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Gingivectomy with high-power laser for correction of the gummy smile resulting from altered passive eruption—a case series

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Abstract

To compare the efficacy between the surgical techniques of gingivectomy with high-power laser (HPL) and conventional gingivectomy for correction of a gummy smile (GS) due to altered passive eruption (APE). This was a case series of six female patients diagnosed with GS associated with APE. For the conventional gingivectomy procedure and for the one using the diode laser (808 nm, 2 W, in continuous mode), the six upper anterior teeth were divided into two groups (control (CG)—# 11, # 12, # 13, and test (TG)—# 21, # 22, # 23). Analyses of intraoperative bleeding and levels of pain and postoperative tissue repair were performed. The thermal pattern analysis was performed using infrared thermography. The level of significance was set at p < 0.05. There was no intraoperative bleeding in the TGs (p = 0.002). The CG showed tissue repair significantly better than the TG on the 14th postoperative day (p = 0.004). There were no statistically significant differences regarding the level of postoperative pain between the groups (p > 0.05). Regarding the thermographic analysis, there were also no statistically significant differences (p > 0.05). HPL gingivectomy was more effective, regarding the absence of intraoperative bleeding, while the conventional technique promoted better tissue repair. No significant differences were observed in the other parameters, possibly due to the minimal damage caused by gingivectomy, with either HPL or the conventional procedure, as there was no removal of bone tissue.

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References

  1. Antoniazzi RP, Fischer LS, Balbinot CEA, Antoniazzi SP, Skupien JA (2017) Impact of excessive gingival display on oral health-related quality of life in a Southern Brazilian young population. J Clin Periodontol 44(10):996–1002. https://doi.org/10.1111/jcpe.12753

    Article  PubMed  Google Scholar 

  2. Longo E, Frosecchi M, Marradi L, Signore A, de Angelis N (2019) Guided periodontal surgery: a novel approach for the treatment of gummy smile. A case report. Int J Esthet Dent 14(4):384–392

    PubMed  Google Scholar 

  3. Alammar A, Heshmeh O, Mounajjed R, Goodson M, Hamadah O (2018) A comparison between modified and conventional surgical techniques for surgical lip repositioning in the management of the gummy smile. J Esthet Restor Dent 30(6):523–531. https://doi.org/10.1111/jerd.12433

    Article  PubMed  Google Scholar 

  4. Mazzuco R, Hexsel D (2010) Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol 63(6):1042–1051. https://doi.org/10.1016/j.jaad.2010.02.053

    Article  CAS  PubMed  Google Scholar 

  5. Jha N, Ryu JJ, Wahab R, Al-Khedhairy AA, Choi EH, Kaushik NK (2017) Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: an introductory review. Oncotarget 12 8(12):20496–20509. https://doi.org/10.18632/oncotarget.14887

    Article  Google Scholar 

  6. Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M, Duarte PM (2014) Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol 85(4):536–544. https://doi.org/10.1902/jop.2013.130145

    Article  PubMed  Google Scholar 

  7. Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G (2018) Esthetic treatment of altered passive eruption. Periodontol 2000 77(1):65–83. https://doi.org/10.1111/prd.12206

    Article  PubMed  Google Scholar 

  8. Devi PK, Kumar GP, Bai YD, Ammaji AD (2013) Ipsilateral idiopathic gingival enlargement and it’s management using conventional gingivectomy and diode laser: a recurrent case after 15 years. J Indian Soc Periodontol 17(3):387–390. https://doi.org/10.4103/0972-124X.115649

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kumar P, Rattan V, Rai S (2015) Comparative evaluation of healing after gingivectomy with electrocautery and laser. J Oral Biol Craniofac Res 5(2):69–74. https://doi.org/10.1016/j.jobcr.2015.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  10. de Araújo JGL, Araújo EMDS, Rodrigues FCN, Paschoal MAB, Lago ADN (2019) High power laser and photobiomodulation in oral surgery: case report. J Lasers Med Sci 10(1):75–78. https://doi.org/10.15171/jlms.2019.12

