Influence of Facial and Occlusal Characteristics on Gummy Smile in Children: A Case-Control Study

Diana Maria Barbosa L, Lucia V. Bernal, Oscar Arturo Zapata, Andres Agudelo-Suarez, Laura Angel, Flavio Estrada, Johan Suarez

Abstract


Objective: To determine the association between occlusal and soft tissue characteristics with the presence of gingival smile (GS) in a pediatric population with inter-transitional mixed dentition. Material and Methods: Case-control study was performed with a probabilistic sample of 163 children in inter-transitional mixed dentition (age:8.8 years ±0.8). Cases were 37 children with GS, and controls were 126 children without GS. Occlusal variables were assessed through clinical examination, and soft tissue variables were assessed through photograms. Kappa test and intraclass correlation coefficient were done (0.87-0.96). The association between malocclusion, gender, and types of smile was assessed using a Chi square test. Comparison of quantitative variables in smile groups was made by Student t test. A multivariate binary logistic regression was performed. Results: Class II malocclusion, short upper lip at smile and short incisor  clinical crown, were risk factors for gummy smile (OR= 10.4, 95%CI 3.07- 34.95,  OR= 2.1, 95%CI 1.44- 3.13 and OR= 2.5 95%CI 1.34- 4.54 respectively). Lower facial height was a protective factor against GS (OR= 0.76; 95%CI 0.69- 0.85). The logistic regression model explains 48% of GS variability. Conclusion: Class II malocclusion is considered a risk factor for gummy smile. Other variables associated to gummy smile were short upper lip and short incisor clinical crown. Clinicians should considered these aspects in clinical examination of each patient to provide an adequate diagnostic and plan of treatment to control and/or correct a GS.


Keywords


Smiling, case-control studies, risk factors, Malocclusion, Angle class II, Child

Full Text:

PDF

References


Maulik C, Nanda R. Dynamic smile analysis in young adults. Am. J Orthod Dentofacial Orthop 2007; 132(3):307-15.

McLeod C, Fields HW, Hechter F, Wiltshire W, Rody W, Christensen J. Esthetics and smile characteristics evaluated by laypersons. Angle Orthod 2011; 81(2):198-205.

Ioi H, Nakata S, Counts AL. Influence of gingival display on smile aesthetics in Japanese. Eur J Orthod 2010; 32(6):633-7.

Sarver DM. The importance of incisor positioning in the esthetic smile: the smile arc. Am J Orthod Dentofacial Orthop 2001; 120(2): 98-111.

Ackerman JL, Ackerman MB, Brensinger CM LJ. A morphometric analysis of the posed smile. Clin Orthod Res 1998; 1(1):2–11.

Van der Geld P, Oosterveld P, Kuijpers-Jagtman AM. Age-related changes of the dental aesthetic zone at rest and during spontaneous smiling and speech. Eur J Orthod 2008; 30(4):366-73.

Redlich M, Mazor Z, Brezniak N. Severe high Angle Class II Division 1 malocclusion with vertical maxillary excess and gummy smile: a case report. Am. J. Orthod. Dentofacial Orthop 1999; 116(3):317-20.

Kokich VO, Kiyak A, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 1999; 11(6):311-24.

Monaco A, Streni O, Marci MC, Marzo G, Gatto R GM. Gummy smile: clinical parameters useful for diagnosis and therapeutic approach. J Clin Pediatr Dent 2004; 29(1):19-25

Ackerman MB, Ackerman JL. Smile analysis and design in the digital era. J Clin Orthod 2002; 36(4):221-36.

Peck S, Peck L, Kataja HA. The Gingival Smile line. Angle Orthod 1992; 62(2):91-100.

Wu H, Lin J, Zhou L, Bai D. Classification and craniofacial features of gummy smile in adolescents. J Craniofac Surg 2010; 21(5):1474-9.

Pithon MM, dos Santos CR, Lima Santos N de, Aguiar Sales Lima SO, da Silva Coqueiro R, dos Santos RL. Impact of malocclusion on affective/romantic relationships among young adults. Angle Orthod 2015; 14. doi: http://dx.doi.org/10.2319/030915-146.1.

Guo J, Gong H, Tian W, Tang W, Bai D. Alteration of gingival exposure and its aesthetic effect. J Craniofac Surg 2011; 22(3):909–13.

Salud M de. Colombia. Ministerio de Salud. III Estudio Nacional de Salud Bucal. ENSAB. Bogotá ; 1998.

Mamandras AH. Growth of lips in two dimensions: a serial cephalometric study. Am J Orthod 1984; 86(1):61–6.

Mamandras AH. Linear changes of the maxillary and mandibular lips. Am J Orthod Dentofacial Orthop 1988; 94(5):405.

Baume LJ. Physiological tooth migration and its significance for the development of occlusion: ii. the biogenesis of accessional dentition. J Dent Res 1950; 29(3):331–7.

Coelho N, Alfaro P, López H. Condicionantes clínicos de la sonrisa gingival. Rev Cienc Clín 2002; 3(1):19–25.

Nasr MW, Jabbour SF, Sidaoui JA, Haber RN, Kechichian EG.. Botulinum toxin for the treatment of excessive gingival display: A systematic review. Aesthet Surg J 2016; 36(1):82-8.

Desai S, Upadhyay M, Nanda R. Dynamic smile analysis: changes with age. Am.J Orthod Dentofacial Orthop 2009; 136(3):310.e1–10.

Lemeshow S, Hosmer DW J. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115(1):92–106.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596):1453–7.

Khan F, Abbas M. Frequency of gingival display during smiling and comparison of biometric measurements in subjects with and without gingival display. J Coll Physicians Surg Pak 2014; 24(7):503–7.

Nanda RS, Meng H, Kapila S, Goorhuis J. Growth changes of the soft tissue facial profile. Angle Orthod 1990; 60(3):177-90.

Sarver DM. The face as the determinant of treatment choice. In: JJ M, editor. Front. Dent. Facial Esthet Monogr 38, Craniofacial Growth Ser. Michigan: University of Michigan; 2001.

Miron H, Calderon S, Allon D. Upper lip changes and gingival exposure on smiling: vertical dimension analysis. Am. J Orthod Dentofacial Orthop 2012; 141(1):87-93.

Singer RE. A study of the morphologic, treatment, and esthetic aspects of gingival display. Am J Orthod 1974; 65(4):435-6.

Graber LW, Vanarsdall RL VK. Guia interceptiva de la oclusion con enfasis en el diagnostico. Ortod. Principios y tècnicas actuales. Madrid: Elsevier; 2006. p. 423-77.

Meyers DM. A multivariate analysis of the relations between craniofacial structure and occlusion with DiPaolo’s quadrilateral measures. Am J Orthod Dentofac Orthop 1992; 102(1):52-61.

Zupan S, Pohar M, Far F, Ovsenik M. Overjet as a predictor of sagittal skeletal relationships. Eur J Orthod 2008; 30(3):269-73.




PBOCI IS A MEMBER OF CROSSREF AND ALL THE CONTENT OF ITS JOURNALS ARE LINKED BY DOIS THROUGH CROSSREF.