Facial profile changes due to bone cement graft to manage the hyperactive muscles of the gingival smile.

OBJECTIVE: To evaluate facial profile changes promoted by polymethyl methacrylate (PMMA) cement graft to reduce excessive gingival display due to hyperactivity of the elevator muscles of the upper lip during smiling. METHODS: Eleven patients (all females, age range: 20 to 43 years) presenting gingival smile that were treated with PMMA cement grafts in a private clinic were selected for this retrospective study. Three angular and ten linear cephalometric facial profile measurements were performed preoperatively (baseline, T1) and at least 6 months postoperatively (T2). Differences between T1 and T2 were verified by Wilcoxon test, and the correlation between the thickness of the graft and facial profile changes was statistically evaluated by Spearman's Coefficient test. The significance level was set at p< 0.05. RESULTS: The nasolabial angle (p= 0.03) and the labial component of the nasolabial angle showed statistically significant differences (p= 0.04), with higher values in T2. No correlations were found between the graft thickness and the statistically significant facial profile changes (p> 0.05). CONCLUSIONS: The PMMA bone cement graft projected the upper lip forward, thereby increasing the nasolabial angle without affecting the nasal component. No correlations between the graft thickness and the facial profile changes were detected.

Four-year follow-up of a polymethyl methacrylate-based bone cement graft for optimizing esthetics in maxillary anterior implants: a case report.

Tooth loss promotes bone and gingival tissue remodeling, thus breaking the harmony between the residual ridge and natural teeth. This is critical in the anterior region of the mouth, and the integration of several dental specialties is often essential to successful rehabilitation with implants. This article describes a multidisciplinary approach to implant-supported oral rehabilitation in the maxillary anterior region, presenting a new technique for optimizing esthetics in implants. A 19-year-old woman was missing her central and lateral incisors and had 2 dental implants in the lateral incisor sites. The patient exhibited deficient thickness of the alveolar edge, loss of lip support, and absence of gingival architecture, and the implants were improperly placed. A multidisciplinary team created a correct emergence profile through a polymethyl methacrylate-based bone cement graft along with connective tissue grafts. This technique may be a useful therapeutic adjunct in dental implantology, showing good predictability and regular healing procedures.

Reposicionamento labial com cimento ortopédico associado a aumento estético de coroa clínica / Lip repositioning by application of bone cement associated with esthetic crown lengthening

O sorriso gengival é uma causa comum de insatisfação entre os pacientes. Em alguns casos, o lábio superior pode não ter suporte ósseo adequado na dinâmica do sorriso, encurtando-se ao se alojar em uma depressão óssea no fundo de vestíbulo, em sorrisos mais amplos ou mesmo durante a fala. Este artigo descreve um tratamento inovador, indicado em casos de falta de suporte labial causado por depressão óssea no fundo de vestíbulo: o aumento estético de coroa clínica e reposicionamento labial com cimento ortopédico...

Gingival smile is a common reason of disatisfaction between patients. In some cases, the upper lip may not have adequate bone support when smiling, and gets shrinked as it lodges in the sub-nasal bone depression, whether in an open smile or when the patient is speaking. This paper describes a novel treatment indicated for cases of lacking support of the upper lip caused by a sub-nasal bone depression: clinical crown lengthening associated with lip repositioning using bone cement...