Cupar method for the correction of excessive gummy smile
Lampros Zouloumis, Nikolaos Lazaridis, Ioannis Aetopoulos
University Clinic of Oral and Maxillofacial Surgery. Dental School, Aristotle University of Thessaloniki, «G. Papanikolaou» General Hospital. Thessaloniki, Greece (Head: Professor N. Lazaridis)
Hellenic Archives of Oral & Maxillofacial Surgery (2010) 2, 69-81
SUMMARY: Gummy smile is a special aesthetic problem, common to many people. Its main characteristic is the excessive display of gingival tissue, above the necks of the teeth, when smiling. Among the major factors associated with gummy smile are delayed passive eruption, hyperfunctional upper lip elevator muscles and skeletal disorders caused during the development of the maxilla. The treatment is causative; it aims at treating individual aetiological factors and involves periodontal plastic surgery, orthodontic treatment, prosthetic rehabilitation and botulinum toxin injections into the elevator muscles of the upper lip. Anterior maxillary alveolar osteotomy is performed by Oral-Maxillofacial Surgeons to treat gummy smile, in cases where skeletal disorders and, especially, maxillary protrusion are the aetiological factor. The present pa - per focuses on the Cupar method and its use in pati - ents with gummy smile. The Cupar method is a relatively simple and uneventful procedure used to perform anterior maxillary alveolar osteotomy.
KEY WORDS: Cupar method, anterior maxillary oste - otomy, gummy smile
REFERENCES
llen EP: Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am 32(2):307-30, 1988
Bell WH: Correction of maxillary excess by anterior maxillary oste - otomy. A review of three basic procedures. Oral Surg Oral Med Oral Pathol 43(3): 323-32, 1977
Benedetto AV: The cosmetic uses of Botulinum toxin type A. Int J Dermatol 38(9):641-55, 1999
Binder WJ, Blitzer A, Brin MF: Treatment of hyperfunctional lines of the face with botulinum toxin A. Dermatol Surg 24(11):1198- 205, 1998
Cupar I : Surgical treatment of alterations in form and position of the maxilla. Osterr Z Stomatol 51(11):565-77, 1954
Ezquerra F, Berrazueta MJ, Ruiz-Capillas A, Arregui JS: New approach to the gummy smile. Plast Reconstr Surg 104(4):1143-50, 1999
Garber DA, Salama MA : The aesthetic smile: diagnosis and treatment. Periodontol 2000 11:18-28, 1996
Garcia A, Fulton JE Jr. : Cosmetic denervation of the muscles of facial expression with botulinum toxin: a dose –response study. Dermatol Surg 22:39-43, 1996
Greenberg AM. : Maxillary Osteotomies and Considerations for Rigid Internal Fixation, In Greenberg AM and Prein J: Cranioma - xillofacial Reconstructive and Corrective Bone Surgery. Prin - ciples of Internal Fixation Using AO/ASIF Technique. Springer 2002, p. 581-605
Gunaseelan R, Anantanarayanan P, Veerabahu M, Vikraman B, Sripal R: Intraoperative and perioperative complications in anterior maxillary osteotomy: a retrospective evaluation of 103 patients. J Oral Maxillofac Surg 67(6):1269-73, 2009
Henderson D: Corrective Surgery of the maxilla. In Hederson D: A Colour Atlas and Textbook of Orthognathic Surgery. The Sur - gery of Facial Skeletal Deformity. Wolfe Medical Publications LTD 1985, p.263-269
Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, Kim ST, Kim HJ, Lee KJ: Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod 79(1):70-7, 2009
Jahanbin A, Pezeshkirad H: The effects of upper lip height on smile esthetics perception in normal occlusion and nonextraction, ortho dontically treated females. Indian J Dent Res 19(3):204-7, 2008
Kapagiannidis D, Kontonasaki E, Bikos P, Koidis P: Teeth and gingival display in the premolar area during smiling in relation to gender and age. J Oral Rehabil 32(11):830-7, 2005
Kim JR, Son WS, Lee SG: A retrospective analysis of 20 surgically corrected bimaxillary protrusion patients. Int J Adult Orthodon Orthognath Surg 17(1):23-7, 2002
Kim TW, Kim H, Lee SJ: Correction of deep overbite and gummy smile by using a mini-implant with a segmented wire in a growing Class II Division 2 patient. Am J Orthod Dentofacial Orthop 130(5):676-85, 2006
Kole H : Surgical operations on the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol 12(3):277-88, 1959
Lee JK, Chung KR, Baek SH: Treatment outcomes of orthodontic treatment, corticotomy-assisted orthodontic treatment, and ante rior segmental osteotomy for bimaxillary dentoalveolar protrusion. Plast Reconstr Surg 120(4):1027-36, 2007
Litton C, Fournier P: Simple surgical correction of the gummy smile. Plast Reconstr Surg 63(3):372-3, 1979
Murphey PJ, Walker RV: Correction of maxillary protrusion by oste - otomy and orthodontic therapy. J Oral Surg Anesth Hosp Dent Serv 21: 275-90, 1963
Niamtu J 3rd: Botox injections for gummy smiles. Am J Orthod Dentofacial Orthop 133(6):782-3; author reply 783-4, 2008
Park JU, Hwang YS: Evaluation of the soft and hard tissue changes after anterior segmental osteotomy on the maxilla and man - dible. J Oral Maxillofac Surg 66(1):98-103, 2008
Peck S, Peck L, Kataja M: The gingival smile line. Angle Orthod. 62(2):91-100, 1992
Perciaccante VJ, Bays RA: Maxillary Orthognathic Surgery. In Miloro M, Ghali GE, Larsen PE, Waite PD: Peterson’s Principles of Oral and Maxillofacial Surgery. Second edition, BC Decker Inc 2004, p.1179-1204
Pessa JE: Improving the acute nasolabial angle and medial nasolabial fold by levator alae muscle resection. Ann Plast Surg 29(1):23- 30, 1992
Polat-Ozsoy O, Arman-Ozcirpici A, Veziroglu F: Miniscrews for upper incisor intrusion. Eur J Orthod 31(4):412-6, 2009
Polo M: Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop 133(2):195-203, 2008
Rai Balwant: Anterior segmental osteotomies for management of dento-osseous deformities. Dissertation.com, 2006, p. 18-19.
