic natural teeth, offering both esthetic and functional features, leading to satisfactory long-term outcomes if managed properly. This review paper delves into the specific application of laser technology in the context of prosthetic rehabilitation involving fixed partial dentures. By investigating intraoral laser procedures, it contributes to understanding laser's role in improving patients' satisfaction and clinical efficiency in this field.

A Systematic Review and Meta-Analysis Comparing Surgical and Nonsurgical Treatments for Excessive Gingival Display

Excessive gingival display (EGD) is defined as more than 2 mm of gingiva display above the maxillary incisors at maximum smile. Various skeletal, dental, and soft tissue etiological factors for EGD have been suggested. This study assessed the effectiveness and stability of surgical (SX) and nonsurgical (NSX) interventions for correction of EGD through a systematic review and meta-analysis following PRISMA 2020 guidelines. An electronic search of Ovid MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, and LILACS was conducted (2010-2023). Results were expressed as mean change in gingival display using the random-effects model at 1, 3, 6, and 12-month follow-up. At 1 month, SX and NSX treatments yielded a comparable mean reduction of 3.50 mm (2.13-4.86) and 3.43 mm (2.67-4.19) in gingival display, respectively. However, by 6 months, NSX treatments showed a reduction of 0.51 mm compared to 2.86 mm with SX treatments. SX outcomes remained stable past 6 months, while NSX outcomes partially relapsed at 6 months and returned to baseline levels at 12 months. Notably, NSX treatments were more effective in cases with mild initial EGD, while SX treatments showed a better outcome in severe cases. To draw more robust conclusions regarding the treatment outcomes, future primary studies of greater rigor are required.

Gummy Smile Prevalence Among Ha'il City Female Young Adults and Its Impact on Quality of Life: A Cross-Sectional Study

BACKGROUND

Gummy smile (GS) has a direct effect on individuals, especially among young adults, because of its association with smile avoidance. The younger populations are sensitive about their smiles and prefer aesthetic, beautiful smiles, a lack of which can negatively impact their quality of life.

OBJECTIVES

This study aims to measure the GS prevalence among young adults aged 16 to 18 attending high schools in Ha'il City, Saudi Arabia, evaluating oral health related to quality of life (OHQoL) in those suffering GS by using the OHQoL questionnaire (OHIP-14).

METHODS

A cross-sectional study was conducted on 385 female high school students located in Ha'il. Students with GS took a survey on oral health using OHIP-14. For this, SPSS was used to analyze the data.

RESULTS

The study included 200 people with GS (52%). The mean age was 18±0.01. The prevalence of GS was analyzed, with a mean value of 4.68±1.2 mm, indicating most students had GS ranging between 4 and 5 mm. The most frequent value for all items in the OHIP-14 questionnaire was 1, indicating that students often had their quality of life affected. The non-parametric Kruskal-Wallis test indicated the results had a significant value (p < 0.05), showing a positive and significant association.

CONCLUSION

Based on the OHIP-14 questionnaire and respecting the methodology, it was concluded that the quality of life has been affected for all female students with GS. The high prevalence for ages 16-18 showed most students agreed their lives were being affected by GS and their condition needed to be treated. It was also confirmed by the significant association of GS with items of oral health and quality of life.

A Comparison of Self-Perceived Oral and Facial Esthetics in Patients After Lip Repositioning Surgery With Modified and Conventional Techniques

BACKGROUND

Patients with excessive gingival display (EGD) are treated with lip repositioning surgeries (LRS). This study used a questionnaire to analyze and evaluate how patients who received LRS with modified and traditional techniques perceived their own oral and facial esthetics at various timelines after their surgeries.

METHODS

An orofacial esthetic questionnaire (OEQ) was used in this cross-sectional study. The participants were patients who underwent LRS for the treatment of their EGD. They were divided into control (n=100) and test (n=100) groups. For the control group, LRS were performed using traditional/conventional techniques, and for the test group, LRS were performed using a modified approach. An OEQ was used to record responses. The scale comprised eight questions targeted to capture participating patients' perceptions about their own oral and facial esthetics at four timelines (baseline and one-month, six-month, and one-year follow-up). Patients responded to each question on a 10-point Likert scale (0: very dissatisfied, 10: very satisfied). Data was analyzed by independent samples T-tests using Statistical Package for the Social Sciences (SPSS) version 21.0 software (IBM SPSS Statistics, Armonk, NY).

