Overview
The aim of the current study is to evaluate the use of a PEEK shell placed in the anterior maxilla placed by tunnel technique in decreasing the gingival display
Description
While lip repositioning has been established as a treatment modality to address excess gum display (EGD) , an often overlooked contributing factor is the lack of lip support. This is often caused by the architecture of the maxilla at the subnasal area. Maxillary overgrowth may give rise to a subnasal skeletal depression producing decreased lip support and marked upper lip retraction during a smile.
Restricting muscle pull by lip repositioning surgery as a treatment option limits muscle movement, however it does not address lip support. In 2018 an alternative intervention was later proposed in a case report study . The technique involves raising a full thickness flap and applying PMMA (polymethyl methacrylate) cement to fill the subnasal depression and limit the upper lip movement. Since its introduction, a limited number of studies have attempted to investigate the technique, however there are not enough studies to support the outcome or the stability of the technique. The aim of the current study is to evaluate the use of a tunnel technique with a 3D printed PEEK (Polyetherether ketone) shell to fill the skeletal subnasal depression
Eligibility
Inclusion Criteria:
- Patients with excess gingival display 2.5mm or more
- Patients with an exaggerated subnasal concavity
- Decreased value of SNA ( angle between sella, nation, A point) in cephalometric measurement
- Decreased cephalometric measurement of A to N-perpendicular (perpendicular from N on FHP)
- Decreased value in cephalometric measurement of the convexity at point A (linear measurement from point A to facial plane)
- Decreased value of Ricketts Esthetic plane in cephalometric measurement
- Decreased value of Holdaway H-angle in cephalometric measurement
- Nasolabial angle 100° ± 20
- Patients 20-60 years old
- Medically free
- Compliant patient that agrees to the follow up period
Exclusion Criteria:
- Pregnant and lactating females
- Smokers
- Diabetics
- Patients with parafunctional habits that may affect the outcome of the procedure
- Medically compromised patients