Introduction:
One of the most common esthetic complaints among dental patients is a gingival smile, which may be of multifactorial etiology, e.g. gingival hyperplasia, skeletal deformities featuring overgrowth of the anterior maxilla, altered passive eruption, maxillary alveolar tooth extrusion, fine lip and hypermobility of lip elevator muscles, which must be diagnosed prior to treatment so that the appropriate management approach can be selected. Maxillary overgrowth may give rise to subnasal skeletal depression where the upper lip retracts to during smiling, causing gingival exposure. The objective of this case report was to describe a lip repositioning technique using polymethylmethacrylate (PMMA)-based bone cement for esthetic smile rehabilitation.
Case report:
A 23-year-old female attended the Esthetic Dentistry Clinic of our institute, reporting dissatisfaction with her smile, due to the size of her teeth and the amount of gingiva exposed when smiling. A rehabilitation planning was designed, which was performed with periodontal surgical intervention to fill the subnasal depression with PMMA-based bone cement. After crown lengthening, the PMMA-based bone cement was prepared with gentamicin in a sterile surgical bowl. When the mixture stopped sticking to the surgical gloves, it was then positioned into the subnasal pit, under constant and copious saline irrigation. With the cement in place, the prosthesis was shaped in a maximum thickness of 7-mm. After complete polymerization and under abundant cooling, refinement and finishing of the PMMA prosthesis was performed. The prosthesis was fixed onto the bone with two titanium-based bone graft fixation screws. The smile aesthetic rehabilitation was complemented using 10 lithium disilicate-based ceramic veneers.
Discussion and conclusion:
PMMA-based bone cement proved effective when combined to clinical crown lengthening for esthetic smile rehabilitation, acting as a filling material for subnasal depression, providing new lip support.