RESULTS

Seven (3.5%) out of the total (N=200) patients were unable to take part in the study's OEQ. At one-year follow-up, the mean and standard deviation (SD) for the test group's gingival display (GD) were 2.48±0.86 mm and 3.77±1.76 mm, respectively, and comparisons revealed that the test group's GD was significantly lower (p=0.000) than the control group. Results from the participant responses to OEQ using the Likert scale at one-year follow-up revealed significant differences between the control and test groups for all questions, except question 5 (p=0.06), as the shape of the teeth will not be affected by LRS. Patients in the test group who underwent LRS with a modified approach have a high level of satisfaction (satisfaction score: >9). Patients in the control group scored their satisfaction less favorably, with certain questions (question 3) receiving scores as low as 0.31. Perception of oral and facial esthetics was significantly higher for the test group at different time points. At one-year follow-up, the mean difference was 4.46, which was the greatest (p=0.000).

CONCLUSIONS

EGD improved significantly at one year with the modified lip repositioning technique. The satisfaction level of patients with outcomes of the modified lip repositioning was significantly higher as compared to the satisfaction level of patients who underwent the conventional technique.

Contemporary treatment techniques for excessive gingival display caused by altered passive eruption or lip hypermobility

OBJECTIVES

Excessive gingival display (EGD), also known as gummy smile, has various causes, including altered passive eruption (APE) and hypermobile upper lip (HUL). This state-of-the art narrative review explores current concepts regarding soft tissue EGD etiologies and the contemporary modalities available for APE or HUL treatment.

DATA, SOURCES, STUDY SELECTION

Literature search was conducted for a narrative review on the etiology, diagnosis, and treatment of EGD caused by APE and HUL. Searching for articles was carried out in PubMed and Google Scholar. Published articles, including case reports, case series, observational and interventional clinical trials, and critical appraisals of the literature (e.g., systematic reviews) on the etiology, diagnosis, and treatment of EGD caused by APE and HUL were retrieved and reviewed. Particular focus was placed on novel treatment modalities introduced in the last five years.

CONCLUSIONS

Recent research evidence indicates that APE and HUL are the two major soft tissue-based EGD etiologies. Aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) are the established surgical treatment modalities for APE and HUL, respectively. The last few years have seen the introduction of new techniques for APE and HUL management, an expansion of the available ACL and LRS technique variations, and additional evidence further supporting the effectiveness of these two procedures. Several of the recently introduced approaches offer unique, innovative, and potentially impactful concepts. However, for many of these newly described treatments the available evidence is limited to case reports and the exact indications remain to be adequately defined.

CLINICAL SIGNIFICANCE

Altered passive eruption and hypermobile upper lip are the common soft tissue causes of gummy smile and can be successfully managed through aesthetic crown lengthening and lip repositioning surgery, respectively. A wide range of newly introduced approaches promises to further facilitate gummy smile treatment and improve outcomes.

Histological artifacts associated with laser and electroscalpel gingivectomy: Case series

Introduction. Over time, efforts have been invested in the design of new instruments that overcome the disadvantages of the gold standard instrument in surgery, the scalpel. As a result, electronic equipment has emerged such as the electric scalpel and laser devices. The available evidence on these instruments suggests that the tissue response is related to each instrument’s physical and biological cutting principles. Objective. To compare the histological changes in gingiva samples associated with surgical cutting performed with a 940 nm diode laser, a 2780 nm erbium, chromium: yttriumscandium-gallium-garnet (Er,Cr:YSGG) laser, and an electric scalpel, by presenting a series of cases. Case presentation. We present three cases of healthy patients undergoing cosmetic surgery. The clinical examination revealed exposure of a keratinized gingiva band greater than 4 mm, normal color and texture in gingival tissue, with a firm consistency and no bleeding on periodontal probing. Gingivectomy was indicated with the following protocols: Diode laser of 940 nm at 1 W, in continuous mode; Er,Cr:YSGG laser of 2780 nm at 2.5 W, 75 Hz, H mode, air 20, water 40, gold tip MT4); and electric scalpel in cutting mode at power level four. Gingival tissue samples were taken and stored in 10% formaldehyde for histological analysis. Conclusion. All the evaluated cutting instruments generated histological changes produced by the thermal effect, the main ones being collagen coagulation and carbonization. The depth of thermal damage caused by the 2780 nm Er,Cr:YSGG laser was much lesser than that induced by the electric scalpel and the 940 nm diode laser.