This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This presentation gives a brief description of the clinical features and causes of gummy smile conditions , their clinical and differential dignosis , as well as the different treatment methods that may be used to correct these problems .
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Smile is more than a form of communication; it is kind of socialization
and attraction. Although moderate gummy smile can be quite acceptable and
esthetically pleasing if the gum is healthy, more pronounced cases are
less well tolerated and require treatment.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
COS definition, development and treatment in orthodontics. Deep overbite and reverse curve. Different ways to level the COS. intrusion, extrusion or both.
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
Smile is more than a form of communication; it is kind of socialization
and attraction. Although moderate gummy smile can be quite acceptable and
esthetically pleasing if the gum is healthy, more pronounced cases are
less well tolerated and require treatment.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
COS definition, development and treatment in orthodontics. Deep overbite and reverse curve. Different ways to level the COS. intrusion, extrusion or both.
Smile: is the most pleasant and wanted expression by each one of us.
Smile: is amused facial expression with the corner of mouth turned up and exposed front teeth
Facial expression, postures of lips, occlusion and arrangement of teeth, buccal corridor, shape of teeth, gingival color, texture, contour and other several aspects constitute component of smile
Most of patients come to us to improve their smiles, the orthodontic studies stress on skeletal structure than soft tissue structure, and the smile still receives relatively little attention
Nature of smile:
1- Posed smile: voluntary, static, sustained, social smile not elicited by an emotion
2- Un-posed smile: spontaneous, involuntary, dynamic, natural, and not sustained characterized by greater lip elevation
Smile types: smile styles:
1- Commissures smile: the corner of the mouth turned upward called Monalisa smile
2- Cuspid smile: the upper lip is elevated, the entire lip rises like a window shade
3- Complex smile: the upper lip moves superiorly as in cuspid smile and lower lip moves inferiorly
Evaluation of posed smile:
variables Normal smile Not good smile
Smile arc Consonant Non consonant
Smile index Average Increased / decreased
Morley’s ratio 75 – 100% (normal) Disturbed
Buccal corridor Average Obliterated / excessive
Smile line Average High / low
Occlusal plane No canting Canting occlusal plane
Important definitions:
Smile arc:
the curvature formed by an imaginary line tangent to the incisal edges of the teeth, modified in varying degree of curvature in relationship to the lower lip
Range: from no curvature to an accentuated curvature was in relation to the lower lip, so quantification differed for each model
Buccal corridor:
the amount of dark space displayed between the facial surfaces of the posterior teeth and the corner of the mouth, calculated as the total dark space on both sides of the mouth as a percentage of the total smile width
Range: from 6% to 26.5 in approximately 0.5% increments
Maxillary gingival display or gummy smile:
The amount of gingival show above the central incisor crown and below the center of the upper lip. Negative number indicate gingival exposure. Positive number indicate tooth overlap by the lip
Range: from 1mm of gingival display (-1) to almost 7mm of tooth coverage for the female models, and approximately 2mm of gingival display (-2) to 6mm tooth coverage for male models
The variation between the models was due to differences in sizes and coordinating the images for different faces
Maxillary midline to face:
The relationship of maxillary dental midline (measured between the central incisors) to the midline of the face, defined by the center of the philtrum and the facial midline
Range: the maxillary midline was moved to the left of the face in approximately 0.25 mm increments. The right and left buccal corridor was maintained throughout the movement of the dentition. The maximum deviation show is 6mm
Maxillary to mandibular mid
Smile analysis in vertical dimention:- factors to be considered when observed...Dr.Maulik patel
This is article description of smile when observing in vertical dimension ,maily used by dentist (orthodontist) while treatment of gummy smile with braces.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Open bite 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Embryology, Anatomy, diagnosis, Management of individuals with clefts of the lip and/or palate, Management in the neonatal period, Management during childhood, Cleft management in adolescence and early adulthood, Importance of dental care in overall management,
All you need to know about the gummy smile its causes and examination are included in the powerpoint, how to diagnose gummy smile, its treatment options and cases are presented in the powerpoint.
