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The aim of the current study is to evaluate the use of a PEEK shell placed in the anterior maxilla placed by tunnel technique in decreasing the gingival display
While lip repositioning has been established as a treatment modality to address excess gum display (EGD) , an often overlooked contributing factor is the lack of lip support. This is often caused by the architecture of the maxilla at the subnasal area. Maxillary overgrowth may give rise to a subnasal skeletal depression producing decreased lip support and marked upper lip retraction during a smile.
Restricting muscle pull by lip repositioning surgery as a treatment option limits muscle movement, however it does not address lip support. In 2018 an alternative intervention was later proposed in a case report study . The technique involves raising a full thickness flap and applying PMMA (polymethyl methacrylate) cement to fill the subnasal depression and limit the upper lip movement. Since its introduction, a limited number of studies have attempted to investigate the technique, however there are not enough studies to support the outcome or the stability of the technique. The aim of the current study is to evaluate the use of a tunnel technique with a 3D printed PEEK (Polyetherether ketone) shell to fill the skeletal subnasal depression
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PEEK shell in the anterior maxilla inserted by tunnel technique | Experimental | use of a minimally invasive tunnel technique to fill the skeletal subnasal depression with a PEEK shell in patients with an exaggerated subnasal depression associated with lack of lip support and excessive lip translation |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| tunnel technique with a 3D printed PEEK shell to fill the skeletal subnasal depression | Other | The area will be anesthetized using infiltration technique with 1.5ml of anesthetic solution containing Articaine Hydrochloride 68 mg/1.7 ml with Adrenaline 0.017 mg/1.7 ml Two bilateral full thickness vertical incisions will be created using a #15 blade. One on each side of the frenum A subperiosteal tunnel connecting the two vertical incisions will be created using a periosteal elevator/tunneling knife until the complete communication between the two ends is established The custom made PEEK framework will be inserted from the incision on one side and eased through until it sits in the subnasal concavity. Once fitted in place the shell will be fixed in place using two mini screws bilaterally, one on each side. The two vertical incisions will be closed by interrupted sutures 6-0 Polyglycolic acid suture material |
| Measure | Description | Time Frame |
|---|---|---|
| Gingival display | measured using a periodontal probe in millimeters | Day 0 - Month 3 - Month 6 |
| Measure | Description | Time Frame |
|---|---|---|
| lip translation | measured using a periodontal probe in millimeters | Day 0 - Month 3 - Month 6 |
| profile angle | lateral cephalometric xray |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Farah Mamdouh | Cairo | 11835 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29262052 | Background | Brizuela M, Ines D. Excessive Gingival Display. 2023 Mar 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK470437/ | |
| Background | El-Bokle, Dalia & Ghany, Amany. (2022). A sequential diagnostic scheme for excessive gingival display (Gummy Smile). AJO-DO Clinical Companion. 2. 10.1016/j.xaor.2022.05.003 | ||
| 36766919 |
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2025
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|
| Day 0 - Month 6 |
| lip length | measured using a periodontal probe in millimeters | Day 0 - Month 3 - Month 6 |
| patient satisfaction | measured by a binary Questionnaire ( yes or no) | Day 7 |
| Post operative pain | Measured by the visual analogue scale ( 0 no pain, 10 worst pain) | Day 7 |
| blinded esthetic assessment | measured by a binary scale (yes or no) | Month 3- Month 6 |
| Background |
| Impellizzeri A, Palmigiani R, Horodynski M, D'alfonso T, Polimeni A, De Stefano A, Galluccio G. Is There a Correlation between Gingival Display and Incisal Inclination in a Gummy Smile? Study on Cephalometric Parameters. Healthcare (Basel). 2023 Jan 25;11(3):344. doi: 10.3390/healthcare11030344. |
| 15554398 | Background | 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 Fall;29(1):19-25. doi: 10.17796/jcpd.29.1.y01l3r4m06q3k2x0. |
| Background | Toth, J. M. (2012). Biocompatibility of Polyaryletheretherketone Polymers. PEEK Biomaterials Handbook, 81-92. doi:10.1016/b978-1-4377-4463-7.10007-7 |
| 34970460 | Background | Freitas de Andrade P, Meza-Mauricio J, Kern R, Faveri M. Labial Repositioning Using Print Manufactured Polymethylmethacrylate- (PMMA-) Based Cement for Gummy Smile. Case Rep Dent. 2021 Dec 21;2021:7607522. doi: 10.1155/2021/7607522. eCollection 2021. |
| 30029078 | Background | Arcuri T, da Costa MFP, Ribeiro IM, Barreto BD Junior, Lyra eSilva JP. Labial repositioning using polymethylmethracylate (PMMA)-based cement for esthetic smile rehabilitation-A case report. Int J Surg Case Rep. 2018;49:194-204. doi: 10.1016/j.ijscr.2018.07.008. Epub 2018 Jul 17. |
| Background | ASSENZA, B. & Carinci, Francesco & CRISTINZI, A. & Sinjari, Bruna & Murmura, Giovanna & Scarano, Antonio. (2011). A COSMETIC TECHNIQUE CALLED LIP REPOSITIONING IN PATIENT OF EXCESSIVE GINGIVAL DISPLAY. European Journal of Inflammation. 9. 115-119. |
| 32111273 | Background | Dym H, Pierre R 2nd. Diagnosis and Treatment Approaches to a "Gummy Smile". Dent Clin North Am. 2020 Apr;64(2):341-349. doi: 10.1016/j.cden.2019.12.003. Epub 2020 Jan 24. |
| 35136324 | Background | Saleem R, Kukreja BJ, Goyal M, Kumar M. Treating short upper lip with "Unified lip repositioning" technique: Two case reports. J Indian Soc Periodontol. 2022 Jan-Feb;26(1):89-93. doi: 10.4103/jisp.jisp_90_20. Epub 2022 Jan 1. |