case_images: PMC4795143_01
case_images: Extraoral initial front view showing 5 mm gingival display at smiling
case_images: JISP-20-82-g001.jpg
case_images: PMC4795143_01_JISP-20-82-g001.jpg
case_images: F1
case_images: After clinical examination, a 5 mm gingival display during smile was detected [Figures 1 and 2].
case_images: Extraoral initial lateral view showing 5 mm gingival display at smiling
case_images: JISP-20-82-g002.jpg
case_images: PMC4795143_01_JISP-20-82-g002.jpg
case_images: F2
case_images: After clinical examination, a 5 mm gingival display during smile was detected [Figures 1 and 2].
case_images: Intraoral initial view demonstrating irregular gingival contour and teeth with quadratic shape
case_images: JISP-20-82-g003.jpg
case_images: PMC4795143_01_JISP-20-82-g003.jpg
case_images: F3
case_images: Gingival contour was irregular, with some teeth presenting disproportionate crown height/width ratio and quadratic shape [Figure 3].
case_images: Horizontal incision from the midline to the first molar
case_images: JISP-20-82-g004.jpg
case_images: PMC4795143_01_JISP-20-82-g004.jpg
case_images: F4
case_images: At last, a horizontal incision, parallel to the first one and linking the vertical incisions previously performed [Figure 4], was made.
case_images: Epithelium removed, exposing the connective tissue
case_images: JISP-20-82-g005.jpg
case_images: PMC4795143_01_JISP-20-82-g005.jpg
case_images: F5
case_images: The outlined mucosa was removed, exposing the underlying connective tissue [Figure 5].
case_images: Epithelium removed on both sides of the maxilla
case_images: JISP-20-82-g006.jpg
case_images: PMC4795143_01_JISP-20-82-g006.jpg
case_images: F6
case_images: The procedure was repeated on the left side [Figure 6] and continuous interlocking sutures (polyglactin 910 5/0) were used to stabilize the mucosa to the gingiva [Figure 7].
case_images: Mucosa stabilization and suture
case_images: JISP-20-82-g007.jpg
case_images: PMC4795143_01_JISP-20-82-g007.jpg
case_images: F7
case_images: The procedure was repeated on the left side [Figure 6] and continuous interlocking sutures (polyglactin 910 5/0) were used to stabilize the mucosa to the gingiva [Figure 7].
case_images: Healing 60 days after lip repositioning surgery
case_images: JISP-20-82-g008.jpg
case_images: PMC4795143_01_JISP-20-82-g008.jpg
case_images: F8
case_images: After 2 months [Figure 8], esthetic crown lengthening surgery was made by means of gingivectomy followed by flap elevation and ostectomy/osteoplasty.
case_images: Inverted bevel incision following cementoenamel junction anatomy from #15 to #25
case_images: JISP-20-82-g009.jpg
case_images: PMC4795143_01_JISP-20-82-g009.jpg
case_images: F9
case_images: Subsequently, an inverted bevel incision was made following CEJ anatomy, from tooth #15 to #25 [Figure 9], followed by intra-sulcular incision, removal of outlined marginal gingiva [Figure 10], and mucoperiosteal flap dissection [Figure 11].
case_images: Outlined marginal gingival tissue removed
case_images: JISP-20-82-g010.jpg
case_images: PMC4795143_01_JISP-20-82-g010.jpg
case_images: F10
case_images: Subsequently, an inverted bevel incision was made following CEJ anatomy, from tooth #15 to #25 [Figure 9], followed by intra-sulcular incision, removal of outlined marginal gingiva [Figure 10], and mucoperiosteal flap dissection [Figure 11].
case_images: Mucoperiosteal flap dissection
case_images: JISP-20-82-g011.jpg
case_images: PMC4795143_01_JISP-20-82-g011.jpg
case_images: F11
case_images: Subsequently, an inverted bevel incision was made following CEJ anatomy, from tooth #15 to #25 [Figure 9], followed by intra-sulcular incision, removal of outlined marginal gingiva [Figure 10], and mucoperiosteal flap dissection [Figure 11].
case_images: Ostectomy and osteoplasty made with hand instruments leaving a distance of 2 mm between cementoenamel junction and alveolar bone crest
case_images: JISP-20-82-g012.jpg
case_images: PMC4795143_01_JISP-20-82-g012.jpg
case_images: F12
case_images: Instruments (#2 Fedi and #36/37 Rhodes chisels) were used for ostectomy and osteoplasty aiming to leave a distance of 2 mm between CEJ and ABC [Figure 12].
case_images: Flap repositioned and stabilized with vertical mattress sutures
case_images: JISP-20-82-g013.jpg
case_images: PMC4795143_01_JISP-20-82-g013.jpg
case_images: F13
case_images: To finish the procedure, mattress suture (poligalactina 910 5/0) was used for flap stabilization [Figure 13].
case_images: Postoperative view 9 months after lip repositioning and 7 months after esthetic crown lengthening
case_images: JISP-20-82-g014.jpg
case_images: PMC4795143_01_JISP-20-82-g014.jpg
case_images: F14