{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:19:16Z","timestamp":1783772356489,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T00:00:00Z","timestamp":1509494400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> This case report describes the management of a patient diagnosed with excessive gingival display caused by altered passive eruption and hyperactive lip. Treatment for this patient was staged and included esthetic crown lengthening and a subsequent lip repositioning procedure.<\/jats:p><jats:p><jats:bold>Case Presentation:<\/jats:bold> A 17\u2010year\u2010old female was referred for assessment of a \u201cgummy smile.\u201d The patient reported a history of mouth breathing and a sports injury causing a non\u2010vital tooth #9, which had been temporarily restored. After periodontal evaluation, the patient was diagnosed with plaque\u2010induced gingivitis and excessive gingival display due to hyperactive lip and altered passive eruption. After initial therapy, an esthetic crown lengthening procedure was performed on the maxillary anterior sextant, resulting in ideal maxillary anterior crown contours. Six weeks after esthetic crown lengthening, the patient was treated for hyperactive lip by a modified lip repositioning surgery. Subsequently, the patient received a permanent restoration on tooth #9. During the 1.5\u2010year follow\u2010up time the patient repeatedly expressed her satisfaction with the improvement of her smile. Persistent mouth breathing and associated recurrent gingival inflammation remained a challenge.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The presented case illustrates results of sequentially applied techniques for management of a gummy smile of multifactorial etiology and limitations imposed by unresolved factors. Excessive gingival display can be a significant esthetic concern for patients. Understanding the etiology can be challenging due to multiple factors that may be concomitantly involved. Accurate diagnosis and treatment planning are critical for proper management. When multifactorial etiology is present, multiple treatment modalities, including various surgical approaches, are necessary to obtain positive outcomes in such patients.<\/jats:p>","DOI":"10.1902\/cap.2017.160074","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T10:01:10Z","timestamp":1491904870000},"page":"167-173","source":"Crossref","is-referenced-by-count":32,"title":["Treatment of Gummy Smile of Multifactorial Etiology: A Case Report"],"prefix":"10.1002","volume":"7","author":[{"given":"Monica P.","family":"Gibson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitris N.","family":"Tatakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0757.1996.tb00179.x"},{"key":"e_1_2_9_3_1","first-page":"809","article-title":"Excessive gingival display \u2013 Etiology, diagnosis, and treatment modalities","volume":"40","author":"Silberberg N","year":"2009","journal-title":"Quintessence Int"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199909020-00042"},{"key":"e_1_2_9_5_1","first-page":"695","article-title":"Correction of vertical maxillary excess by superior repositioning of the maxilla","volume":"31","author":"Zahrani AA","year":"2010","journal-title":"Saudi Med J"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12482"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2007.04.033"},{"key":"e_1_2_9_8_1","first-page":"952","article-title":"Aesthetic surgery of the malformation of the smile (in Spanish)","volume":"60","author":"Rubinstein AM","year":"1973","journal-title":"Prensa Med Argent"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12046"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.4317\/medoral.18044"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12617"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31825dc32f"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2010.02.053"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181e3b6d4"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1902\/cap.2017.160074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T21:33:10Z","timestamp":1760045590000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1902\/cap.2017.160074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1902\/cap.2017.160074"],"URL":"https:\/\/doi.org\/10.1902\/cap.2017.160074","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}