Gummy Smile과 과개교합을 동반한 II급 부정교합 환자의 미니스크루를 이용한 비발치 교정치료

강시원 대한치과교정학회 2021 대한치과교정학회 임상저널 Vol.11 No.1

Gummy smile is a clinical condition that refers to excessive gingival display during smile, which is often accompanied by vertical dentoalveolar excess in the anterior region. With orthodontic miniscrews, three-dimensional total arch movement, including intrusion without side effects on the anchor tooth can be achieved. But proper biomechanical understanding and careful monitoring are required to design an appropriate force system and to prevent unwanted side effects. An 18-year-old girl presented with chief complaints of gummy smile and crowding. She showed a deep bite and skeletal Class II relationship. The patient was treated with total arch intrusion and distalization using two maxillary inter-premolar orthodontic miniscrews which provided biomechanically effective force system to correct the gummy smile. Counter-clockwise autorotation of the mandible was also obtained improving her facial profile.

잇몸과다노출미소의 새로운 교정 방법: 상순거근봉양술

한기환,박병주 대한성형외과학회 2002 Archives of Plastic Surgery Vol.29 No.3

For decades, many surgical techniques have been devised for correction of the gummy smile including mucosal resection, myectomy, the implant spacer technique, and osseous shortening of the alveolar-maxillary complex in case of vertical maxillary excess. However there are several problems in those techniques: the mucosal resection and the myectomy tends to recur, there would be the morbidity of the implant in the implant spacer technique, and the osseous shortening of the alveolar-maxillary complex is a procedure for the long face syndrome. Our technique is freeing the levator labii suprioris muscles and cinching them to the anteroinferior nasal septal cartilage for loss of muscle action. Seventeen patients(14 females and 3 males; mean age, 24 years) underwent operations. Preoperative photogrammetric analysis indicated the range of gum exposure when smiling was 2.0-9.0mm(mean, 3.8mm) and the maxillary lip length in repose was 17.0-29.0mm(mean, 23.1mm). Three to 31 months(mean, 12 months) after the operation, the results were analysed using the Wilcoxon signed ranks test. The postoperative gum exposure was ranged 0.0-4.0mm(mean, 0.4mm) (-3.4mm, p<0.05). And the maxillary lip length was elongated about 4%(+1.0 mm, p<0.05). Results were also analyzed clinically by the ordinary scale method. The gum exposure when smiling was excellent and the nature of the smile was good. Upper lip stiffness developed in all patients, but resolved completely within 1 month after the operatio. Hypesthesia of the upper lip was noted in 8 cases, but also disappeared within 2 months. Additionally, this technique resulted in narrowing of the interalar distance. Our technique is effective in correcting a gummy smile, but would not be recommended for patients with an abnormally narrow interalar distance.

잇몸이 노출된 미소의 교정술

김영진,신극선,김규호 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.4

What is called "gummy smile" is that the lip retraction is too extreme and it exposes all of the incisors plus a large portion of gum above and that is felt by many patients to be unaesthetics. A simple procedure is described to correct this unpleasant smile and the procedure consists of segmental resection of levator labii superioris muscle more than 1㎝ in length. We have operated on five patients of gummy smile with levator segmental myectomy in four cases and combined with mucosal excision in one case. The patients were followed up from 1 month to 3 months with mean periods of 2 months and operative results were satisfactory except one case who had temporary paresthesiain the upper lip for 1 month.

