Alternative to Aesthetic treatment for Gummy Smile Acosta,H. DDS 1 ; Villavicencio, LM. DDS 2 ;Peña M.E. DDS, MSD,

3

Universidad Autónoma de Querétaro, México

Introduction

Discussion

Treatment sequence • • • • •

There are different causes of the gingival smile, as well as the ways of treating it • Orthognathic surgery • Orthodontics • Positioning of lip • Gingivectomy • Osteotomy

•

Digital design Diagnostic wax-up and surgical guide Gingivectomy-Osteotomy 5-12 (+2mm) new wax up Preparation of veneers 6-11 (-3mm incisal edge reduction) Cementation of feldspathic veneers

With the digital analysis/design we obtained: • acceptance of the patient • final measures for the surgical Guide • Proportion for veneers • a size and shape guide for the laboratory

Conclusion

a diagnostic mistake could lead to unsatisfactory results. it is of great importance to determine the etiology of a gummy smile and it can be solved through crown lengthening and bone surgery

Digital design 2 mm

Initial

10mm

8 mm

3mm

3 mm

3 mm

2 mm 9.5 mm

2 mm

Periodontal surgery

2 mm

Wax Up

Lab work

Initial

References 1.Silberberg N. , Goldstein M., Smidt A. Excessive gingival display- Etiology, diagnosis and treatment modalities, Quintessence Int 2009;40:809-818 2.Magne, P., & Belser, U. (2002). Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Quintessence Publishing Company. 3.Chiche, G. J., & Aoshima, H. (2004). Smile design: a guide for clinician, ceramist, and patient. Quintessence Publishing Company. 4.Chiche, G., & Pinault, A. (1994). Artistic and scientific principles applied to esthetic dentistry. Esthetics of anterior fixed prosthodontics. Chicago: Quintessence Books, 13-32. 5.Cohen, E. S. (2007). Atlas of cosmetic and reconstructive periodontal surgery. PMPH-USA. 6.Fradeani, M. (2004). Esthetic analysis: a systematic approach to prosthetic treatment (Vol. 1). Quintessence Publishing (IL). 7.Benedetti, R., & Santos-Morales, R. I. (2008). Treatment of altered passive eruption: periodontal plastic surgery of the dentogingival junction. Eur J Esthet Dent, 3, 212-223.

Preparations

2 mm

10mm

8 mm

Final

3mm 8.Calixto, Arellano F. (2015). Erupción pasiva alterada, tratamiento prótesis-perio. IMORA 9.Coachman, C., et al. Smile design: From digital treatment planning to clinical reality. Interdisciplinary Treatment Planning, 2, 119-174. 10.Espín, C. V., & Buendía, M. D. C. L. (2013). Tratamiento interdisciplinario de paciente con sonrisa gingival: Reporte de un caso. Revista odontológica mexicana, 17(1), 51-56. 1.- Resident postgraduate oral rehabilitation, UAQ 2.- Professor of oral rehabilitation postgraduate, UAQ 3.- Coordinator of postgraduate of oral rehabilitation, UAQ