Lip reposition surgery: A new call in periodontics
A 35-year-old female patient reported to the outpatient department of Periodontics and Oral Implantology, Ahmedabad Dental College and Hospital with the chief complaint of excessive gingival display. The patient was apparently asymptomatic except the embarrassment of going in public due to gummy smile. On examination, she had an excessive gingival display of around 8-10 mm extending from maxillary right first molar (16) to maxillary left first molar (26). Furthermore, marginal gingival discrepancy was reported in relation to maxillary right central incisor (11) and maxillary left central incisor (21) along with short clinical crowns. The patient's medical history was non-contributory and there was no contraindication to surgical treatment.\nThe treatment suggested and performed were:\nSurgical crown lengthening[] in relation to maxillary right lateral incisor (12) to maxillary left lateral incisor (22) Surgical lip repositioning procedure for correction of a gummy smile.\nSurgical technique was performed after following complete aseptic precautions. Standard skin preparation was carried out by 10% povidone-iodine solution and temporary draping was done. Local infiltration was done using local anesthetic solution Lignox® (2% Lignocaine with 1:200,000 Adrenaline) in the vestibular mucosa and lip extending from right first molar to left first molar.\nThe surgical area was outlined using an indelible pencil. The procedure was initiated with a 15 no Bard-Parker blade by giving a partial-thickness incision following the mucogingival junction extending from right first premolar (14) to left first premolar (24). Followed by the first incision, another second horizontal incision parallel to first was made in the labial mucosa 10-12 mm apical to mucogingival junction. These two incisions were connected at each end by creating an elliptical pattern []. The partial-thickness flap was excised leaving the underlying connective tissue exposed to the oral cavity []. It is noteworthy that the amount of partial-thickness flap excised should be either double the amount of gingival display that needs to be reduced or a maximum of 10-12 mm tissue excision in order to prevent the involvement of labial minor salivary glands severing of which may lead to the formation of mucocele.\nComplete hemostasis should be attained by pressure pack. Henceforth, parallel incised margins were approximated with an interrupted stabilization suture using Vicryl® 5-0 at the midline to ensure proper alignment of the midline of the lip with that of the teeth []. Multiple interrupted sutures at a distance of 1 mm were taken on either side of the midline suture to approximate the flap margins.\nNon-steroidal anti-inflammatory drugs (Tablet Ibuprofen 400 mg 4 times a day for 3 days) along with oral antibiotics (Capsule Amoxicillin 500 mg 3 times a day for 7 days) were prescribed post-operatively. Patient was instructed to use ice packs immediate post-operatively for few hours with intermittent application on the upper lip and to minimize lip movement while smiling and talking. Patient was recalled for follow-up after a week.\nPost-operative symptoms included mild pain and swelling with feeling of tension on the upper lip while smiling. Sutures were removed after 2 weeks. The site healed uneventfully with scar formation at the suture line, which was concealed under the lip and was not apparent when the patient smiled.\nThis esthetic procedure is safe and has minimal side-effects. The patient was recalled after every 3 months for follow-up. The patient was highly pleased and satisfied with the esthetic outcome [Figures -].