Rees, T. D. , and La Trenta, G. S.: the long face syndrome and rhinoplasty. Perspect. Plast. Surg. 3: 16, 1989
Reyneke JP: Basic guidelines for the diagnosis and treatment of specific dentofacial deformities. In: Reyneke JP: Essentials Of Ortho - gnathic Surgery. Quintessence Publishing Co, Inc 2003, p. 193- 200
Roshna T, Nandakumar K: Anterior esthetic gingival depigmentation and crown lengthening: report of a case. J Contemp Dent Pract 6(3):139-47, 2005 Rubin LR, Mishriki Y, Lee G: Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg 83(1):1-10, 1989
White RP Jr, Terry BC: Segmental Jaw Surgery. In: Proffit WP, White RP: Surgical-Orthodontic Treatment. Mosby 1991, p. 284-290
Ziccardi VB, Wilk R: Anterior and Posterior Maxillary Segmental Oste otomies. In Fonseca R, Betts NJ, Turvey TA: Oral and Maxil lo facial Surgery / Orthognathic Surgery. WB Saunders Company 2000, p. 249-260
University Clinic of Oral and Maxillofacial Surgery. Dental School, Aristotle University of Thessaloniki, «G. Papanikolaou» General Hospital. Thessaloniki, Greece (Head: Professor N. Lazaridis)
Hellenic Archives of Oral & Maxillofacial Surgery (2010) 2, 69-81
SUMMARY: Gummy smile is a special aesthetic problem, common to many people. Its main characteristic is the excessive display of gingival tissue, above the necks of the teeth, when smiling. Among the major factors associated with gummy smile are delayed passive eruption, hyperfunctional upper lip elevator muscles and skeletal disorders caused during the development of the maxilla. The treatment is causative; it aims at treating individual aetiological factors and involves periodontal plastic surgery, orthodontic treatment, prosthetic rehabilitation and botulinum toxin injections into the elevator muscles of the upper lip. Anterior maxillary alveolar osteotomy is performed by Oral-Maxillofacial Surgeons to treat gummy smile, in cases where skeletal disorders and, especially, maxillary protrusion are the aetiological factor. The present pa - per focuses on the Cupar method and its use in pati - ents with gummy smile. The Cupar method is a relatively simple and uneventful procedure used to perform anterior maxillary alveolar osteotomy.