Surgical orthodontics ii /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Exploring Materials for Orthodontic Mini-Implants: A Comprehensive Overview.pdfsafabasiouny1
A temporary anchorage device (TAD) is a device that is temporarily fixed to bone for the purpose of enhancing orthodontic anchorage either by supporting the teeth of the reactive unit ( indirect anchorage ) or by obviating the need for the reactive unit altogether(direct anchorage), and which is subsequently removed after use.
They can be located transosteally, subperiosteally or endosteally; and they can be fixed to bone either mechanically (cortically stabilized) or biochemecially (osseointegrated). It should also be pointed out that dental implants placed for the ultimate purpose of supporting a prosthesis, regardless of the fact that they may be used for orthodontic anchorage, are not considered temporary anchorage devices since they are not removed and discarded after orthodontic treatment. By using dental implants and temporary anchorage devices for orthodontic purposes we are able to obtain zero anchorage loss.
Currently, several terms are used to refer to skeletal anchorage devices, the most inclusive being temporary anchorage devices. Other names include implants, mini-implants, miniscrews, micro-screws, screws, mini-plates, and plates.
Implants and mini-implants usually necessitate osseointegration for stability, whereas screws, miniscrews and micro-screws are generally loaded immediately after placement and receive their stability from mechanical retention in the bone
Plates are attached to bone through a surgical procedure necessitating the elevation of a flap. A portion is left emerging in the oral cavity to serve as appoint of application of the force system
Strategies for Managing White Spot Lesions in Orthodontic Patients and A Sugg...safabasiouny1
“white opacity,” occur as a result of subsurface enamel demineralization that is located on smooth surfaces of teeth. Or “subsurface enamel porosity from carious demineralization” that presents itself as “a milky white opacity when located on smooth surfaces
Etiology:
1. prolonged “undisturbed” plaque accumulation on the affected teeth surface, commonly due to inadequate oral hygiene. Under these conditions, acids diffuse into the enamel and the demineralization continues in the subsurface enamel, then the intact enamel surface collapses and becomes cavitated.
2. The presence of fixed orthodontic appliances causes an increasing number of plaque retention sites as a result of the presence of brackets, bands, wires, and other applications, which makes the cleaning of teeth more difficult. furthermore, excess bonding, long etching time (>15 s), decayed/treated molars, and the duration of treatment are considered other risk factors
3. The other important factors that impact this process are the patient’s modifying factors, including medical history, dental history, medication history, diet, levels of calcium, phosphate, and bicarbonate in saliva, fluoride levels, and genetic susceptibility.
Incidence:
• Orthodontic treatment has been reported as the most frequent factor for this situation, and equal susceptibility has been reported whether teeth are banded or bonded.
• The prevalence of WSLs varies widely in the literature. It ranges from 23 to 95%. The reported prevalence of WSLs is quite variable, depending on the sample size, method of detection, the use of a fluoride regimen during treatment, inclusion of pre-existing developmental enamel defects, and selected patients' groups.
• WSLs developed more frequently in the maxillary arch than they did in the mandibular.
• The researchers identified other risk factors during the treatment such as treatment time exceeded 36 months, patients with poor oral hygiene, and patients whose oral hygiene declined during treatment and pre-existing WSLs.
• They observed that the lesions are often symmetrical.
• WSLs are often seen under loose bands, around the periphery of the bracket base and in areas that are difficult to be detected by the patient and not easily accessed by the toothbrush
• More frequently on the maxillary laterals, maxillary canines, and mandibular molars. In other studies, different results were obtained. According to these studies, the most inclined teeth to demineralization are the first permanent molars, the maxillary incisors, the mandibular lateral incisors, and canines.
"Breath Easy: The Role of Orthodontics in Managing Obstructive Sleep Apnea"safabasiouny1
obstructive sleep apnea and orthodontics including diagnosis and treatment
Sleep disruption caused by breathing disorders are potentially life-threatening and therefore an important global health issue.
Sleep disorders, particularly untreated obstructive sleep apnea (OSA) has been known as a risk and possible causative factor in
1.
development of systemic hypertension,
2.
depression,
3.
stroke, angina
4.
cardiac dysrhythmias.
