The Predictability of Laser Assisted Lip Repositioning: A New Evaluation Clinical Scoring Esthetic Scale

Case Report

Austin J Surg. 2020; 7(3): 1251.

The Predictability of Laser Assisted Lip Repositioning: A New Evaluation Clinical Scoring Esthetic Scale

Hala H Hazzaa1*, Gasser M Elewa2 and Sherin A Ali3

1Professor of Oral Medicine, Diagnosis and Periodontology, Faculty of Oral and Dental Medicine, Al Azhar University (Girls Branch), Egypt

2Consultant of Laser Applications in Dentistry, General Organization for Teaching Hospitals and Institutes, Egypt

3Associate Professor of Oral Medicine, Diagnosis and Periodontology, Faculty of Dentistry, Tanta University, Egypt

*Corresponding author: Hala H Hazzaa, Professor of Oral Medicine, Diagnosis and Periodontology, Faculty of Oral and Dental Medicine, Al Azhar University (Girls Branch), Cairo, Egypt

Received: July 03, 2020; Accepted: July 28, 2020; Published: August 04, 2020

Abstract

Objective: Lip Repositioning is an invasive surgical method used for correcting the Gummy Smile (GS). Postsurgical relapse is an additional problem that needs to be addressed. Therefore, this bifold6-months study was first conducted to evaluate the Laser-Assisted Lip Repositioning (LALR) as a predictable approach when used in the treatment of patients with hyperactive lip. Additionally, EGD was assessed by a novel Clinical Scoring Esthetic Scale (CSES).

Patients and Methods: This clinical trial was performed on 20 cases with GS using LALR. Esthetic outcomes were assessed using CSES at baseline and 6 months after surgery. This score blindly evaluates the percentages (%) of Excessive Gum Display Difference (EGDD) in each patient. The clinical Evaluation of 5 Lay Persons (ELP) was additionally considered to the display zone of every patient’s spontaneous smile; using a % esthetic scale (0 to 100) by comparing the pre- and post-operative photographs. The EGDD value was added to the % ELP values, then; divided by 2 and the resulting % indicated the clinical grading that was assigned from 1 to 5; with score 1 = Excellent while score 5 = Poor clinical outcome.

Results: The mean scores of CSES of our patients revealed a significant reduction (2.21 ± 1.281) (P-Value ≤ 0.05) at 6-months.

Conclusion: This preliminary clinical report showed predictable results of the laser-assisted lip repositioning technique. The CSES system may be a useful tool to assess the esthetic outcome following lip repositioning procedures.

Keywords: Gummy Smile; Satisfaction; Relapse; Diode Laser

 

Introduction

Excessive Gingival Display (EGD), commonly termed Gummy Smile (GS), is a condition characterized by an overexposure of the maxillary gingiva while smiling [1,2]. Although the degree of unattractiveness varies between populations, a gingival excess of more than 3 mm is agreed upon worldwide [1-3], with female predominance [4]. GS may result from a single discrepancy, but is more commonly the result of the interplay of multiple factors may be broadly defined as dento-alveolar and nondento-alveolar. Dento-alveolar discrepancies include factors that affect dentition in the form of short clinical crowns, gingival hypertrophy or hyperplasia, altered passive eruption, and extrusion. Nondento-alveolar discrepancies involve Vertical Maxillary Excess (VME) and hyperactive, incompetent, or short lip [5].

Lip Repositioning (LR) procedure was first described in 1973by Rubinstein and Kostianovsky [6] as part of medical plastic surgery. The technique involves a single partial thickness elliptical incision in the depth of the anterior maxillary vestibule and aims to limit smile muscle pull (zygomaticus minor, Levator anguli, orbicularis oris, and levator labii superioris) by reducing the depth of the upper vestibule.

However, the classical LR resulted in increased patient morbidity owing to the scalpel being utilized to remove the strip of the labial mucosa and the frenum. The use of a scalpel resulted in bleeding with decreased visibility in the operatory ?eld, postoperative swelling, and bruising [7], in addition to the postoperative relapse. Several modifications have been therefore introduced to the classical LP approach to improve its clinical outcome, and to minimize its morbidity [8-10]. In this regard, laser-assisted excision serves as an alternate option and provides immediate hemostasis thereby reducing the incidence of hematoma [11]. Although laser assisted approach seems promising in our point of research; literature is sparse related to the clinical application and results obtained [12,13].

Overall, the treatment of GS is mainly indicated for esthetic reasons, to achieve the “Ideal Smile” and patient’s satisfaction. Thus, every effort should be done to give the best chance for our patients to enhance the final esthetic outcomes. However, the esthetic assessment is mainly subjective and might be influenced by cultural background. An objective esthetic evaluation is therefore required to assess the outcomes of plastic surgeries. Taken together, this novel and bifold clinical trial aimed to assess the Laser Assisted Lip Repositioning (LALR) as a predictable method for treating GS-cases; and to additionally propose a Clinical Scoring Esthetic Scale (CSES) as an assessment system for the esthetic outcomes following post-treatment.

Patients and Methods

Study Population

This study was conducted on 20 patients who were treated by LALR during the period from January 2018 to April 2019. Participants were selected from the outpatient clinics of the Oral Medicine and Diagnosis department, Faculty of Oral and Dental Medicine, Al-Azhar University for girls, Egypt; with a common chief complaint of EGD on smiling, with natural anterior dentition and periodontal health. The protocol of the study was approved by the ethical committee of Al-Azhar University for Girls, Egypt.

Extra- and intra-oral examinations were prepared to ensure the suitability of the participants to the study protocol.

Inclusion Criteria

Smokers, pregnant and lactating patients were excluded from this study. In addition, patients with excessive VME were excluded [15].

Preoperative Procedures

Preoperative clinical photographs were taken for each participant. The exact conditions were recorded to ensure reproducibility for postsurgical photographs. The taken photographs included frontal and profile view of relaxed and maximum smile and close-up of lips relaxed and in maximum spontaneous smile.

Measurements of EGD were taken at the maximum smile, and relaxed smile were recorded using a graduated periodontal probe starting from the free gingival margin till the upper lip border.

All participants were asked to fill out preoperative questionnaires to record their own assessment of their smile and later asked to fill out the same questionnaire at the end to record any changes in self-assessment, and evaluate any postoperative complications.

The protocol of the study was explained to all the participating patients, written informed consent was obtained from each case. As part of the routine protocol, oral prophylaxis was done and oral hygiene instructions were given for all the participants. The laser parameters were listed in (Table 1).

Surgical Procedures