Keywords
How to Cite
Abstract
Objective: To conduct a narrative review of the literature in order to evaluate the clinical outcomes of lip repositioning surgery for the management of upper lip hypermobility, with emphasis on long-term stability.
Methods: A narrative review was performed including original articles with a minimum follow-up of 24 months and systematic reviews retrieved from PubMed, Scopus, and Web of Science. Clinical studies, case reports, and case series assessing esthetic outcomes, stability, and patient satisfaction after lip repositioning surgery were included.
Results: Ten clinical studies with follow-up ≥24 months and five systematic reviews were analyzed. Clinical studies reported immediate reductions in gingival display ranging from 3 to 6 mm, with partial relapse of 0.5 to 2 mm after 24 to 72 months. Nevertheless, most patients maintained a final gingival exposure <3 mm, considered esthetically acceptable. Modified techniques, such as frenulum preservation, use of internal or periosteal sutures, and association with myotomy or botulinum toxin, showed a trend toward greater stability. Systematic reviews confirmed short-term effectiveness but highlighted the lack of longitudinal studies and methodological heterogeneity.
Conclusion: Lip repositioning is a conservative and effective technique for the treatment of gummy smile associated with upper lip hypermobility, providing immediate esthetic improvement and high patient satisfaction. However, partial relapse is common, and long-term predictability remains uncertain, underscoring the need for prospective, multicenter clinical trials with extended follow-up to establish standardized protocols.
References
Andijani, R. I., & Tatakis, D. N. (2019). Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile. Journal of periodontology, 90(3), 256–262. Doi: https://doi.org/10.1002/JPER.18-0468
Ardakani, M. T., Moscowchi, A., Valian, N. K., & Zakerzadeh, E. (2021). Lip repositioning with or without myotomy: a systematic review. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 47(1), 3–14. Doi:https://doi.org/10.5125/jkaoms.2021.47.1.3
Armitage G. C. (1999). Development of a classification system for periodontal diseases and conditions. Annals of periodontology, 4(1), 1–6. https://doi.org/10.1902/annals.1999.4.1.1
Bhola, M., Fairbairn, P. J., Kolhatkar, S., Chu, S. J., Morris, T., & de Campos, M. (2015). LipStaT: The Lip Stabilization Technique- Indications and Guidelines for Case Selection and Classification of Excessive Gingival Display. The International journal of periodontics & restorative dentistry, 35(4), 549–559. Doi:https://doi.org/10.11607/prd.2059
Bittencourt, S., Dourado, M., Tunes, U. R., SOBRAPE. (2022). Periodontia Estética: Uma Abordagem Multidisciplinar. 1ª edição. Santos Publicações. (pp. 115-132).
Foudah M. A. (2019). Lip repositioning: An alternative to invasive surgery a 4 year follow up case report. The Saudi dental journal, 31(Suppl), S78–S84. Doi:https://doi.org/10.1016/j.sdentj.2019.02.030
Geron, S., & Atalia, W. (2005). Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination. The Angle orthodontist, 75(5), 778–784. Doi:https://doi.org/10.1043/0003-3219(2005)75[778:IOSOTP]2.0.CO;2
Jacobs, P. J., & Jacobs, B. P. (2013). Lip repositioning with reversible trial for the management of excessive gingival display: a case series. The International journal of periodontics & restorative dentistry, 33(2), 169–175. Doi:https://doi.org/10.11607/prd.1483
Kokich, V. O., Kokich, V. G., & Kiyak, H. A. (2006). Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 130(2), 141–151. Doi:https://doi.org/10.1016/j.ajodo.2006.04.017
Mahardawi, B., Chaisamut, T., & Wongsirichat, N. (2019). Gummy Smile: A Review of Etiology, Manifestations, and Treatment. Siriraj Medical Journal, 71(2), 168–174. Doi: https://doi.org/10.33192/Smj.2019.26
Mendoza-Geng, A., Gonzales-Medina, K., Meza-Mauricio, J., Muniz, F. W. M. G., & Vergara-Buenaventura, A. (2022). Clinical efficacy of lip repositioning technique and its modifications for the treatment of gummy smile: systematic review and meta-analysis. Clinical oral investigations, 26(6), 4243–4261. Doi:https://doi.org/10.1007/s00784-022-04467-0
Ozturan, S., Ay, E., & Sagir, S. (2014). Case series of laser-assisted treatment of excessive gingival display: an alternative treatment. Photomedicine and laser surgery, 32(9), 517–523. Doi: https://doi.org/10.1089/pho.2014.3737
Pinho S, Ciriaco C, Faber J, Lenza MA. Impact of dental asymmetries on the perception of smile esthetics. Am J Orthod Dentofacial Orthop. 2007 Dec;132(6):748-53. doi: 10.1016/j.ajodo.2006.01.039. PMID: 18068592.
Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop. 2008 Feb;133(2):195-203. doi: 10.1016/j.ajodo.2007.04.033. PMID: 18249285.
Ribeiro-Júnior, N. V., Campos, T. V., Rodrigues, J. G., Martins, T. M., & Silva, C. O. (2013). Treatment of excessive gingival display using a modified lip repositioning technique. The International journal of periodontics & restorative dentistry, 33(3), 309–314. Doi: https://doi.org/10.11607/prd.1325
Roden-Johnson, D., Gallerano, R., & English, J. (2005). The effects of buccal corridor spaces and arch form on smile esthetics. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 127(3), 343–350. Doi: https://doi.org/10.1016/j.ajodo.2004.02.013
Santos-Pereira S.A., Cicareli, A.J., Idalgo, F.A., Nunes, A.G., Kassis, E.N, Castanha, H.J.F., Bellini-Pereira, S.A (2020) Effectiveness of lip repositioning surgeries in the treatment of excessive gingival display: A systematic review and meta-analysis. J Esthet Restor Dent. 33:446–457. Doi:https://doi.org/10.1111/jerd.12695
Silva, C. O., Rezende, R. I., Mazuquini, A. C., Leal, V. C., Amaral, G. S. A., Guo, X., & Tatakis, D. N. (2021). Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness. Journal of clinical periodontology, 48(6), 826–833. Doi: https://doi.org/10.1111/jcpe.13461
Silva, C. O., Ribeiro-Júnior, N. V., Campos, T. V., Rodrigues, J. G., & Tatakis, D. N. (2013). Excessive gingival display: treatment by a modified lip repositioning technique. Journal of clinical periodontology, 40(3), 260–265. Doi:https://doi.org/10.1111/jcpe.12046
Simon, Z., Rosemblatt, A. & Dorfmann, W. (2007) Eliminating a gummy smile with surgical lip repositioning. Journal of Cosmetic Dentistry 23, 100–108.
Tatakis, D. N., & Silva, C. O. (2023). Contemporary treatment techniques for excessive gingival display caused by altered passive eruption or lip hypermobility. Journal of dentistry, 138, 104711. Doi: https://doi.org/10.1016/j.jdent.2023.104711
Tawfik, O. K., El-Nahass, H. E., Shipman, P., Looney, S. W., Cutler, C. W., & Brunner, M. (2018). Lip repositioning for the treatment of excess gingival display: A systematic review. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.], 30(2), 101–112. Doi:https://doi.org/10.1111/jerd.12352
Younespour, S., Yaghobee, S., Aslroosta, H., Moslemi, N., Pourheydar, E., & Ghafary, E. S. (2021). Effectiveness of Different Modalities of Lip Repositioning Surgery for Management of Patients Complaining of Excessive Gingival Display: A Systematic Review and Meta-Analysis. BioMed research international, 2021, 9476013. Doi:https://doi.org/10.1155/2021/9476013
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Kalini Almeida da SILVEIRA, Larissa de Souza FERRARESSO, Vitoria Caetano CERVANTES, Gabriela de Souza ZIMIANI