5.
can be associated with motor vehicle accidents,
6.
poor work performance and therefore, also makes a person prone to occupational accidents and reduced quality of life.
7.
adversely affects patients on their personal, social and professional levels.
Obstructive sleep apnea (OSA)
Definition: cessation of airflow for more than 10 seconds and hypopnoea is 50% reduction in air flow
It is Classified as central, obstructive and mixed and can be graded as mild, moderate and severe
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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3. 1.The commissure smile( Mona Lisa smile)
found when people greet each other in social
contexts or
at unusual locations such as the elevator
2. Cuspid or social smile
Globally used in self-portraits disclosed in social
networks
the upper lip is uniformly pulled upward showing
anterosuperior teeth, spontaneously or not
3. Complex smile or spontaneous smile
Characterized by movement of lower lip and wide
movement of the upper lip.
It is also known as spontaneous smile (usually
involuntary)
which realistically depicts patients' smile design
According to Camara 2010 esthetic planning should be based on
complex smile
4. Low smile
•The displays less than 75% of the maxillary incisors in a full smile
•found in about 20% of the population.
The average smile
reveals 75% to 100% of the upper incisors and is the most frequent type
(found in about 70% of the young adult population).
High smile
The reveals the complete cervico-incisal length of the upper incisors and a
contiguous band of gingiva
occurs in about 10%of the U.S. population.
“Gummy” smile
•A fourth type of lip line height, which occurs when patients show more than 4-mm
of gingiva on smiling
Upper lip coverage will always increase with age and therefore the percentage of high
smiles may be greater among younger age groups and smaller among older adults.
There is also a sexual dimorphism in that low smile lines are predominantly a male
characteristic and high smiles are predominantly a female characteristic. It is clinically
relevant that Gummy smiles are self-corrected to a certain extent over time, especially in
men.
5. 1st stage (voluntary smile) 2nd stage (spontaneous smile)
The upper lip is elevated towards the nasolabial
sulcus by contraction of the levator muscles,
which originate from this sulcus and are inserted into
the lips
The medial bundles elevate the lip in the region of
the anterior teeth
The lateral bundles in the region of the posterior
teeth until they meet with resistance from the
adipose tissue in the cheeks.
Starts with a higher elevation of both the lips and the
nasolabial sulcus through the agency of three
muscle groups:
The upper lip levator, which originates from
the infraorbital region,
Zygomatic major muscle
Superior fibers of the buccinator muscle
6. • A condition characterized by excessive exposure of
maxillary gingiva during smiling also called “high smile
line” or “gingival smile line”.
Etiology of Gummy Smile (GS):
•Altered passive eruption (short clinical crown)
•Anterior Dentoalveolar Extrusion
•retroclined upper incisors
Dental
Bony maxillary excess as:
•vertical maxillary excess
•bimaxillary protrusion.
Skeletal
•Excessive gingival overgrowth
•upper lip: (The Muscle of the upper lip is
hyperactive or Short upper lip)
soft tissue
8. • Tooth eruption is divided into two phases:
active
• the movement of the
teeth in the direction of
the occlusal plane
passive
• the exposure of the
teeth by apical
migration of the
gingiva.
9. condition occurs when the gingiva fails to migrate in the
apical direction during the eruption of teeth, thus, it remains
in a coronal position in relation with the cemento-enamel
junction (CEJ), which results in having an unacceptable
gingival exposure and unfavorable small size of the teeth
when smiling.
12% of the population
Definition
Incidence
10. Type II
Vertical
dimension of the
keratinized
gingiva is
normal
the mucogingival
junction is
positioned at the
level of the CEJ
Type I
Vertical length of
keratinized
gingiva is
greater than
normal
Mucogingival
junction (MGJ) is
located in an
apical position
to the level of
the
cementoenamel
junction (CEJ)
Sub type
A
The
measurement
between the
maxillary
alveolar crest
and the CEJ is
around 1.5 mm,
and in this case
a regular
attachment can
be found
Sub type
B
The level of
maxillary
alveolar crest is
at the level of
the CEJ, or
occlusal to the
CEJ in some
cases
Classification of APE
When compared to normal crown length of a central incisor (~11mm) a
patient's incisors can be classified as short, average or long. According to Rossi
et al. it was classified into two types and two sub types
11. • To assess upper lip length one needs to measure :
1-Philtrum height
the distance between the subnasale (Sn) and Stomion (St)
points of the upper lip (normally around 23 mm in males and 20
mm in females).
