Buccal Maxillary Exostoses may Contribute to Excessive Gingival Display and Smile Aesthetics: Study

Maxillary exostoses, bony growths on the upper jaw, can lead to increased movement of the lips, resulting in an unbalanced smile that may expose excessive gum tissue when the patient smiles. Prominent BMEs have rarely been considered in the etiology of EGD despite their potential anatomical impact. Therefore, Cléverson O. Silva, Professor and Postdoctoral Program Director, Postgraduate Program in Integrated Dentistry, State University of Maringá (UEM), Maringá, PR, Brazil, and colleagues aimed to highlight the contribution of BMEs to EGD in the report.

The clinical report presents two cases of patients with excessive gingival display (EGD) associated with buccal maxillary exostoses, a hypermobile upper lip, vertical maxillary excess, and altered passive eruption.

Both patients underwent esthetic crown lengthening (ECL) as their initial surgical intervention. During the ECL procedure, the BMEs were removed through osteoplasty. The changes in their smiles and excessive gingival display were assessed 3 to 6 months postoperatively.

Based on the report, the researchers made the following observations:

• Both patients experienced a remarkable reduction in gingival display, measuring 8 mm and 6 mm, which is significantly greater than what is typically expected from ECL alone.
• The removal of the BMEs accounted for 75% and 67% of the decrease in excessive gingival display, respectively.
• The reductions in EGD correlated with observed decreases in lip mobility during smiling.

In summary, the report aimed to highlight the significant role of maxillary exostoses in increasing upper lip mobility and the resulting excessive gingival display. Two patients with prominent maxillary exostoses underwent osteoplasty to reduce the buccal prominence of the alveolar process. This treatment led to a notable decrease in upper lip hypermobility and the original excessive gingival display. Additionally, the contribution of the osteoplasty procedure to the reduction of excessive gingival display was quantified.

"Despite the limitations of this report, the presence of prominent maxillary exostoses can play a role in the development of excessive gingival display, partly by affecting lip mobility during smiling. Effectively managing these exostoses through osteoplasty can lead to significant reductions in gingival display, enhancing smile aesthetics and increasing patient satisfaction," the researchers concluded.

Reference:

Silva CO, da Silva RC, Tatakis DN. Maxillary exostoses as contributing etiology to lip hypermobility and associated excessive gingival display: A clinical report. J Prosthet Dent. 2024 Aug 26:S0022-3913(24)00516-X. doi: 10.1016/j.prosdent.2024.07.029. Epub ahead of print. PMID: 39191538.