    Article  PubMed  Google Scholar 

  11. Ortega-Concepción D, Cano-Durán JA, Peña-Cardelles JF, Paredes-Rodríguez VM, González-Serrano J, López-Quiles J (2017) The application of diode laser in the treatment of oral soft tissues lesions. A literature review. J Clin Exp Dent 9(7):e925–e928. https://doi.org/10.4317/jced.53795

    Article  PubMed  PubMed Central  Google Scholar 

  12. Amorim JC, de Sousa GR, de Barros SL, Prates RA, Pinotti M, Ribeiro MS (2006) Clinical study of the gingiva healing after gingivectomy and low-level laser therapy. Photomed Laser Surg 24(5):588–594. https://doi.org/10.1089/pho.2006.24.588

    Article  PubMed  Google Scholar 

  13. Brignardello-Petersen R (2020) Use of lasers seems to result in a small decrease in postoperative complications after labial frenectomy compared with scalpels. J Am Dent Assoc 151(5):e42. https://doi.org/10.1016/j.adaj.2019.12.006

    Article  PubMed  Google Scholar 

  14. Taher Agha M, Polenik P (2020) Laser treatment for melanin gingival pigmentations: a comparison study for 3 laser wavelengths 2780, 940, and 445 nm. Int J Dent 2020:3896386. https://doi.org/10.1155/2020/3896386

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Campos L, Gallottini M, Pallos D, Simões A, Martins F (2018) High-power diode laser on management of drug-induced gingival overgrowth: report of two cases and long-term follow-up. J Cosmet Laser Ther 20(4):215–219. https://doi.org/10.1080/14764172.2017.1400165

    Article  PubMed  Google Scholar 

  16. Lione R, Pavoni C, Noviello A, Clementini M, Danesi C, Cozza P (2020) Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: a randomized controlled trial. Eur J Orthod 42(1):78–85. https://doi.org/10.1093/ejo/cjz032

    Article  PubMed  Google Scholar 

  17. Farista S, Kalakonda B, Koppolu P, Baroudi K, Elkhatat E, Dhaifullah E (2016) Comparing laser and scalpel for soft tissue crown lengthening: a clinical study. Glob J Health Sci 8(10):55795. https://doi.org/10.5539/gjhs.v8n10p73

    Article  PubMed  Google Scholar 

  18. De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J (2009) The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 36(5):428–433. https://doi.org/10.1111/j.1600-051X.2009.01398.x

    Article  PubMed  Google Scholar 

  19. Malpartida-Carrillo V, Tinedo-Lopez PL, Guerrero ME, Amaya-Pajares SP, Özcan M, Rösing CK (2021) Periodontal phenotype: a review of historical and current classifications evaluating different methods and characteristics. J Esthet Restor Dent 33(3):432–445. https://doi.org/10.1111/jerd.12661

    Article  PubMed  Google Scholar 

  20. de Melo DP, Bento PM, Peixoto LR, Martins SKLD, Martins CC (2019) Is infrared thermography effective in the diagnosis of temporomandibular disorders? A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 127(2):185–192. https://doi.org/10.1016/j.oooo.2018.09.006

    Article  PubMed  Google Scholar 

  21. Całkosiński I, Dobrzyński M, Rosińczuk J, Dudek K, Chrószcz A, Fitaet K et al (2015) The use of infrared thermography as a rapid, quantitative, and noninvasive method for evaluation of inflammation response in different anatomical regions of rats. Biomed Res Int 2015:972535. https://doi.org/10.1155/2015/972535

    Article  PubMed  PubMed Central  Google Scholar 

  22. Öncü E, Erbeyoğlu AA, Alan R (2017) Comparison of gingivectomy procedures for patient satisfaction: conventional and diode laser surgery. Selcuk Dent J 4:6–9

