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通过唇重新定位瓣、牙冠延长术和二硅酸锂贴面治疗重度露龈笑的牙周与修复综合治疗:病例报告

Periodontal and restorative integration for managing extreme gummy smiles with lip repositioning flap, crown lengthening, and lithium disilicate veneers: A case report.

作者信息

Ramadhan Daniyal Lazuardi, Sampoerno Galih, Saraswati Widya, Krismariono Agung, Binti Tengku Ahmad Noor Tengku Natasha Eleena

机构信息

Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia.

Department of Peiodontology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia.

出版信息

J Oral Biol Craniofac Res. 2025 Sep-Oct;15(5):955-962. doi: 10.1016/j.jobcr.2025.06.017. Epub 2025 Jun 29.

DOI:10.1016/j.jobcr.2025.06.017
PMID:40678474
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12268189/
Abstract

BACKGROUND

Excessive gingival display, commonly referred to as a gummy smile, has a major impact on facial aesthetics and patient confidence. Addressing this condition often requires a multidisciplinary approach combining periodontal and restorative procedures.

PURPOSE

This case report intends to demonstrate the efficacy of a comprehensive treatment strategy that included a lip repositioning flap, crown lengthening, and lithium disilicate veneers in achieving esthetic rehabilitation of an extreme gummy smile.

CASE

A 29-year-old male patient presented with excessive gingival display and short clinical crowns, resulting in a disharmonious smile. The patient expressed dissatisfaction with her smile aesthetics and sought a minimally invasive yet effective solution.

CASE MANAGEMENT

The initial evaluation includes clinical and radiographic assessments to identify gingival biotype, crown-to-root ratio, and amount of gingival excess. A lip repositioning flap was performed to optimize gingival levels, followed by crown lengthening to expose adequate tooth structure for veneering. Lithium disilicate veneers were created utilizing a digital approach to improve precision and aesthetics. The treatment lasted six months, which ensured adequate healing and functional integration.

CONCLUSION

The combination of periodontal surgery and advanced restorative techniques successfully addressed the patient's esthetic concerns, achieving a balanced gingival-dental relationship and a natural, harmonious smile. This case demonstrates the value of an interdisciplinary approach in managing complex esthetic challenges, providing predictable and satisfying outcomes for both clinicians and patients.

摘要

背景

牙龈过度外露,通常称为露龈笑,对面部美观和患者自信有重大影响。治疗这种情况通常需要牙周和修复手术相结合的多学科方法。

目的

本病例报告旨在证明一种综合治疗策略的有效性,该策略包括唇重新定位瓣、牙冠延长术和二硅酸锂贴面,以实现对极度露龈笑的美学修复。

病例

一名29岁男性患者出现牙龈过度外露和临床牙冠短的情况,导致笑容不协调。患者对自己的笑容美观不满意,寻求一种微创但有效的解决方案。

病例管理

初始评估包括临床和影像学评估,以确定牙龈生物型、冠根比和牙龈多余量。进行唇重新定位瓣以优化牙龈水平,随后进行牙冠延长术以暴露足够的牙体结构用于贴面。采用数字化方法制作二硅酸锂贴面,以提高精度和美观度。治疗持续了六个月,确保了充分的愈合和功能整合。

结论

牙周手术和先进的修复技术相结合成功解决了患者的美学问题,实现了牙龈与牙齿关系的平衡以及自然、和谐的笑容。本病例证明了跨学科方法在处理复杂美学挑战中的价值,为临床医生和患者提供了可预测且令人满意的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/5f58aa58132c/gr11.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/5f58aa58132c/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/032a7f9f6a32/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/0b3b22bc07f0/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/cd2755f1263d/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/dc0e269219eb/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/d1a1fa4e091e/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/fb26d7ad71a3/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/87784710590a/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/9df87d0a3403/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/3a520835ead1/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/7129e25c1049/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/655be3161c43/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edb2/12268189/5f58aa58132c/gr11.jpg

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本文引用的文献

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Clinical Considerations for Crown Lengthening: A Comprehensive Review.牙冠延长术的临床考量:全面综述
Cureus. 2024 Nov 3;16(11):e72934. doi: 10.7759/cureus.72934. eCollection 2024 Nov.
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Integrating digital smile design into restorative Dentistry: A narrative review of the applications and benefits.将数字化微笑设计融入口腔修复学:应用与益处的叙述性综述
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Contemporary treatment techniques for excessive gingival display caused by altered passive eruption or lip hypermobility.
由于被动萌出异常或唇过度活动导致的牙龈过度显露的当代治疗技术。
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Clinical Evaluation of Lithium Disilicate Veneers Manufactured by CAD/CAM Compared with Heat-pressed Methods: Randomized Controlled Clinical Trial.CAD/CAM 制作的二硅酸锂瓷贴面与热压铸法制作的瓷贴面的临床评价:随机对照临床试验。
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