Comparison Between Lip Repositioning and Muscle Traction Technique in Treatment of Gummy Smile

Controlled Randomized Clinical Trial of Containment of the Elevator Muscle of Upper Lip and Wing of Nose Technique Versus Conventional Lip Repositioning for Treatment of Gummy Smile

The goal of this clinical trial is to compare and evaluate the effectiveness of conventional and modified lip repositioning for the treatment of gummy smile.

The main question it aims to answer:

Which of these treatment modalities (conventional lip repositioning and containment of the elevator muscle of the upper lip and wing of nose (EMULWN)) has the most durable and least relapse in the treatment of gummy smile?"

Researchers will compare:

1. The primary outcome was the decrease in excessive gingival display by measuring smile line (gingival display) and smile index before and after treatment modalities.
2. The The secondary outcome was to measure the durability and possibility of relapse over 6 months after treatment with high patient satisfaction.

For patients seeking long-term correction of excessive gingival displays, there are different treatment modalities. Both lip repositioning and muscle traction techniques showed improvement in the decrease in the amount of gingival display, while the containment surgery of the muscle of the upper lip and wing of the nose showed durable and satisfactory esthetics with less patient discomfort and less pain immediately after the procedure and needs more time to study or may need some modification. Also, lip repositioning showed satisfactory results to the patients but with more pain immediately after the procedure.

Inclusion Criteria:

1. Adult patients aged between 18 and 38 years.
2. Gummy smile ranging between 4 and 6 mm, due to short upper lip and hyperactive lip elevator muscles (lip mobility >8 mm).
3. Good periodontal health based on the examination of the gingival inflammation index, bleeding index, and probing the depth of gingival pockets.
4. Healthy patients or people with well-controlled systemic disease.

Exclusion Criteria:

1. Smokers.
2. Pregnant or lactating women.
3. Less than 3 mm of attached gingiva that might create difficulties in flap design, stabilization, and suturing.
4. Vertical maxillary excess of more than 6 mm.
5. Poorly controlled systemic diseases that preclude local anesthesia.
6. Altered passive eruption, which needs gingivectomy or an apically positioned flap.
7. Skeletal causes of gummy smile as protruded maxilla.