Impact of orthognathic surgery on the treatment of gummy smile: an integrative review
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REVIEW ARTICLE
Impact of orthognathic surgery on the treatment of gummy smile: an integrative review Amanda Felix Gonçalves Tomaz 1 & Liliane Cristina Nogueira Marinho 1 & Ana Rafaela Luz de Aquino Martins 1 & Ruthineia Diógenes Alves Uchoa Lins 1 & Bruno César de Vasconcelos Gurgel 1 Received: 11 December 2019 / Accepted: 29 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The gingival smile is considered unpleasant and can be treated in different ways according to its etiological factor. When caused by maxillary vertical growth excess, orthognathic surgery may be indicated to correct the vertical excess. The aim of this integrative review was to evaluate the impact of orthognathic surgery on the treatment of gingival smile. An electronic search was performed of the PubMed/Medline, Cochrane Library, Scopus, and Google Scholar databases. The selection of studies was performed by two blinded reviewers. Firstly, studies were selected by reading the titles and the abstracts of articles. The references from each study selected were then searched to find articles that were not found in the electronic search. After reading the full-text articles, studies that met the inclusion criteria were selected. A total of 667 studies were identified, but only 19 were selected for the integrative review after applying the inclusion and exclusion criteria. The selected articles reported maxillary impaction from 2 to 10 mm, but this amount of superior repositioning of maxilla does not appear to be related to the initial gingival exposure described. Orthognathic surgery is not the first choice of treatment for gingival smile, but it appears to be a suitable therapy for other conditions in the same patient for improving a gummy smile by correction of gingival exposure. Keywords Orthognathic surgery . Dental esthetics . Maxillary osteotomy . Maxilla
Introduction Numerous patients attend dental surgeries with requests for improvements in smile aesthetics, and the gummy smile has become an aspect that has generated great concern for dentists, in general, since it constitutes a major aesthetic complaint. Gingival excess is classified by the American Academy of Periodontology (AAP, 2017) as a mucogingival deformity and condition around the teeth and is classified as “other conditions affecting the periodontium”. It is widely accepted that gingival exposure of up to 3 mm is aesthetically acceptable and that slight gum exposure may be considered attractive [1, 2]. Other authors point out that an exposure of more than 2 mm of gum during a smile constitutes
* Amanda Felix Gonçalves Tomaz [email protected] 1
Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
a gingival smile and its etiology is related to several factors such as; maxillary vertical excess, altered passive eruption of the upper anterior teeth, hyperfunction of the upper lip levator muscles, superior dentoalveolar protrusion, or an association of these factors [2–4]. For this reason
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