상악의 수직적 과잉과 Gummy Smile을 동반한 장안모 돌출 환자에서 효율적인 수직조절 치료전략

강시원(Si-Won Kang) 대한치과교정학회 2022 대한치과교정학회 임상저널 Vol.12 No.2

In the treatment of a hyperdivergent patient, making sufficient facial change without surgery is challenging because the chin is retrusive, rotated backwardly. The patient may be still protrusive after the treatment if sagittal retraction is only performed. Since the mandible moves in a rotational manner, vertical control can result in significant sagittal correction in profile through the autorotation of the mandible. Since the orthodontic mini-implant is a very effective tool for vertical control, especially, for intrusion, it can play a crucial role in making facial change for a hyperdivergent patient. A 24-year-old girl was presented with chief complaints of protrusion and gummy smile. Her profile showed protrusion, lip incompetency and very retrusive chin. She showed excessive gingival display during smiling. Her diagnosis included skeletally hyperdivergent Class II pattern, anteriorly and vertically excessive maxilla. The patient was treated with total arch intrusion in maxilla and mandible using two orthodontic mini-implants for each arch. Total arch intrusion in both arches created counter-clockwise autorotation of the mandible which dramatically improved her profile. Intrusion in the maxillary anterior region decreased excessive gingival display and made an attractive smile for the patient.

일부 여대생의 구강 및 안모상태와 치은노출(Gummy smile)과의 상관성

소미현 ( Mi Hyun So ) 한국치위생학회 2012 한국치위생학회지 Vol.12 No.2

Objectives : The author has studied about correlation of gingival exposure upon smiling and oral facial status that reduce facial aesthetic. Methods : The subjects in this study are 91 female vulunteers who were in aged 21.4±1.89 in Suwon. Objectives should be normal oral and facial status without the prosthodontic, orthodontic appliance or conqenital missing tooth, and agree to be examined the oral status and impression taking. 1.Measure the length of gingival exposure upon smiling. 2.Measure of the size on central incisor. 3.Measure of Facial. SPSS(SPSS 10.0 for windows, SPSS Inc, Chicago, USA) was utilized for calculating the correlation coefficient between gingival exposure upon smiling and facial status. Regression analysis was calculated in order to predict the R square for gingival exposure upon smiling. Results : 1.Correlation coefficient between the gingival exposure and length of maxillary central incisor was calculated as reversed correlation(r=-.302, p<0.01), and between the gingival exposure and the ratio of the length of central incisor/width of central incisor was revealed as reversed correlation(r=-.250, p<0.05) on smiling. 2.There was correlation between the gingival exposure and the facial height(r=.351, p<0.01), mandibular height(r=.327, p<0.01) and the lower facial height(r=0.454, p<0.01) upon smiling. 3.There was correlation between the gingival exposure and the ratio of the facial height/facial width(r=.358, p<0.05), the ratio of the upper facial height/facial width(r=.214, p<0.05), and the ratio of the lower facial height/facial height(r=.383, p<0.01) upon smiling. 4.The equation of the regression analysis for gingival exposure upon smiling could be estimated as gingival exposure upon smiling=-5.319+.279×lower facial height-.615×maxillary central incisal length-.05×nasolabial angle. Conclusions : Considering these results, it recommended that treatment planning should be designed in consideration of such factors as the length of maxillary central incisor, facial height, upper lip height and lower facial height, in order to promote the easthetic problems of face on smiling.

Nonsurgical correction of a severe anterior deep overbite accompanied by a gummy smile and posterior scissor bite using a miniscrew-assisted straight-wire technique in an adult high-angle case

Xue-Dong Wang,Jie-Ni Zhang,Da-Wei Liu,Fei-fei Lei,Yan-Heng Zhou 대한치과교정학회 2016 대한치과교정학회지 Vol.46 No.4

In the present report, we describe the successful use of miniscrews to achieve vertical control in combination with the conventional sliding MBT<SUP>TM</SUP> straightwire technique for the treatment of a 26-year-old Chinese woman with a very high mandibular plane angle, deep overbite, retrognathic mandible with backward rotation, prognathic maxilla, and gummy smile. The patient exhibited skeletal Class II malocclusion. Orthodontic miniscrews were placed in the maxillary anterior and posterior segments to provide rigid anchorage and vertical control through intrusion of the incisors and molars. Intrusion and torque control of the maxillary incisors relieved the deep overbite and corrected the gummy smile, while intrusion of the maxillary molars aided in counterclockwise rotation of the mandibular plane, which consequently resulted in an improved facial profile. After 3.5 years of retention, we observed a stable, well-aligned dentition with ideal intercuspation and more harmonious facial contours. Thus, we were able to achieve a satisfactory occlusion, a significantly improved facial profile, and an attractive smile for this patient. The findings from this case suggest that nonsurgical correction using miniscrew anchorage is an effective approach for camouflage treatment of high-angle cases with skeletal Class II malocclusion.