    Article  Google Scholar 

  23. Sobouti F, Rakhshan V, Chiniforush N, Khatami M (2014) Effects of laser-assisted cosmetic smile lift gingivectomy on postoperative bleeding and pain in fixed orthodontic patients: a controlled clinical trial. Prog Orthod 15:66. https://doi.org/10.1186/s40510-014-0066-5

    Article  PubMed  PubMed Central  Google Scholar 

  24. Coslet JG, Vanarsdall R, Weisgold A (1977) Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan 70(3):24–28

    CAS  PubMed  Google Scholar 

  25. Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS et al (2018) A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol 45(Suppl 20):S1–S8. https://doi.org/10.1111/jcpe.12935

    Article  PubMed  Google Scholar 

  26. Song JW, Leesungbok R, Park SJ, Chang SH, Ahn SJ, Lee SW (2017) Analysis of crown size and morphology, and gingival shape in the maxillary anterior dentition in Korean young adults. J Adv Prosthodont 9(4):315–320. https://doi.org/10.4047/jap.2017.9.4.315

    Article  PubMed  PubMed Central  Google Scholar 

  27. Santos BRM, Demeda CF, Silva EENF, Britto MHMF, Lima KC, Melo MCN (2014) Prevalence of subgingival Staphylococcus at periodontally healthy and diseased sites. Braz Dent J 25(4):271–276. https://doi.org/10.1590/0103-6440201302285

    Article  PubMed  Google Scholar 

  28. Closs LQ, Branco P, Rizzatto SD, Raveli DB, Rösing CK (2007) Gingival margin alterations and the pre-orthodontic treatment amount of keratinized gingiva. Braz Oral Res 21(1):58–63. https://doi.org/10.1590/S1806-83242007000100010

    Article  PubMed  Google Scholar 

  29. Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47(1):207–214. https://doi.org/10.1002/1097-0142(19810101)47:1%3c207::aid-cncr2820470134%3e3.0.co;2-6

    Article  CAS  PubMed  Google Scholar 

  30. Gift AG (1989) Visual analogue scales: measurement of subjective phenomena. Nurs Res 38(5):286–288

    Article  CAS  Google Scholar 

  31. Landry RG, Turnbull RS, Howley T (1988) Effectiveness of benzydamyne HCl in the treatment of periodontal post-surgical patients. Res Clin Forums 10:105–118

    Google Scholar 

  32. Brioschi ML, Macedo JF, Macedo RAC (2003) Skin thermometry: new concepts. J Vasc Bras 2(2):151–160

    Google Scholar 

  33. Woźniak K, Szyszka-Sommerfeld L, Trybek G, Piątkowska D (2015) Assessment of the sensitivity, specificity, and accuracy of thermography in identifying patients with TMD. Med Sci Monit 21:1485–93. https://doi.org/10.12659/MSM.893863

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mostafa D (2018) A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: a case report. Int J Surg Case Rep 42:169–174. https://doi.org/10.1016/j.ijscr.2017.11.055

    Article  PubMed  Google Scholar 

  35. Aguilar-Duran L, Mir-Mari J, Figueiredo R, Valmaseda-Castellón E (2020) Is measurement of the gingival biotype reliable? Agreement among different assessment methods. Med Oral Patol Oral Cir Bucal 25(1):e144–e149. https://doi.org/10.4317/medoral.23280

    Article  CAS  PubMed  Google Scholar 

  36. Foudah MA (2019) Lip repositioning: an alternative to invasive surgery a 4 year follow up case report. Saudi Dent J 31(Suppl):S78–S84. https://doi.org/10.1016/j.sdentj.2019.02.030

    Article  PubMed  PubMed Central  Google Scholar 

  37. Monaco A, Streni O, Marci MC, Marzo G, Gatto R, Giannoni M (2004) Gummy smile: clinical parameters useful for diagnosis and therapeutical approach. J Clin Pediatr Dent 29(1):19–25. https://doi.org/10.17796/jcpd.29.1.y01l3r4m06q3k2x0

