NCT07285343

Comparison Between Lip Repositioning and Muscle Traction Technique in Treatment of Gummy Smile

Controlled Randomized Clinical Trial of Containment of the Elevator Muscle of Upper Lip and Wing of Nose Technique Versus Conventional Lip Repositioning for Treatment of Gummy Smile

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 20 (actual)
• Sponsor: Suez Canal University · Academic / Other
• Sex: All
• Age: 18 Years – 38 Years
• Healthy volunteers: Not accepted

Summary

The goal of this clinical trial is to compare and evaluate the effectiveness of conventional and modified lip repositioning for the treatment of gummy smile. The main question it aims to answer: Which of these treatment modalities (conventional lip repositioning and containment of the elevator muscle of the upper lip and wing of nose (EMULWN)) has the most durable and least relapse in the treatment of gummy smile?" Researchers will compare: 1. The primary outcome was the decrease in excessive gingival display by measuring smile line (gingival display) and smile index before and after treatment modalities. 2. The The secondary outcome was to measure the durability and possibility of relapse over 6 months after treatment with high patient satisfaction.

Detailed description

For patients seeking long-term correction of excessive gingival displays, there are different treatment modalities. Both lip repositioning and muscle traction techniques showed improvement in the decrease in the amount of gingival display, while the containment surgery of the muscle of the upper lip and wing of the nose showed durable and satisfactory esthetics with less patient discomfort and less pain immediately after the procedure and needs more time to study or may need some modification. Also, lip repositioning showed satisfactory results to the patients but with more pain immediately after the procedure.

Conditions

• Gummy Smile Due to Hypermobile Upper Lip
• Excessive Gingival Display

Interventions

Type	Name	Description
PROCEDURE	lip repositioning	Local anesthesia was administered in the vestibular mucosa. A partial-thickness incision was made at the mucogingival junction from the mesial line angle of the right first molar to the mesial line angle of the left first molar. A second partial- thickness incision, parallel to the first, was made in the labial mucosa, 10 to 12 mm apical to the mucogingival junction. The incisions were connected at each first molar, creating an elliptical outline. The epithelium was removed within the outline of the incisions, leaving the underlying connective tissue exposed. Care was taken to avoid damage to any minor salivary glands in the submucosa. The parallel incision lines were approximated with interrupted stabilization sutures at the midline and other locations along the borders of the incision to ensure proper alignment of the lip midline with the midline of the teeth. Then, a continuous interlocking suture was used to approximate both flap ends.
PROCEDURE	Containment of the elevator muscle of the upper lip and wing of nose (EMULWN) technique	Local anesthesia was administered in the vestibular mucosa and lip then a vertical incision was made on the labial frenum, and two more horizontal incisions were made on the mucogingival line, starting from the frenum incision up to the height of the canines. The flap was carefully divulsed with Goldman Fox scissors and also a curved hemostat, separating the external epithelium from the muscle bundle mucosa on both sides at the height of the lateral incisors and canines. With an absorbable suture thread, the elevator muscle of the upper lip and wing of the nose was pulled downwards, repositioning its bundle nearer the highest portion of the keratinized gingiva. Simple sutures were made, as many as necessary, in order to contain the pulled muscle in this position. The procedure ended up with a continuous suture in the labial frenum and in the horizontal incisions with the use of a 4-0 silk suture thread. The external stitches should be removed in 10-15 days" time.

Timeline

• Start date: 2023-03-01
• Primary completion: 2025-01-01
• Completion: 2025-03-01
• First posted: 2025-12-16
• Last updated: 2025-12-16

Locations

2 sites across 1 country: Egypt