Lip repositioning with a myotomy of the elevator muscles for the management of a gummy smile

BACKGROUND: Excessive gingival display ≥4 mm is commonly referred to as a "gummy smile", which is caused by several different etiologies and can be corrected using various techniques. Therefore, the etiology of a gummy smile dictates the most appropriate treatment approach. OBJECTIVES: The aim of this study was to evaluate the surgical lip repositioning technique (a full-thickness flap with a myotomy of the elevator muscles) in the management of a gummy smile in the range of 4-6 mm, caused by soft tissue disorders (short upper lip, hyperactive lip elevator muscles). MATERIAL AND METHODS: A prospective study was conducted between April 2016 and May 2017. Fourteen adult patients, aged 18-38 years, with a gummy smile of 4-6 mm, caused by soft tissue disorders were included in the study. All patients were treated by the surgical lip repositioning technique (a full-thickness flap with a myotomy of the elevator muscles) in the Department of Oral and Maxillofacial Surgery at Damascus University, Syria. The amount of gingival display in a full smile and complications after surgery were evaluated in the current study. RESULTS: The results were as follows: the mean amount of gingival display in a full smile was 6.36 mm preoperatively, after 1 month postoperatively - 0.91 mm, after 3 months - 2.27 mm, after 6 months - 2.45 mm. The post-surgery complications were as follows: the infection did not appear in any patient, flap dehiscence appeared in 2 patients (14.2%), numbness appeared in 9 patients (64.2%). Pain recurrences varied between mild pain in 5 patients (35.7%) and moderate pain in 3 patients (21.4%). CONCLUSIONS: The proposed surgical lip repositioning technique showed effectiveness in reducing the amount of gingival display in a full smile through postoperative follow-up periods. All the postoperative complications are temporary and fade within a short period after the surgical procedure, making lip repositioning a safe surgical technique.