Labial Repositioning Using Print Manufactured Polymethylmethacrylate- (PMMA-) Based Cement for Gummy Smile

Patricia Freitas de Andrade, Jonathan Meza-Mauricio, Ricardo Kern, Marcelo Faveri, Patricia Freitas de Andrade, Jonathan Meza-Mauricio, Ricardo Kern, Marcelo Faveri

Abstract

Treating patients with excessive gingival display (EGD) to provide them with a pleasant smile is a challenge to periodontists. A gummy smile can be due to excessive vertical bone growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, or altered passive eruption (APE). In addition, many patients have a lack of lip support due to marked depression of the anterior process of the maxilla. In these cases, lip repositioning using polymethylmethacrylate (PMMA) cement could be performed. This article describes a case of EGD with subnasal depression. In the clinical examination, the presence of a marked subnasal depression was found, in which the upper lip lodged during a spontaneous smile. In addition to this, gingival exposure extending from the maxillary molar on one side of the mouth to the one on the opposite side was also found during the spontaneous smile. Therefore, the periodontal surgical intervention proposed consisted of performing a procedure to fill the subnasal depression with PMMA cement. This article describes a digital approach to plan the use of PMMA cement in lip repositioning in a patient with gummy smile and subnasal depression. The patient reported no postoperative complications. Six months after the surgery, the patient revealed a more harmonious smile than before, with reduction in the gingival exposure and new adequate support for and repositioning of the upper lip.

Conflict of interest statement

The authors have no current or potential conflicts of interest to declare.

Copyright © 2021 Patricia Freitas de Andrade et al.

Figures

Figure 1
Figure 1
(a, b) Preoperative view of patient's smile.
Figure 2
Figure 2
(a) Cone-beam computed tomography scan was performed to evaluate the subnasal depression and to plan the PMMA block. (b–g) Planning of the PMMA block in a 3D planning software according to the defect geometry. (h) Printed PMMA block.
Figure 3
Figure 3
(a, b) View of subnasal depression. (c–e) The PMMA block was fixed with two titanium-based bone graft fixation screws. (f) The gingival flap was repositioned with vertical mattress sutures.
Figure 4
Figure 4
(a, b) Six months later: postoperative view of patient's smile.

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Source: PubMed

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