| Abstract | Gummy smile je naziv za osmijeh kod kojeg se vidi više gingive od standardnih vrijednosti, odnosno više od tri milimetra, što se smatra neestetskim i kod pacijenata izaziva nezadovoljstvo. Etiologija gummy smilea je raznolika, često i kombinacija više čimbenika, a ovaj rad fokusira se na odgoĎenu pasivnu erupciju. Točan mehanizam nastanka odgoĎene pasivne erupcije još nije utvrĎen, a uzroci mogu biti genetičke, morfološke i hormonalne prirode. Dijagnoza se temelji na nekoliko raznih metoda
kao što su transgingivno sondiranje i sondiranje kosti, ali najpouzdanija metoda je CBCT. Dijagnostičkim postupcima nastojimo utvrditi koji je tip APE-a prisutan, a razlikujemo dva tipa, ovisno o odnosu gingive i kliničke krune, i dva podtipa temeljena na odnosu alveolarnog grebena i caklinsko-cementnog spojišta. Terapija je isključivo kirurška kojom se pacijentu vraća skladan odnos mekih i tvrdih tkiva. Ovisi o tipu i podtipu APE-a pa je tako u slučaju tipa 1 A dovoljna gingivektomija, a kod ostalih oblika apikalno repozicionirani reţanj uz ostektomiju i osteoplastiku čiji je cilj ukloniti dovoljno kosti da se postigne adekvatna biološka širina za što bolje cijeljenje. Problem je nepredvidljivost rezultata cijeljenja i povratak mekog tkiva nakon operacije koji je
neizbjeţan, ali njegova se veličina moţe smanjiti odreĎivanjem fenotipa gingive i uklanjanjem dovoljne količine kosti. Bitan čimbenik predstavlja pozicioniranje reţnja pri šivanju. Razna istraţivanja dokazala su da je povratak mekog tkiva manji što je udaljenost reţnja od koštanog grebena veća te se na tome temelje najnoviji koncepti resektivne kirurgije. Novitet je i očuvanje suprakoštanih vlakana, FibReORS, kojim se takošer smanjuje povratak mekog tkiva. |
| Abstract (english) | Gummy smile is term used for a smile having excessive gingival display, more than 3 mm, which is considered unesthetic and causes dissatisfaction with patiens. Etiology of gummy smile is various, often even a combination of multiple factors and this thesis is focused on altered passive eruption. The exact mechanism of delayed passive eruption has not yet been determined, and the causes can be genetic, morphological or hormonal. The diagnosis is based on several different
methods such as transgingival probing and bone probing, but the most reliable method is CBCT. Through diagnostic procedures, we try to determine which type of APE is present, and we distinguish between two types, depending on the relationship between the gingiva and the clinical crown, and two subtypes based on the relationship between the alveolar crest and the cemento-enamel junction. The therapy is only surgical, which restores the harmonious relationship between soft and hard tissues to the patient. It depends on the type and subtype of APE, so in the case of type 1 A, gingivectomy is sufficient, and in other forms, an apically repositioned flap with ostectomy and osteoplasty is needed, the goal of which is to remove enough bone to achieve an adequate biological width for better healing. The problem is the unpredictability of healing results and soft tissue rebound after surgery, which is inevitable, but its size can be reduced by determining the gingival phenotype and removing a sufficient amount of bone. An important factor is the positioning of the flap while
suturing. Various studies have proven that soft tissue rebound is smaller the greater the distance of the flap from the bone crest, and the latest concepts of resective surgery are based on this. Also a novelty, the preservation of supraosseous fibers, FibReORS, reduces soft tissue rebound. |
