title: Improving gingival smile by means of guided bone regeneration principles.
abstract: OBJECTIVE
  This study evaluated the effectiveness of guided bone regeneration (GBR) carried out with xenogenic bone substitute (Bio-OssTM) and collagen resorbable membrane (Bio-GideTM) to improve gingival smile (GS) in patients with excessive vertical maxillary growth (EVMG).
  
  
  METHODS
  Twelve healthy women aged between 20 and 49 years old (mean age of 26 years), with 5 mm or more of gingival exposure during fully posed smile (FPS) due to EVMG, were included. Baseline digital photographs were taken with standardized head position at rest and FPS. In eight out of 12 cases, crown lengthening procedure was indicated and the initial incision was made 2 to 4 mm from the gingival margin. In four cases, with no indication for crown lengthening procedure, a sulcular incision was performed. GBR was performed in all cases, using micro screws and/or titanium mesh associated with Bio-OssTM and Bio-GideTM. After 10 days, sutures were removed. Recall appointments were scheduled at 1, 6, and 12 months when standardized photographs were again taken. ImageToolTM software was used to measure the gingival exposure (GE) during FPS from the standardized close-up smile photographs at baseline and 12 months.
  
  
  RESULTS
  GE mean at baseline was 275.44 mm2. After 12 months, patients who undergone exclusively GBR procedure, presented GE reduction of 40.7%, ∆ = 112.01 mm2 (statistically significant, p = 0.12), and patients who had crown lengthening associated with the graft had a reduction of 60%, ∆ = 167.01 mm2.
  
  
  CONCLUSIONS
  Our results using GBR to improve GS in cases of EVMG showed an exceptionally high patient acceptance and satisfaction. One-year follow-up confirmed stable results.
authors.affiliation: State University of New York, Buffalo, New York, USA.
authors.forename: Carlos Eduardo de Almeida
authors.initials: CE
authors.lastname: Ferreira
authors.affiliation: Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
authors.forename: Roberto Carlos Bodart
authors.initials: RC
authors.lastname: Brandão
authors.affiliation: São Leopoldo Mandic, Campinas, São Paulo, Brazil.
authors.forename: Carolina Borges
authors.initials: CB
authors.lastname: Martinelli
authors.affiliation: Universidade Estadual Paulista, Araraquara, São Paulo, Brazil.
authors.forename: Túlio Bonna
authors.initials: TB
authors.lastname: Pignaton
mesh_terms: D000328:Adult; D001861:Bone Regeneration; D001863:Bone Screws; D018786:Bone Substitutes / Q000627:therapeutic use*; D004955:Esthetics, Dental; D005260:Female; D005881:Gingiva / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008437:Maxilla / Q000254:growth & development; D008875:Middle Aged; D017060:Patient Satisfaction; D019252:Radiography, Dental, Digital; D012904:Smiling; D013526:Surgical Mesh; D055815:Young Adult
chemical_list: D018786:Bone Substitutes