Altered passive eruption으로 인해 gummy smile을 보이는 증례에서 적용되는 심미적 치관 연장술: 임상증례

박주언 ( Ju Un Park ) 조선대학교 구강생물학연구소 2005 Oral Biology Research (Oral Biol Res) Vol.29 No.3

Treatment of excessive gingival display using modified lip repositioning technique with esthetic crown lengthening: Case reports

( Gwi-hyeon Min ),( Sang-joun Yu ),( Byung-ock Kim ),( Won-pyo Lee ) 조선대학교 구강생물학연구소 2018 Oral Biology Research (Oral Biol Res) Vol.42 No.2

Excessive gingival display that can be seen when a person smiles can cause non-esthetic problem. This gummy smile is mainly caused by an altered passive eruption, bony maxillary excess, and excessive maxillary lip mobility. Thus far, an altered passive eruption has been successfully treated using esthetic crown lengthening. Recently, an alternative to orthognathic surgery has been proposed for the treatment of a gummy smile. Studies using a lip repositioning procedure have actively been performed. In this report, we present three cases of treatment for excessive gingival display using the modified lip repositioning technique associated with esthetic crown lengthening.

Esthetic Crown Lengthening

김광효,Kim, Kwang Hyo 대한심미치과학회 2017 Journal of the Korean Academy of Esthetic Dentistr Vol.26 No.2

Excessive gingival display의 원인은 다양하며 원인에 따라 치료방법은 다르지만, 여기서는 gingiva와 alveolar bone이 치아면을 과도하게 덮고 있는 경우에 어떻게 치료하는가에 관해 다루고자 한다. 이것은 gummy smile의 가장 흔한 원인이며 필자의 임상경험을 토대로 그것에 대한 treatment protocol과 guideline을 체계적으로 설명하고자 한다. The causes of excessive gingival display vary, and treatment methods differ depending on the cause. Here, we will discuss how to treat gingiva and alveolar bone in the event of excessive covering of the tooth surface. This is the most common cause of gummy smile and I will systematically explain the treatment protocol and guideline based on my clinical experience.

보툴리눔독소 A를 이용한 잇몸 웃음 교정 시 올바른 주사 위치에 대한 연구

김영진,전영준,배준성 대한미용성형외과학회 2006 Archives of Aesthetic Plastic Surgery Vol.12 No.2

Gummy smile refers to the excessive exposure of the upper gum when a one smiles, more than 2-3 mm, accompanying the elevation of upper lip. Recently, it is of an increasing concern that the injection of botulinum toxin A to levator labii superioris alaeque nasi muscle and levator labii superioris muscle which are major lip-elevating muscles, has the corrective effect by weakening of these muscles. It is important to understand anatomical marker of the targeted muscle to which safe and effective injection can be performed. This study was performed to investigate the marker to find the targeted muscle easily applicable in practice by reviewing previous literatures. From January 2004 to May 2005, on 5 females that have a gummy smile, we marked injection points to the target muscle, and confirmed their effectivity, accuracy, and safety by EMG. Then we injected botulinum toxin A, and investigate amount of the gum exposure when smiles and occurrence of the side effect serially. 4 weeks after injection, we observed satisfied result without any side effects. Conclusively, as injection points of botulinum toxin A which we presented, are comparatively correct by anatomy, they are easily applicable in practice.