Join me as I summarise Mona Ghoussoub’s lecture looking at the excessive gingival display (EGD).
Mona looked at the diagnosis and treatment of EGD, with a focus on aetiology leading to treatment method, effect of age, and input of multidisciplinary care for appropriate cases.
Definition Kokich 1999, Machado 2014
· Negative effects = 4mm + gingival display
Treatment approach
Early treatment
o Medical ENT allergology
o Excessive gingival show age 7-8 years
o Nasal obstruction causes decrease in lip closing force Sabashi 2011
o Detect and refer ENT if suspect nasal obstruction
§ Dark eyes
§ Flat cheeks
§ Increase LAFH
o Orthodontic – prevention
o Utility arch
§ Intrusion upper anterior teeth
§ 4 brackets and molar bands
§ Retain with 2 layers of Essix + brass wire – for rigidity
Late treatment
o Orthodontic
o Alignment
§ 2 occlusal planes in maxilla in 2 div 2, posterior higher, anterior lower
· Straight wire – reciprocal effects
o Intrusion of anterior teeth
o Extrusion of posterior teeth
o Expansion
§ RME
· Posterior expansion = gingival position moves upwards
o When constricted, greater posterior gingival show
o Intrusion
§ Ricketts / Burstone 3 piece intrusion arch
§ Headgear – J hook intrude upper anterior teeth
§ TAD placement for anterior intrusion
· UR1-UL1 labial
· Powerchain archwire to TAD
§ TAD for posterior intrusion
· U5-U6 region buccal
· Direct retraction U3- TAD
o Below centre of rotation = posterior intrusion
o MDT
o Periodontics
§ Gingivectomy – passive over-eruption of dentition
· Ideal where tooth width:height ratio increased
§ Guided Tissue Regeneration for VME
· Stable after 1 year
· 40-60% improvement in excessive gingival growth, with crown lengthening
· Bony cavity at anterior superior aspect of maxilla
o Results in the lip raising higher
o Bone augmented at the level of the Le-fort 1
o Can be clinically simulated with cotton wool rolls in upper labial sulcus and taking photos
o Orthognathic surgery
§ Decompensate
· Maxillary impaction
o Plastic surgery Pierre 2020
§ Short lip / mild VME = lip repositioning surgery Rubinstein 1973
· Limit the smile muscle pull by reducing the depth of the upper vestibule– zygomaticus minor, levator Angulo, orbicularis oris, levator labil superior Tawfik 2018
· Conservative when compared to OGN
· Technique
o Split thickness flap – expose connective tissue
o Advance mucosa and suture at mucogingival junction
· Limited studies
· Overcorrect as some relapse expected
· Systematic review improve EGD 3-4mm Tawfik 2018
§ Hypermobile lip – Botox Cengiz 2020
· Reduce muscle activity – levator labil superios LLSAN, zygomaticus minor / major, risorius muscle
· NOT classified as an alternate treatment for EGD
o Use = indication for patient outcomes possible for lip reposition
· Temporary effects – relapse at 6 months
· Problems
o Dose related results
o Excessive upper lip ptorsis
o Too little – not achieve desired result
o Smile effected if erroneous
§ = require expert to use
