Myotomy of the levator labii superioris muscle and lip repositioning: a combined approach for the correction of gummy smile.
BACKGROUND
Treatment of excessive gingival display usually involves procedures such as Le Fort impaction or maxillary gingivectomies. The authors propose an alternative technique that reduces the muscular function of the elevator of the upper lip muscle and repositioning of the upper lip.


METHODS
Fourteen female patients with excessive gingival exposure were operated on between February of 2008 and March of 2009. They were filmed before and at least 6 months after the procedure. They were asked to perform their fullest smile, and the maximum gingival exposures were measured and analyzed using ImageJ software. Patients were operated on under local anesthesia. Their gingival mucosa was freed from the maxilla using a periosteum elevator. Skin and subcutaneous tissue were dissected bluntly from the underlying musculature of the upper lip. A frenuloplasty was performed to lengthen the upper lip. Both levator labii superioris muscles were dissected and divided.


RESULTS
The postoperative course was uneventful in all of the patients. The mean gingival exposure before surgery was 5.22 +/- 1.48 mm; 6 months after surgery, it was 1.91 +/- 1.50 mm. The mean gingival exposure reduction was 3.31 +/- 1.05 mm (p < 0.001), ranging from 1.59 to 4.83 mm.


CONCLUSIONS
This study shows that the proposed technique was efficient in reducing the amount of exposed gum during smile in all patients in this series.
Ishida
Luis H
LH
São Paulo, Brazil From the Division of Plastic Surgery, University of São Paulo.
Ishida
Luiz C
LC
Ishida
Jorge
J
Grynglas
Julio
J
Alonso
Nivaldo
N
Ferreira
Marcus C
MC
D000293:Adolescent; D000328:Adult; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D008046:Lip / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult
Tjan AH, Miller GD, The JG. Some esthetic factors in a smile. J Prosthet Dent. 1984;51:24–28.
Peck S, Peck L, Kataja M. Some vertical lineaments of lip position. Am J Orthod Dentofacial Orthop. 1992;101:519–524.
Ezquerra F, Berrazueta MJ, Ruiz-Capillas A, Arregui JS. New approach to the gummy smile. Plast Reconstr Surg. 1999;104:1143–1150.
Monaco A, Streni O, Marci MC, Marzo G, Gatto R, Giannoni M. Gummy smile: Clinical parameters useful for diagnosis and therapeutical approach. J Clin Pediatr Dent. 2004;29:19–25.
Robbins JW. Differential diagnosis and treatment of excess gingival display. Pract Periodontics Aesthet Dent. 1999;11:265–272.
Abramoff MD, Magelhaes PJ, Ram SJ. Image processing with ImageJ. Biophotonics Int. 2004;11:36–42.
Dong JK, Jin TH, Cho HW, Oh SC. The esthetics of the smile: A review of some recent studies. Int J Prosthodont. 1999;12:9–19.
Garber DA, Salama MA. The aesthetic smile: Diagnosis and treatment. Periodontology 1996;11:18–28.
Levine RA, McGuire M. The diagnosis and treatment of the gummy smile. Compend Contin Educ Dent. 1997;18:757–62.
Miskinyar SA. A new method for correcting a gummy smile. Plast Reconstr Surg. 1983;72:397–400.
Rees TD. The lip-tip-columella complex and alar base. In: Rees TD, La Trenta GS, eds. Aesthetic Plastic Surgery. 2nd ed. Philadelphia: Saunders; 1994:245–292.
Edwards JG. A clinical study: The diastema, the frenum, the frenectomy. Oral Health 1977;67:51–62.
Hwang WS, Hur MS, Hu KS, et al. Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod. 2009;79:70–77.
Polo M. Botulinum toxin type A in the treatment of excessive gingival display. Am J Orthod Dentofacial Orthop. 2005;127:214–218.
Niamtu J III. Botox injections for gummy smiles. Am J Orthod Dentofacial Orthop. 2008;133:782–783.
Ellenbogen R, Swara N. The improvement of the gummy smile using the implant spacer technique. Ann Plast Surg. 1984;12:16–24.
Rubin LR, Mishriki Y, Lee G. Anatomy of the nasolabial fold: The keystone of the smiling mechanism. Plast Reconstr Surg. 1989;83:1–10.