2-Commissure height
by measuring perpendicularly the distance between these
structures (C1 and C2) and their projections (C1’and C2’) in a
horizontal line that joins the two wing bases.
The linear values of these measures are not as important as
the relationship between the length of the philtrum and
commissures.
In children and adolescents, philtrum height is slightly lower
than or roughly equal to commissure height and this
difference can be explained by differential maturation of the
lips during growth.
Normally, when this happens in adults it causes increased
exposure of the incisors during rest and speech
12. Definition:
Wolford et al. defined Maxillary vertical hyperplasia or
vertical maxillary excess as an excessive vertical growth of
the maxilla which may or may not lead to an anterior open
bite.
Vertical maxillary
excess
13. 1
The length of the lower 3rd of the face is
more than the other two 3rds- steep
mandibular plane
2 Incompetent lip with greater display of
maxillary incisors at rest.
3
The incisal edge of the upper anterior teeth
might be covered by the lower lip dt excessive
downward growth of the maxilla
4
Inclination towards class II malocclusion
with or without open bite
5
The nose is longer, the alar bases are
small, the zygoma appears to be generally
flat.
6
Anterior maxillary height (upper incisor to
the palatal plane) is greater+1.03 mm in
males and 2.13 mm in females
7
Harmony of the occlusal plane between the
anterior and the posterior segments
Diagnostic criteria of VME
29.
7
20.
6
15. • Dentoalveolar flaring of both the maxillary and mandibular
anterior teeth, which cause the lips to be protruded, thus,
producing an additional convexity of the facial profile.
• Bimaxillary protrusion is mainly accompanied by several
degrees of lip deficiency defined as more than 4 mm of lip
detachment at the rest state
Bimaxillary protrusion
16. • Hormonal differences which take place in pregnancy and
puberty
• Drug induced gingival overgrowth
• Oral contraceptives
• Certain drugs as antidepressent, anti convulsant,
immunosupressant drugs.
• Genetic predisposition
• Oral hygiene condition
• Orthodontic treatment using orthodontic appliances
• Blood diseases as leukemia, leukemic cells might infiltrate to the
17. This condition may be associated with:
Incisor attrition and/or Deep bite
As the maxillary incisors extrude to make contact (passive
eruption), there is excessive gingival display and a curvature of
the occlusal plane, which is associated with a disharmony
between the anterior and posterior segments.
Retroclined upper incisors
Iatrogenic retroclination or abnormal axial inclination.
18. The volume of lip movement that exists when an individual
smiles, and is associated with a hyper function of the lip
elevator muscles and basically leads to excessive gingival
display.
If the total distance that the lip travels when smiling is
greater than ~ 9mm, the diagnosis is hypermobile lip.
Peck and Peck reported an
average lip movement of 5.2
mm (23% decrease) from a
measured lip length during a full
smile.
Robbins stated that the upper
lip is generally elevated around
6-8 mm from the rest position to
the position reached when a full
smile takes place.
20. Altered passive eruption (short clinical crown)
• Altered passive eruption may be resolved with periodontal surgery.
• The selected surgical procedure depends solely on the type of altered
passive eruption.
Degree TTT modalities
Type IA
Gingivectomy
Type IB
Gingivectomy+ Osteoplasty
Type IIA APF (apically positioned
flap)
Type IIB
Osteoplasty+APF
21. 1
2
Growing pt
Adult
Anatomically Short upper
lip
1-Lip repositioning surgery
composed of an oval mucosal excision followed by
coronally advanced flap. The procedure restricts the
muscle pull of the elevator lip muscles by shortening the
vestibule, thus reducing the gingival display while
smiling
2-Lip Stabilization Technique(LipStaT)
Vertical incision is done posteriorly to connect the
inferior incision (at the mucogingival junction) and the
superior incision (into the vestibule).
