A Novel Nonsurgical Smooth Thread Technique to Correct Gummy Smiles

Abstract Background “Gummy smile” describes the aesthetically unappealing display of gums that extends more than 2 to 3 mm when individuals smile. The multifactorial etiology of the gummy smile leads to various surgical and nonsurgical treatment strategies, including orthodontic therapies, lip fillers, and primarily botulinum toxin as a nonsurgical treatment. Objectives In this paper, the authors present the preliminary report of a novel, minimally invasive, and non-neurotoxic treatment option for gummy smiles based on the insertion of smooth-surfaced resorbable polydioxanone threads along the vectors of the lip elevator muscles, offering long-lasting satisfactory aesthetic outcomes. Methods The proposed subcutaneous thread insertion technique utilizes 23 G, 38 mm cannulas with 14 smooth threads per cannula. Twenty-two female patients with subjectively distressing gummy smiles have been treated so far. The correction of gummy smiles is rapid and has been documented for up to 18 months, with the most protracted case lasting 20 months. The first cannula is positioned 1.5 cm from the labial commissure and 0.5 cm above it, following the vector of the orbicularis oris muscle from the modiolus to the upper white lip. The second cannula targets the levator labii superioris muscle vector, entering from the modiolus, and the third cannula follows the zygomaticus major and zygomaticus minor muscle vectors. The insertion points are the same for the first, second, and third cannula. The fourth cannula is inserted 2 cm from the insertion point of the first, second, and third cannulas toward the premasseteric area and the internal corner of the eye, crossing the third thread in a crossed pattern. Only the 2 threads along the levator labii superioris and orbicularis oris vectors were inserted in 1 of the 22 treated patients, who displayed no molar teeth exposure while smiling. Results No novel excessive gingival display has occurred in the 22 ambulatory patients treated so far for 9 to 12 months. In the patients treated so far, the mean distances between the diagnostic reference points decreased by 0.85 and 1.25 mm after 2 and 6 weeks, respectively, with negligible pain during the procedure and high satisfaction among all patients. Conclusions The proposed smooth thread technique could be a technically convenient and minimally invasive option for addressing disturbing gummy smile problems. Level of Evidence: 4 (Therapeutic)