Treatment of bilateral maxillary buccal exostoses on gummy smile

Buccal exostoses are benign, broad-based surface masses of the outer or facial aspect of the maxilla and less commonly at the mandible, usually found in the premolar and molar region.
A definitive female sex prediction is the characteristic of this condition. They are painless, self-limiting and may increase patient concern about poor esthetics. Gummy smile is an excessive gingival display during smiling which can occur in response to certain medications such as phenytoin or smaller than normal teeth due to developmental events, tooth eruption abnormalities, orthodontic treatments and even congenital defects. The objective of this treatment is to eliminate buccal exostoses and gingival overexposure with osseous resective surgery and crown lengthening to improve the esthetics of the gingiva, especially on anterior teeth.
Case: A 30-year-old female, buccal exostoses with gummy smile on the buccal aspect from molar to canines region of the bilateral maxillary arch. This case was managed by a combination of osseous resection surgery to treat exostosis and crown lengthening to remove alveolar bone and excessive gingival. Treatment selected for this case is osseous resective surgery and crown lengthening that aimed for the removal of bone and to achieve a physiological bone architecture bilateral exostoses, functional of gingiva and aesthetic. Treatment selected treatment for this case is osseous resection surgery and crown lengthening that aims for removal of bone and achieving physiological bone architecture bilateral exostoses, functional of gingiva and aesthetic. The surgical procedure was aimed to re-establish the biological width, apically while exposing more tooth structure.
Conclusion: The exostoses and gummy smile result in poor esthetics. Osseous resective surgery and crown lengthening were the treatment options to makes patient smile more proportional and achieving optimal aesthetics.

Keywords: exostoses, gummy smile, osseous resection, crown lengthening