KEY WORDS: Cupar method, anterior maxillary oste - otomy, gummy smile
REFERENCES
llen EP: Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am 32(2):307-30, 1988
Bell WH: Correction of maxillary excess by anterior maxillary oste - otomy. A review of three basic procedures. Oral Surg Oral Med Oral Pathol 43(3): 323-32, 1977
Benedetto AV: The cosmetic uses of Botulinum toxin type A. Int J Dermatol 38(9):641-55, 1999
Binder WJ, Blitzer A, Brin MF: Treatment of hyperfunctional lines of the face with botulinum toxin A. Dermatol Surg 24(11):1198- 205, 1998
Cupar I : Surgical treatment of alterations in form and position of the maxilla. Osterr Z Stomatol 51(11):565-77, 1954
Ezquerra F, Berrazueta MJ, Ruiz-Capillas A, Arregui JS: New approach to the gummy smile. Plast Reconstr Surg 104(4):1143-50, 1999
Garber DA, Salama MA : The aesthetic smile: diagnosis and treatment. Periodontol 2000 11:18-28, 1996
Garcia A, Fulton JE Jr. : Cosmetic denervation of the muscles of facial expression with botulinum toxin: a dose –response study. Dermatol Surg 22:39-43, 1996
Greenberg AM. : Maxillary Osteotomies and Considerations for Rigid Internal Fixation, In Greenberg AM and Prein J: Cranioma - xillofacial Reconstructive and Corrective Bone Surgery. Prin - ciples of Internal Fixation Using AO/ASIF Technique. Springer 2002, p. 581-605
Gunaseelan R, Anantanarayanan P, Veerabahu M, Vikraman B, Sripal R: Intraoperative and perioperative complications in anterior maxillary osteotomy: a retrospective evaluation of 103 patients. J Oral Maxillofac Surg 67(6):1269-73, 2009
Henderson D: Corrective Surgery of the maxilla. In Hederson D: A Colour Atlas and Textbook of Orthognathic Surgery. The Sur - gery of Facial Skeletal Deformity. Wolfe Medical Publications LTD 1985, p.263-269
Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, Kim ST, Kim HJ, Lee KJ: Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod 79(1):70-7, 2009
Jahanbin A, Pezeshkirad H: The effects of upper lip height on smile esthetics perception in normal occlusion and nonextraction, ortho dontically treated females. Indian J Dent Res 19(3):204-7, 2008
Kapagiannidis D, Kontonasaki E, Bikos P, Koidis P: Teeth and gingival display in the premolar area during smiling in relation to gender and age. J Oral Rehabil 32(11):830-7, 2005
Kim JR, Son WS, Lee SG: A retrospective analysis of 20 surgically corrected bimaxillary protrusion patients. Int J Adult Orthodon Orthognath Surg 17(1):23-7, 2002
Kim TW, Kim H, Lee SJ: Correction of deep overbite and gummy smile by using a mini-implant with a segmented wire in a growing Class II Division 2 patient. Am J Orthod Dentofacial Orthop 130(5):676-85, 2006
Kole H : Surgical operations on the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol 12(3):277-88, 1959
Lee JK, Chung KR, Baek SH: Treatment outcomes of orthodontic treatment, corticotomy-assisted orthodontic treatment, and ante rior segmental osteotomy for bimaxillary dentoalveolar protrusion. Plast Reconstr Surg 120(4):1027-36, 2007
Litton C, Fournier P: Simple surgical correction of the gummy smile. Plast Reconstr Surg 63(3):372-3, 1979
Murphey PJ, Walker RV: Correction of maxillary protrusion by oste - otomy and orthodontic therapy. J Oral Surg Anesth Hosp Dent Serv 21: 275-90, 1963
Niamtu J 3rd: Botox injections for gummy smiles. Am J Orthod Dentofacial Orthop 133(6):782-3; author reply 783-4, 2008
Park JU, Hwang YS: Evaluation of the soft and hard tissue changes after anterior segmental osteotomy on the maxilla and man - dible. J Oral Maxillofac Surg 66(1):98-103, 2008
Peck S, Peck L, Kataja M: The gingival smile line. Angle Orthod. 62(2):91-100, 1992
Perciaccante VJ, Bays RA: Maxillary Orthognathic Surgery. In Miloro M, Ghali GE, Larsen PE, Waite PD: Peterson’s Principles of Oral and Maxillofacial Surgery. Second edition, BC Decker Inc 2004, p.1179-1204
Pessa JE: Improving the acute nasolabial angle and medial nasolabial fold by levator alae muscle resection. Ann Plast Surg 29(1):23- 30, 1992
Polat-Ozsoy O, Arman-Ozcirpici A, Veziroglu F: Miniscrews for upper incisor intrusion. Eur J Orthod 31(4):412-6, 2009
Polo M: Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop 133(2):195-203, 2008
Rai Balwant: Anterior segmental osteotomies for management of dento-osseous deformities. Dissertation.com, 2006, p. 18-19.
Rees, T. D. , and La Trenta, G. S.: the long face syndrome and rhinoplasty. Perspect. Plast. Surg. 3: 16, 1989
Reyneke JP: Basic guidelines for the diagnosis and treatment of specific dentofacial deformities. In: Reyneke JP: Essentials Of Ortho - gnathic Surgery. Quintessence Publishing Co, Inc 2003, p. 193- 200
Roshna T, Nandakumar K: Anterior esthetic gingival depigmentation and crown lengthening: report of a case. J Contemp Dent Pract 6(3):139-47, 2005 Rubin LR, Mishriki Y, Lee G: Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg 83(1):1-10, 1989
White RP Jr, Terry BC: Segmental Jaw Surgery. In: Proffit WP, White RP: Surgical-Orthodontic Treatment. Mosby 1991, p. 284-290
Ziccardi VB, Wilk R: Anterior and Posterior Maxillary Segmental Oste otomies. In Fonseca R, Betts NJ, Turvey TA: Oral and Maxil lo facial Surgery / Orthognathic Surgery. WB Saunders Company 2000, p. 249-260
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