Does Lip-Repositioning Surgery Improve Long-Term Smile Outcome and Dental Esthetics in Patients With Excessive Gingival Display? A Review of the Current Literature.

Focused Clinical Question: In patients with normal crown dimensions and excessive gingival display, does lip-repositioning surgery improve long-term smile outcome and dental esthetics? Clinical Scenario: A 27-year-old systemically healthy female presents with the chief complaint of "excessive gingival display when smiling" (Fig. 1). She reports that orthodontic treatment was performed and that she was referred for orthognathic surgery to correct the maxillary vertical excess and altered passive eruption. Clinically, the patient is periodontally healthy with favorable long-term periodontal prognosis. She is unsatisfied with her smile and states that it is "compromising her self-esteem." However, she refuses to accept the orthognathic surgery because of the extensiveness and morbidity of the procedure. She inquires about alternative solutions for her esthetic problem and whether it is possible to solve her gummy smile with a less invasive procedure. Lip-repositioning and anatomic crown-lengthening surgeries are presented as treatment options. The patient decides to pursue these treatment options. Lip-repositioning surgery is performed as described by Rosenblatt and Simon and Simon et al., and healing is uneventful. Anatomic crown lengthening is performed 6 months after the previous surgery. The patient is pleased with the reduction of the excessive gingival display after these procedures (Fig. 2). However, there is lack of clinical evidence regarding the long-term stability of this surgical procedure.