Management of Excess Gingival Display Using Tunnel Technique With 3D Designed PEEK Shell: A Case Series

Not Applicable

Recruiting

Interventions: Other: tunnel technique with a 3D printed PEEK shell to fill the skeletal subnasal depression

Brief Summary: The aim of the current study is to evaluate the use of a PEEK shell placed in the anterior maxilla placed by tunnel technique in decreasing the gingival display

Detailed Description: While lip repositioning has been established as a treatment modality to address excess gum display (EGD) , an often overlooked contributing factor is the lack of lip support. This is often caused by the architecture of the maxilla at the subnasal area. Maxillary overgrowth may give rise to a subnasal skeletal depression producing decreased lip support and marked upper lip retraction during a smile.

Restricting muscle pull by lip repositioning surgery as a treatment option limits muscle movement, however it does not address lip support. In 2018 an alternative intervention was later proposed in a case report study . The technique involves raising a full thickness flap and applying PMMA (polymethyl methacrylate) cement to fill the subnasal depression and limit the upper lip movement. Since its introduction, a limited number of studies have attempted to investigate the technique, however there are not enough studies to support the outcome or the stability of the technique. The aim of the current study is to evaluate the use of a tunnel technique with a 3D printed PEEK (Polyetherether ketone) shell to fill the skeletal subnasal depression

Recruitment & Eligibility

Inclusion Criteria

Patients with excess gingival display 2.5mm or more
Patients with an exaggerated subnasal concavity
Decreased/low normal value of SNA ( angle between sella, nation, A point) in cephalometric measurement
Decreased/low normal cephalometric measurement of A to N-perpendicular (perpendicular from N on FHP)
Decreased/low normal value in cephalometric measurement of the convexity at point A (linear measurement from point A to facial plane)
Decreased/low normal value of Ricketts Esthetic plane in cephalometric measurement
Decreased/low normal value of Holdaway H-angle in cephalometric measurement
Nasolabial angle range from 100° to 120°
Patients 20-60 years old
Medically free
Compliant patient that agrees to the follow up period

Exclusion Criteria

Patients with flared upper incisors in lateral cephalometric X-ray
Pregnant and lactating females
Smokers
Diabetics
Patients with parafunctional habits that may affect the outcome of the procedure
Medically compromised patients

Arm && Interventions

Group	Intervention	Description
PEEK shell in the anterior maxilla inserted by tunnel technique	tunnel technique with a 3D printed PEEK shell to fill the skeletal subnasal depression	use of a minimally invasive tunnel technique to fill the skeletal subnasal depression with a PEEK shell in patients with an exaggerated subnasal depression associated with lack of lip support and excessive lip translation

Primary Outcome Measures

Name	Time	Method
Gingival display	Day 0 - Month 3 - Month 6	measured using a periodontal probe in millimeters

Secondary Outcome Measures

Name	Time	Method
Post operative pain	Day 7	Measured by the visual analogue scale ( 0 no pain, 10 worst pain)
profile angle	Day 0 - Month 6	lateral cephalometric xray
lip translation	Day 0 - Month 3 - Month 6	measured using a periodontal probe in millimeters
blinded esthetic assessment	Month 3- Month 6	measured by a binary scale (yes or no)
patient satisfaction	Day 7	measured by a binary Questionnaire ( yes or no)
lip length	Day 0 - Month 3 - Month 6	measured using a periodontal probe in millimeters

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