Surgical and Prosthetic Approach for Oral Rehabilitation of Patient with Excessive Gingival Display and Gummy Smile

Aims: The aim of this study is to describe the surgical and prosthetic approaches of oral rehabilitation of a partially edentulous patient with a vertical maxillary excess with excessive gingival display when smiling.

Presentation of Case: A 40-year-old female patient complaining of cosmetic dental problems reported to the School of Dentistry at Franca University (UNIFRAN). After a clinical examination and radiographic imaging, it was determined that the patient was partially edentulous with vertical maxillary excess with excessive gingival display when smiling. A diagnostic wax-up was performed to determine the ideal position of the anterior teeth in relation to proper oral posture at rest, to the smile line, and to the bone level. In light of the ideal position of the anterior teeth for reducing gingival display when smiling, it was decided to remove the remaining teeth and perform a maxillary ostectomy. After performing the pre-prosthetic surgery, six implants were installed in the remaining maxillary bone, and a provisional conventional complete denture was installed and left in position until the osseointegration period. Later, a complete arch fixed implant-supported prosthesis was manufactured, since the prosthesis–tissue junction was above to the high smile line.

Discussion and Conclusion: Pre-prosthetic ostectomy and treatment by means of a complete arch fixed implant-supported prosthesis produced an effective and predictable outcome, resulting in a very favorable esthetic and functional outcome for the patient.