Modified lip repositioning to correct gummy smile: 8‐year follow‐up of identical twins

BACKGROUND: Excessive gingival display (EGD) is an esthetic concern resulting in a gummy smile. EGD affects patients' self-confidence with negative emotional and psychosocial impact. The amount of gingival display is affected by different etiologies, including skeletal, muscular, or dento-alveolar factors. The treatment generally addresses the etiology and includes surgical lip repositioning (LRP), esthetic crown lengthening, or orthognathic surgery. Modified LRP (mLRP) reduces gingival display with less morbidity compared to orthognathic surgery. METHODS: The current report highlights an 8-year follow-up of identical 27-year-old twin sisters with EGD. The follow-up showed partial relapse in the original LRP and was retreated using mLRP. Therefore, the twins were retreated using mLRP, which had a lower rate of recurrence and higher patient satisfaction. RESULTS: Both patients demonstrated normal healing with a balanced dynamic smile and stable upper-lip position without EGD. CONCLUSION: mLRP provided esthetic results with reduction in gummy smiles. KEY POINTS: Lip repositioning (LRP) surgery is a less invasive alternative to orthognathic surgery in treating gummy smile patients. Modified LRP may work better long-term than the original approach in treating relapses. PLAIN LANGUAGE SUMMARY: This case report discusses treatment for a gummy smile that can affect patients' confidence by compromising their smile. Identical twin sisters who originally had lip repositioning (LRP) surgery to reduce a gummy smile experienced a relapse after 8 years. The relapse was treated with modified LRP surgery, which shows greater stability and less relapse in reducing the gummy smile compared to conventional LRP surgery. The modified approach significantly reduced the amount of gum display in both sisters and stayed stable through 18 months of follow-up.