The rational of this incision is the height being double of
Disadv: this surgical procedures
may lead to a relapse and
undesirable side effects such as
contraction of the scar tissue
23. Degree TTT modalities
Type I: 2-4mm
-Orthodontic intrusion using miniscrews (total arch
intrusion)
-Orthodontics and periodontics to remove excessive
gingival tissue and bone volume (crown lengthening)
resulting from the applied mechanics
Type II: 4-8mm
Orthognathic surgery (Le Fort I osteotomy)
Type III: ≥8mm Orthognathic surgery with or without adjunctive
periodontal and restorative therapy
24. Advantages of total arch intrusion with miniscrews over
orthognathic surgery:
• Fewer risks
• Simpler orthodontic biomechanics
• Less patient discomfort
• Increased cost-effectiveness
• No increase in alar base width
25. Bony maxillary Excess
Bimaxillary protrusion
• use of bilateral anterior and posterior miniscrews to achieve total
arch intrusion of the anterior teeth and retraction of the entire arch.
26. conditions causing Gingival enlargement
• Treatment of this condition should focus on meticulous oral
hygiene.
• Sometimes, periodontal surgery will be needed to eliminate
the excessive amount of soft tissues.
• Meticulous history taking, in addition to an
excisional/incisional biopsy and/ or hematologic/histologic
inspection might be performed generally to make the
correct diagnosis of the uncommon conditions of gingival
enlargement.
27. Dentoalveolar Extrusion
Excessive dental attrition
Intrude the teeth
to correct the
level of the
gingiva then
restore the
normal length
Deep over bite
Orthodontic Intrusion
29. the center of resistance of the 4 incisors lie 8–10 mm apically and 5–7 mm distal
to the lateral incisors
1 Conventional vs miniscrew
2 One miniscrew vs two
3 Distal to centrals or distal to
laterals
30. Excessive activity upper lip
1 Surgical lip repositioning
2 Botox® injections
Polo in 2005 offered the use of botulinum toxin injections as a new nonsurgical method for treating excessive
gingival display.
Idea: When injected intramuscularly at therapeutic doses BTX-A produces partial chemical denervation of
muscles, resulting in localized reduction in muscle activity
Dosage: 2.5 units per 0.1cc injected in a maximum of four sites. This dosage is sufficient; what varies is the
number of injection sites.
Procedure: The toxin is injected into the area of the upper lip to decrease the elevating muscle activity, aimed
in particular at the levator labii superioris muscle. Two and four application sites are recommended for those
with 3-5 mm and more than 5mm of gingival display, respectively.
The use of Botox is not recommended for those who have less than 3 mm display due to the risk of
overcorrection.
Disadv:
• short effect of the toxin, which lasts only 3 to 6 months.
• Botox overdose can cause paralysis of the target muscles.
• mild burning at the injection site
31. A
E
C
D
B
APE
gingivectomy + APF+ osteoplasty
Anatomically short upper
lip
Growing pt lip stretching
Adult lip repositioning or libstat
Management of gummy smile
32. Bony maxillary excess
1. VME
Growing high pull headgear
Adult depend on the degree
(orthognathic or intrusion)
2. Bimax
Retraction with intrusion on
miniscrews
The average anterior maxillary height is 29.7mm, whereas the average posterior maxillary height is 20.6mm
Disadv: frequently cause labial tipping of incisors, extrusion of anchorage teeth
Disadv: frequently cause labial tipping of incisors, extrusion of anchorage teeth
Disadv: frequently cause labial tipping of incisors, extrusion of anchorage teeth
Disadv: frequently cause labial tipping of incisors, extrusion of anchorage teeth
Since a history of excessive incisal wear is usually associated with nocturnal parafunction, it is essential to retain the patient with a Hawley bite plate that slightly opens the posterior bite. The bite plate should be worn at night indefinitely to protect the restorations.
Disadv: frequently cause labial tipping of incisors, extrusion of anchorage teeth
