Simultaneous Esthetic Crown Lengthening and Frenotomy Procedure for Smile Rejuvenation
Abstract
Introduction: Gingival tissue plays an important role in smile aesthetics, especially in the anterior maxillary region. A gummy smile (GS) is a gingival condition that appears excessive when the patient smiles. The prevalence of gummy smile in individuals aged from 20 to 30 is 10% of population. It is more common in women and can cause aesthetic problems. Gummy smile aetiology is multifactorial. This case report discusses gummy smile case caused by altered passive eruption (APE) and associated with the presence of aberrant frenum. Case Report: A 19-year-old female patient with chief complaints of the excessive gingival display. The diagnosis of the case was confirmed by clinically healthy gingiva in an intact periodontium with gummy smile due to the presence of altered passive eruption type I-B accompanied by an aberrant frenum. The final surgical plan was aesthetic crown lengthening (CL) with flap surgery and osteotomy simultaneous with a frenotomy. Conclusion: The aesthetic crown lengthening surgery and frenotomy can be performed simultaneously to correct the gummy condition and improve the patient’s smile profile. Appropriate examination, diagnosis, and treatment planning help achieve optimal patient outcomes.
References
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Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am. 1988;32(2):307–30.
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Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89 Suppl 1:S204–13.
Wijaksana IKE. Perio Dx: Periodontal Sehat, Gingivitis & Periodontitis. Surabaya: Airlangga University Press; 2020. p. 37-42.
Feblina AR, Thahir H. Manajemen Gummy Smile; Sebuah Tinjauan Pustaka. B-Dent J Kedokt Gigi Univ Baiturrahmah. 2021;8(2):138–45.
Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontol 2000. 2018;77(1):65–83.
Andijani RI, Tatakis DN. Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile. J Periodontol. 2019;90(3):256–62.
Volchansky A, Cleaton-Jones PE. Delayed passive eruption. A predisposing factor to Vincent’s infection. J Dent Assoc S Afr. 1974;29(5):291–4.
Nart J, Carrió N, Valles C, et al. Prevalence of Altered Passive Eruption in Orthodontically Treated and Untreated Patients. J Periodontol. 2014;85(11):e348–53.
Aghazada R, Marini L, Zeza B, et al. Experimental gingivitis in patients with and without altered passive eruption. J Periodontol. 2020;91(7):938–46.
Pilloni A, Marini L, Zeza B, Ferlosio A, Aghazada R. Histologic Analysis of Clinically Healthy Human Gingiva in Patients with Altered Passive Eruption. Dent J. 2021;9(3):29–37.
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Winda DA, Amalia M, Sally SK, Abidin T. Crown Lengthening dan Frenektomi Pada Daerah Estetik (Laporan Kasus). Cakradonya Dent J. 2021;13(2):114–9.
Ong M, Tseng S-C, Wang H-L. Crown Lengthening Revisited. Clin Adv Periodontics. 2011;1(3):233–9.
Duruel O, Erduran NE, Tözüm TF. A Modification for Treatment of Excessive Gingival Display: Tooth-Based Lip-Repositioning Technique. Int J Periodontics Restorative Dent. 2020;40(3):457–61.
Gibson MP, Tatakis DN. Treatment of Gummy Smile of Multifactorial Etiology: A Case Report. Clin Adv Periodontics. 2017;7(4):167–73.
Lee EA, others. Aesthetic crown lengthening: classification, biologic rationale, and treatment planning considerations. Pr Proced Aesthet Dent. 2004;16(10):769–78.
Aristiyanto R, Ratih DN. Functional Crown Lengthening: Biological Width Correction. J Indones Dent Assoc. 2020;3(1):43–6.
Tianmitrapap P, Srisuwantha R, Laosrisin N. Flapless Er,Cr:YSGG laser versus traditional flap in crown lengthening procedure. J Dent Sci. 2022;17(1):89–95.
Marcantonio ACM, de Oliveira GJPL, Scardueli CR, Marcantonio CC, Marcantonio RAC, Marcantonio E. Minimally Invasive Surgery for Clinical Crown Lengthening Using Piezoelectric Ultrasound. Seymour K, editor. Case Rep Dent. 2020;2020:1–6.
Joly JC, Mesquita CPF, Carvalho SR. Flapless aesthetic crown lengthening: A new therapeutic approach. Rev Mex Periodontol. 2011;2(3):103–8.
Ribeiro F V, Hirata DY, Reis AF, et al. Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol. 2014;85(4):536–44.
Bose S, Mandal S, Gupta S, Chakrabarty H, Prakash B S D, Chakraborty A. Flapless Esthetic Crown Lengthening (FECL): A New Curative Advancement. Int J Med Sci Curr Res. 2020;3(6):59–63.
Capodiferro S, Tempesta A, Limongelli L, Barile G, Di Venere D, Corsalini M. Minimally invasive (flapless) crown lengthening by erbium:YAG laser in aesthetic zone. F1000Research. 2020;9:1185–95.
Ulfah N, Wijaksana IKE. Gummy Smile Treatment by Aesthetic Crown Lengthening on Altered Passive Eruption Case. Acta Med Philipp. 2021;55(8):860–4.
