Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report

Background: Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. Methods: A 24-year-old female presented for consultation regarding a gummy smile. At full smile the average gingival display ranged from 2 to 4 mm. A clinical examination revealed hypermobility of the upper lip and absence of generalized altered passive eruption. A cephalometric analysis pointed to the presence of vertical maxillary excess. The surgical procedure consisted of an elliptical mucosal excision followed by coronal advancement of the flap. This procedure aimed to limit the activity of the elevator muscles and reestablish the depth of the vestibule. Results: Rapid surgical healing with minimal postoperative sequelae was observed. The patient reported significant reduction of gingival display at 1 week, which was maintained at the 1-year postoperative visit. Reduction in the amount of gingival display at the 1-year follow-up visit was stable. Conclusions: For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results. J Periodontol 2010;81:1858-1863.