PMC4795143_01
Extraoral initial front view showing 5 mm gingival display at smiling
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F1
After clinical examination, a 5 mm gingival display during smile was detected [Figures 1 and 2].
Extraoral initial lateral view showing 5 mm gingival display at smiling
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F2
After clinical examination, a 5 mm gingival display during smile was detected [Figures 1 and 2].
Intraoral initial view demonstrating irregular gingival contour and teeth with quadratic shape
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F3
Gingival contour was irregular, with some teeth presenting disproportionate crown height/width ratio and quadratic shape [Figure 3].
Horizontal incision from the midline to the first molar
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F4
At last, a horizontal incision, parallel to the first one and linking the vertical incisions previously performed [Figure 4], was made.
Epithelium removed, exposing the connective tissue
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F5
The outlined mucosa was removed, exposing the underlying connective tissue [Figure 5].
Epithelium removed on both sides of the maxilla
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F6
The procedure was repeated on the left side [Figure 6] and continuous interlocking sutures (polyglactin 910 5/0) were used to stabilize the mucosa to the gingiva [Figure 7].
Mucosa stabilization and suture
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F7
The procedure was repeated on the left side [Figure 6] and continuous interlocking sutures (polyglactin 910 5/0) were used to stabilize the mucosa to the gingiva [Figure 7].
Healing 60 days after lip repositioning surgery
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F8
After 2 months [Figure 8], esthetic crown lengthening surgery was made by means of gingivectomy followed by flap elevation and ostectomy/osteoplasty.
Inverted bevel incision following cementoenamel junction anatomy from #15 to #25
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F9
Subsequently, an inverted bevel incision was made following CEJ anatomy, from tooth #15 to #25 [Figure 9], followed by intra-sulcular incision, removal of outlined marginal gingiva [Figure 10], and mucoperiosteal flap dissection [Figure 11].
Outlined marginal gingival tissue removed
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F10
Subsequently, an inverted bevel incision was made following CEJ anatomy, from tooth #15 to #25 [Figure 9], followed by intra-sulcular incision, removal of outlined marginal gingiva [Figure 10], and mucoperiosteal flap dissection [Figure 11].
Mucoperiosteal flap dissection
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F11
Subsequently, an inverted bevel incision was made following CEJ anatomy, from tooth #15 to #25 [Figure 9], followed by intra-sulcular incision, removal of outlined marginal gingiva [Figure 10], and mucoperiosteal flap dissection [Figure 11].
Ostectomy and osteoplasty made with hand instruments leaving a distance of 2 mm between cementoenamel junction and alveolar bone crest
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F12
Instruments (#2 Fedi and #36/37 Rhodes chisels) were used for ostectomy and osteoplasty aiming to leave a distance of 2 mm between CEJ and ABC [Figure 12].
Flap repositioned and stabilized with vertical mattress sutures
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F13
To finish the procedure, mattress suture (poligalactina 910 5/0) was used for flap stabilization [Figure 13].
Postoperative view 9 months after lip repositioning and 7 months after esthetic crown lengthening
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F14