correction of gummy smile by invasive and minimally invasive technique

Not yet recruiting

• Conditions: Systemically healthy subjects with gummy smile

• Registration Number: CTRI/2022/11/047354
• Lead Sponsor: Varsha Rani Soni

Brief Summary

Public esthetic awareness iscentered on an attractive smile, and excess gingival display is a frequentcomplaint from patients seeking to improve their appearance. Excessive gingivaldisplay is widespread condition that adversely affects the aesthetic of thesmile.1 The aetiology may be due to skeletal, muscular ordentogingival abnormalities including elongated maxilla, short and/orhypertonic maxillary lips, dentoalveolar compensation Angle’s Class II or ClassIII occlusion and Altered Passive Eruption (APE). 2

Themost common aetiology is altered passive eruption.3 Goldman &Cohen (1968), defined altered or retarded passive eruption as a situation inwhich the gingival margin in the adult is located incisal to the cervicalconvexity of the crown and removed from the cemento–enamel junction of thetooth.4

Althoughthe increasing demand for improving aesthetics is becoming an important part ofthe current practice of periodontal surgery, the medical literature related tothe treatment of the gingival smile is still insufficient, incoherent, and notsupported by the necessary statistical analysis.There are varioustreatment modalities for excessive gingival display which include liprepositioning, crown lengthening, botulinum toxin-A injections and orthognathicsurgeries. The treatment of choice for altered passive eruption is crownlengthening.

Accordingto Glossary of Periodontal terms (2001), crown lengthening is a surgicalprocedure devised to increase the extent of supragingival tooth structure forrestorative or esthetic purpose, or combination of both by apically positioningthe gingival margin, removing supporting bone, or both.5 Thisprocedure reduce the excessive gingival tissue, expose the desirable clinicalcrown, and re-establish the appropriate biologic width. Several surgicaltechniques were proposed most of them include apically repositioning flap withosseous surgery or gingivectomy for the treatment of excessive gingivaldisplay. Conventional open flap generally include elevation of full thicknessflap to access and recontour the bone crest to preserve the biologic width. Thedisadvantages of this technique are, often time-consuming, may cause pain,bleeding, post operative morbidity, gingival tissue rebound and require suture.6The surgical techniques that include flap elevation

 cause more coronal displacement of the gingivalmargin.7 Therefore, more effective and less invasive treatmentmodalities are needed.

The advantages of minimally invasivetechniques are to alleviate post treatment side effects, accelerate healing,and avoid bone resorption caused by the elevation of full thickness flap.8The flapless technique is considered to be a promising alternative approach andis a suture-less, atraumatic, and  lessinvasive technique that has been shown to increase patient satisfaction andcomfort.1

Piezosurgery is proposed as a minimallyinvasive surgical procedure include high precision, a design that increasesease of curvilinear osteotomy, less trauma to soft tissue, preservation ofneurological and vascular structures, promote neo-osteogenesis, reducedhemorrhage that improves viability in working area, minimal thermal damage tothe bone, as well as overall improvement of healing.9

The traditional techniques and instruments ofopen flap approach have many drawbacks. In this scenario, it is considerednecessary that further research into the different methods for crownlengthening should be carried out to produce more effective and satisfyingresults. Therefore, the purpose of this study is to compare the open flapapproach and minimally invasive flapless approach in aesthetic crownlengthening for the treatment of altered passive eruption by piezosurgery

Detailed Description

Not available

Study Timeline

• Last Update Posted: 2022-11-14
• Study Start: 2022-11-22

Recruitment & Eligibility

• Status: Not Yet Recruiting
• Sex: All
• Target Recruitment: 15

Inclusion Criteria

• 1.Patients with excessive gingival display due to Altered Passive Eruption (Type 1B) in at least three maxillary teeth (central incisors, lateral incisors, canines, or premolars) per half contralateral quadrant 2.Age more than or equal to 18 years 3.No sites with clinical attachment loss 4.
• No sites with probing depth >3 mm 5.
• Systemically healthy subjects.

Exclusion Criteria

Pregnant and lactating women Habit of tobacco use (smoked and smokeless) Use of an orthodontic appliance Previous periodontal surgery in the same area Prosthesis on treated teeth Antibiotics or anti-inflammatory therapies during the last three months.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Flapless approach would be showing better clinical results in correcting Altered Passive Eruption when compared to Open Flap approach	6 months

Secondary Outcome Measures

Name	Time	Method
Flapless approach is minimally invasive, with no requirement of suture, this would show better acceptance by the patients	6 months

Trial Locations

Locations (1)

Government Dental College Raipur; 🇮🇳 Raipur, CHHATTISGARH, India

Government Dental College Raipur

🇮🇳Raipur, CHHATTISGARH, India

Dr Varsha Rani Soni

Principal investigator

8889651606

aanmol.soni@gmail.com