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CC BY 4.0 · Eur J Dent 2024; 18(03): 950-956
DOI: 10.1055/s-0044-1785535
Case Report

Digital Planning to Enhance Diagnosis and Precision in Correcting Excessive Gingival Display in the Presence of Asymmetrical Maxillary Position: A Case Report

Isabella Neme Ribeiro Reis 
1   Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
,
Gabriel Bittencourt Damin
1   Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
,
Camilla Rodrigues Pereira 
1   Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
,
Matheus de Alencar Ichigi 
1   Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
,
Luiza Orsi Caminha Sant'Anna 
1   Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
,
Rubens Spin-Neto 
2   Department of Dentistry and Oral Health, Section for Oral Radiology, School of Dentistry, Aarhus University, Aarhus, Denmark
,
Giuseppe Alexandre Romito 
1   Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Abstract

This case report addresses the treatment of excessive gingival display (EGD) in the context of maxillary asymmetry, zenith irregularities, and occlusal plane inclination. Digital planning was pivotal in formulating a precise treatment strategy by incorporating facial photographs, digital models, and cone-beam computed tomography data. Parameters, including occlusal plane inclination, teeth position, and lip-to-gingival margin relationships, were considered to ensure treatment alignment with the patient's facial characteristics. Notably, during the planning phase, it was evident that the conventional approach using the cementoenamel junction as the apical limit for incisions would result in asymmetry. Consequently, the gingival margin position was defined in accordance with facial and lip features. The chosen treatment, flapless crown lengthening, was tailored to the patient's thin phenotype and guided by measurements derived from digital planning. Postsurgery, the patient experienced a swift and painless recovery. A harmonious smile with a stable gingival margin position was achieved at the 1-year follow-up, seamlessly complementing the patient's facial attributes. This case underscores the importance of personalized EGD treatment and the value of digital planning in enhancing diagnostic accuracy and precise treatment planning, ultimately facilitating optimal treatment strategies.

Keywords

gummy smile - excessive gingival display - aesthetics - digital planning - digital smile design