    Article  PubMed  Google Scholar 

  38. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, Sculean A, Tonetti MS, EFP Workshop Participants and Methodological Consultants (2020) Treatment of stage I-III periodontitis-the EFP S3 level clinical practice guideline. J Clin Periodontol 47(Suppl 22):4–60. https://doi.org/10.1111/jcpe.13290

    Article  PubMed  PubMed Central  Google Scholar 

  39. Campos FHO, Ferreira LB, Romano MM, Moreira MS, Eduardo CP, Ramalho KM (2018) Immediate laser-induced hemostasis in anticoagulated rats subjected to oral soft tissue surgery: a double-blind study. Braz Oral Res 32:e56. https://doi.org/10.1590/1807-3107bor-2018.vol32.0056

    Article  PubMed  Google Scholar 

  40. de Magalhaes-Junior EB, Aciole GT, Santos NR, dos Santos JN, Pinheiro AL (2011) Removal of oral lichen planus by CO2 laser. Braz Dent J 22(6):522–526. https://doi.org/10.1590/s0103-64402011000600014

    Article  PubMed  Google Scholar 

  41. Chandel V, Kochhar GK (2012) Eruption cyst: can be treated with diode lasers. J Dent Lasers 6:76–77. https://doi.org/10.4103/0976-2868.106668

    Article  Google Scholar 

  42. Stanton G, Levy M, Stahl SS (1969) Collagen restoration in healing human gingiva. J Dent Res 48:27–31. https://doi.org/10.1177/00220345690480011901

    Article  CAS  PubMed  Google Scholar 

  43. Barbosa JS, Amorim A, Arruda M, Medeiros GBS, Freitas APLF, Vieira LEM et al (2020) Infrared thermography assessment of patients with temporomandibular disorders. Dentomaxillofac Radiol 49(4):20190392. https://doi.org/10.1259/dmfr.20190392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Iosif L, Preoteasa CT, Murariu-Măgureanu C, Preoteasa E (2016) Clinical study on thermography, as modern investigation method for Candida-associated denture stomatitis. Rom J Morphol Embryol 57(1):191–195

    PubMed  Google Scholar 

  45. Pedreira AA, Wanderley FG, Sa MF, Viena CS, Perez A, Hoshi R et al (2016) Thermographic and clinical evaluation of 808-nm laser photobiomodulation effects after third molar extraction. Minerva Stomatol 65(4):213–222

    PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the Coordination for the Improvement of Higher Education Personnel (CAPES) for granting a postgraduate scholarship.

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Authors and Affiliations

  1. Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351, Bairro Universitário, Campina Grande, PB, 58429-500, Brazil

    Diego Filipe Bezerra Silva & Daliana Queiroga de Castro Gomes

  2. Department of Dentistry, State University of Paraíba, R. Baraúnas, 351, Bairro Universitário, Campina Grande, PB, 58429-500, Brazil

    Diego Filipe Bezerra Silva, Gustavo Araújo de Freitas & Luzia Lara Coura Carvalho Leite

  3. Department of Dentistry, Post Graduate Program in Dentistry, State University of Paraíba, R. Baraúnas, 351, Bodocongó, Campina Grande, PB, 58429-600, Brazil

    Diego Filipe Bezerra Silva

  4. University Center of João Pessoa, Rodovia BR-230, km 22, s/n - Água Fria, João Pessoa, PB, 58053-000, Brazil

    Keila Cristina Raposo Lucena

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  1. Diego Filipe Bezerra Silva
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  2. Gustavo Araújo de Freitas
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Correspondence to Diego Filipe Bezerra Silva.

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Silva, D.F.B., de Freitas, G.A., Leite, L.L.C.C. et al. Gingivectomy with high-power laser for correction of the gummy smile resulting from altered passive eruption—a case series. Lasers Med Sci 37, 2999–3009 (2022). https://doi.org/10.1007/s10103-022-03586-0

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