Moura D, Lima E, Lins R, Souza R, Martins A, Gurgel B. The treatment of gummy smile: integrative review of literature. Rev Clin periodoncia, Implantol Rehabil oral. 2017;10(1):26–8.
Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am. 1988;32(2):307–30.
Mercado-García J, Rosso P, Gonzalvez-García M, Colina J, Fernández JM. Gummy Smile: Mercado-Rosso Classification System and Dynamic Restructuring with Hyaluronic Acid. Aesthetic Plast Surg. 2021;45(5):2338–49.
Jepsen S, Caton JG, Albandar JM, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89 Suppl 1:S237–48.
Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018;89 Suppl 1:S204–13.
Wijaksana IKE. Perio Dx: Periodontal Sehat, Gingivitis & Periodontitis. Surabaya: Airlangga University Press; 2020. p. 37-42.
Feblina AR, Thahir H. Manajemen Gummy Smile; Sebuah Tinjauan Pustaka. B-Dent J Kedokt Gigi Univ Baiturrahmah. 2021;8(2):138–45.
Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontol 2000. 2018;77(1):65–83.
Andijani RI, Tatakis DN. Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile. J Periodontol. 2019;90(3):256–62.
Volchansky A, Cleaton-Jones PE. Delayed passive eruption. A predisposing factor to Vincent’s infection. J Dent Assoc S Afr. 1974;29(5):291–4.
Nart J, Carrió N, Valles C, et al. Prevalence of Altered Passive Eruption in Orthodontically Treated and Untreated Patients. J Periodontol. 2014;85(11):e348–53.
Aghazada R, Marini L, Zeza B, et al. Experimental gingivitis in patients with and without altered passive eruption. J Periodontol. 2020;91(7):938–46.
Pilloni A, Marini L, Zeza B, Ferlosio A, Aghazada R. Histologic Analysis of Clinically Healthy Human Gingiva in Patients with Altered Passive Eruption. Dent J. 2021;9(3):29–37.
Cohen ES. Altered Passive Eruption: The Gummy Smile. In: Atlas of cosmetic and reconstructive periodontal surgery. 3 rd. BC Decker Inc; 2007. p. 259–69.
Winda DA, Amalia M, Sally SK, Abidin T. Crown Lengthening dan Frenektomi Pada Daerah Estetik (Laporan Kasus). Cakradonya Dent J. 2021;13(2):114–9.
Ong M, Tseng S-C, Wang H-L. Crown Lengthening Revisited. Clin Adv Periodontics. 2011;1(3):233–9.
Duruel O, Erduran NE, Tözüm TF. A Modification for Treatment of Excessive Gingival Display: Tooth-Based Lip-Repositioning Technique. Int J Periodontics Restorative Dent. 2020;40(3):457–61.
Gibson MP, Tatakis DN. Treatment of Gummy Smile of Multifactorial Etiology: A Case Report. Clin Adv Periodontics. 2017;7(4):167–73.
Lee EA, others. Aesthetic crown lengthening: classification, biologic rationale, and treatment planning considerations. Pr Proced Aesthet Dent. 2004;16(10):769–78.
Aristiyanto R, Ratih DN. Functional Crown Lengthening: Biological Width Correction. J Indones Dent Assoc. 2020;3(1):43–6.
Tianmitrapap P, Srisuwantha R, Laosrisin N. Flapless Er,Cr:YSGG laser versus traditional flap in crown lengthening procedure. J Dent Sci. 2022;17(1):89–95.
Marcantonio ACM, de Oliveira GJPL, Scardueli CR, Marcantonio CC, Marcantonio RAC, Marcantonio E. Minimally Invasive Surgery for Clinical Crown Lengthening Using Piezoelectric Ultrasound. Seymour K, editor. Case Rep Dent. 2020;2020:1–6.
Joly JC, Mesquita CPF, Carvalho SR. Flapless aesthetic crown lengthening: A new therapeutic approach. Rev Mex Periodontol. 2011;2(3):103–8.
Ribeiro F V, Hirata DY, Reis AF, et al. Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol. 2014;85(4):536–44.
Bose S, Mandal S, Gupta S, Chakrabarty H, Prakash B S D, Chakraborty A. Flapless Esthetic Crown Lengthening (FECL): A New Curative Advancement. Int J Med Sci Curr Res. 2020;3(6):59–63.
Capodiferro S, Tempesta A, Limongelli L, Barile G, Di Venere D, Corsalini M. Minimally invasive (flapless) crown lengthening by erbium:YAG laser in aesthetic zone. F1000Research. 2020;9:1185–95.
Published
2023-01-09
How to Cite
WIJAKSANA, I Komang Evan; PINATIH, Made Talitha Suryaningsih; KRISMARIONO, Agung.
Simultaneous Esthetic Crown Lengthening and Frenotomy Procedure for Smile Rejuvenation.
Journal of Indonesian Dental Association, [S.l.], v. 5, n. 2, p. 107-113, jan. 2023.
ISSN 2621-6175.
Available at: <http://jurnal.pdgi.or.id/index.php/jida/article/view/857>. Date accessed: 23 nov. 2024.
doi: https://doi.org/10.32793/jida.v5i2.857.
Section
Case Report
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