Publikationsverlauf

Artikel online veröffentlicht:
14. Mai 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop 2006; 130 (02) 141-151
    CrossrefPubMedSuche in Google Scholar
  • 2 Antoniazzi RP, Fischer LS, Balbinot CEA, Antoniazzi SP, Skupien JA. Impact of excessive gingival display on oral health-related quality of life in a Southern Brazilian young population. J Clin Periodontol 2017; 44 (10) 996-1002
    CrossrefPubMedSuche in Google Scholar
  • 3 Malkinson S, Waldrop TC, Gunsolley JC, Lanning SK, Sabatini R. The effect of esthetic crown lengthening on perceptions of a patient's attractiveness, friendliness, trustworthiness, intelligence, and self-confidence. J Periodontol 2013; 84 (08) 1126-1133
    CrossrefPubMedSuche in Google Scholar
  • 4 Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am 1988; 32 (02) 307-330
    CrossrefPubMedSuche in Google Scholar
  • 5 Aroni MAT, Pigossi SC, Pichotano EC, de Oliveira GJPL, Marcantonio RAC. Esthetic crown lengthening in the treatment of gummy smile. Int J Esthet Dent 2019; 14 (04) 370-382
    PubMedSuche in Google Scholar
  • 6 Dym H, Pierre II R. Diagnosis and treatment approaches to a “Gummy Smile”. Dent Clin North Am 2020; 64 (02) 341-349
    CrossrefPubMedSuche in Google Scholar
  • 7 Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontol 2000 2018; 77 (01) 65-83
    CrossrefPubMedSuche in Google Scholar
  • 8 Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan 1977; 70 (03) 24-28
    PubMedSuche in Google Scholar
  • 9 Arias DM, Trushkowsky RD, Brea LM, David SB. Treatment of the patient with gummy smile in conjunction with digital smile approach. Dent Clin North Am 2015; 59 (03) 703-716
    CrossrefPubMedSuche in Google Scholar
  • 10 Carrera TMI, Freire AEN, de Oliveira GJPL. et al. Digital planning and guided dual technique in esthetic crown lengthening: a randomized controlled clinical trial. Clin Oral Investig 2023; 27 (04) 1589-1603
    CrossrefPubMedSuche in Google Scholar
  • 11 Alazmi SO. Three dimensional digitally designed surgical guides in esthetic crown lengthening: a clinical case report with 12 months follow up. Clin Cosmet Investig Dent 2022; 14: 55-59
    CrossrefPubMedSuche in Google Scholar
  • 12 Nourah D. Digital smile makeover: a multidisciplinary team approach. Eur J Dent 2023; 17 (04) 1349-1355
    Thieme ConnectPubMedSuche in Google Scholar
  • 13 Borges GJ, Ruiz LF, de Alencar AH, Porto OC, Estrela C. Cone-beam computed tomography as a diagnostic method for determination of gingival thickness and distance between gingival margin and bone crest. ScientificWorldJournal 2015; 2015: 142108
    CrossrefPubMedSuche in Google Scholar
  • 14 Pedrinaci I, Calatrava J, Flores J, Hamilton A, Gallucci GO, Sanz M. Multifunctional anatomical prototypes (MAPs): treatment of excessive gingival display due to altered passive eruption. J Esthet Restor Dent 2023; 35 (07) 1058-1067
    CrossrefPubMedSuche in Google Scholar
  • 15 Jafri Z, Ahmad N, Sawai M, Sultan N, Bhardwaj A. Digital smile design-an innovative tool in aesthetic dentistry. J Oral Biol Craniofac Res 2020; 10 (02) 194-198
    CrossrefPubMedSuche in Google Scholar
  • 16 Sousa Dias N, Tsingene F. SAEF - Smile's Aesthetic Evaluation form: a useful tool to improve communications between clinicians and patients during multidisciplinary treatment. Eur J Esthet Dent 2011; 6 (02) 160-176
    PubMedSuche in Google Scholar
  • 17 Trushkowsky R, Arias DM, David S. Digital smile design concept delineates the final potential result of crown lengthening and porcelain veneers to correct a gummy smile. Int J Esthet Dent 2016; 11 (03) 338-354
    PubMedSuche in Google Scholar
  • 18 Tumenas I, Ishikiriama SM. Planejamento estético integrado em Periodontia / Dentística. In: Cardoso RJA, Gonçalves EAN. Estética. São Paulo: Artes Médicas; 2002. : 251–81
    Suche in Google Scholar
  • 19 Gateño J, Jones TL, Shen SGF. et al. Fluctuating asymmetry of the normal facial skeleton. Int J Oral Maxillofac Implants 2018; 47 (04) 534-540
    CrossrefPubMedSuche in Google Scholar
  • 20 Choi KY. Analysis of facial asymmetry. Arch Craniofac Surg 2015; 16 (01) 1-10
    CrossrefPubMedSuche in Google Scholar
  • 21 Stanley M, Paz AG, Miguel I, Coachman C. Fully digital workflow, integrating dental scan, smile design and CAD-CAM: case report. BMC Oral Health 2018; 18 (01) 134-141
    CrossrefPubMedSuche in Google Scholar
  • 22 do Vale Voigt M, Espíndola-Castro LF, de Melo Monteiro GQ, Ortigoza LS, Dos Santos Torreão A, Georg R. DSDapp use for multidisciplinary esthetic planning. J Esthet Restor Dent 2020; 32 (08) 738-746
    CrossrefPubMedSuche in Google Scholar
  • 23 Khurshid Z. Digital dentistry: transformation of oral health and dental education with technology. Eur J Dent 2023; 17 (04) 943-944
    Thieme ConnectPubMedSuche in Google Scholar