thesis protocol leen 1 (1)

Assessment of Modified Lip Repositioning Surgery
and Z Plasty Frenectomy

for Treatment of Excessive Gingival Display
A Thesis Protocol
Submitted for partial fulfillment of the requirements of
the Master Degree in Dental Science
In
Oral and Maxillofacial Surgery
Research code: HE-11
Submitted By
Leen Abd Alrhman Somaf
B.D.S Hama University , 2019
Supervisors:
Title Name Job Title University Signature
Prof. Mohamed Professor of Oral and Suez Canal
Ahmed El Maxillofacial University
sholkamy Surgery, Faculty of
Dentistry
Dr. Mohamed Lecturer in Oral and Suez Canal
Nageh Maxillofacial University
Surgery, Faculty of
Dentistry
Faculty of Dentistry
Suez Canal University
2024
“Thesis Research Protocol”
Student Name: Leen Abd Alrhman Somaf Student Click or tap
ID: here to
enter text.
Submission Date: 6/2/2024
Degree: ☒ M.Sc. ☐ D.Sc. ☐ PH.D.
Department: Oral and Maxillofacial Surgery
Assessment of Modified Lip Repositioning
Surgery
Thesis Title in
English:
and Z Plasty Frenectomy
for Treatment of Excessive Gingival Display
The present research will be conducted after the approval of the Research Ethics
Committee (REC) of the faculty of Dentistry, Suez Canal University. It will be
‫تقييم عملية اعادة تموضع الشفة المعدلة و تقنية تقويم اللجام‬
conducted
Thesison (fifteen
Title in patients with mandibular bilateral partially or totally
Arabic:
‫لعالج فرط الظهور اللثوي‬
impacted third molars that need surgical extraction who will be selected from the
outpatient dental clinic of Oral and Maxillofacial Surgery Department at Suez
Canal University). Ethical considerations regarding patient well-being and
confidenddfdsddstiality will be undertaken by the researcher and an informed
written consent will be signed by the patients before commencing the study
explaining all clinical examinations, procedures and follow up.
Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

1
1. Abstract
Introduction: Excessive gingival display is a cosmetic problem where

it is usually managed by different approaches such as lip repositioning .
In this study, we will evaluate the modified lip repositioning surgery and
z plasty frenectomy as technique for treatment of gummy smile patients.
Aim: the aim is to evaluate the modified lip repositioning surgery to
reduce the gingival display and increase patient satisfaction by a simple
surgical procedure .
Methodology:
Committee (REC) ofThe the clinical study
faculty of will include
Dentistry, Suez 16 patients
Canal with gummy
University. It will be
smile on
conducted divided intopatients
(fifteen two groups equally (Group
with mandibular 1 andpartially
bilateral Group 2).or totally
Group 1: will be treated with conventional modified lip repositioning
technique
outpatient dentaland the labial
clinic of Oralfrenum will be left intact
and Maxillofacial . Department at Suez
Surgery
CanalGroup 2: will Ethical
University). be treated with z plastyregarding
considerations frenectomy.patient well-being and
confidenddfdsddstiality
Follow up intervalswill willbe
beundertaken
at 1,3 and 6bymonths.
the researcher and an informed

2
2. Introduction and Background
Excessive gingival display (EGD), commonly termed gummy smile, is a
condition characterized by an overexposure of the maxillary gingiva while
smiling .It is distinguished by showing more than 1.5-2 mm of the gingiva
.The amount of discrepancy considered unattractive varies between
populations; however, an excess of more than 3 mm is agreed upon
worldwide
Many techniques have been used to restore the dentogingival relation for the
management of gummy smile. Such techniques include crown lengthening
procedures, orthodontic leveling of the gingival margins of maxillary teeth,
Themaxillary teeth intrusion,
present research will be lip repositioning,
conducted orthognatic
after the approval surgery and
of the Research Ethics
nonsurgical
Committee procedures
(REC) like the
of the faculty ofuse of the botulinum
Dentistry, Suez Canaltoxin.
conducted on (fifteen patients with mandibular bilateral partially or totally
Lip repositioning
outpatient dental clinicprocedure
of Oral andwasMaxillofacial
first describedSurgery
by Rubinstein and at Suez
Department
Kostianovsky
Canal University).asEthical
a part of medical plastic
considerations surgery patient well-being and
regarding
The surgery was based
confidenddfdsddstiality onbe
will a strip of maxillary
undertaken by thelabial mucosaand
researcher excision.
an informed
Thisconsent
written technique involves
will be signedremoving
by the apatients
band ofbefore
mucosa from the vestibular
commencing the study
explaining
mucosa all clinical
apical to theexaminations,
mucogingivalprocedures
junction and follow up.
The removal of mucosa was partial, leaving the periosteum intact.
Finally, the lip was immobilized using suture (Rubinstein and
Kostianovsky 1973)
Presented a case report of 25 year old patient with excessive gingival display
using lip repositioning surgery where the technique involves the removal of a
strap of epithelium from the vestibular mucosa thereby shortening the
vestibule, the proposed technique can be used an alternative to invasive
surgery with satisfactory results. It can be used alone or in combination with
other procedures , the advantage of this technique is that it is an easier less
complicated approach with low morbidity providing a satisfactory
camouflage effect (Foudah MA 2019)

3
Botulinum toxin injections and lip repositioning surgery are the primary
options for the treatment of excessive gingival display; orthognathic
surgery is another option. However, botulinum toxin injections do not
have a permanent effect and must be repeated every few months,
whereas orthognathic surgery is an invasive procedure (Polo,
2005, Tawfik et al., 2017)
modified
The present the original
research technique
will be conductedsuch thatthe
after theapproval
upper labial frenum
of the was Ethics
Research
preserved
Committee (REC)to maintain the labial
of the faculty midline and
of Dentistry, reduce
Suez Canal postoperative
morbidity
conducted (Silva et
on (fifteen al., 2013)
patients with mandibular bilateral partially or totally
The etiological
outpatient factors
dental clinic of gummy
of Oral smile may occur
and Maxillofacial Surgeryalone or in
Department at Suez
combination With other factors these of which are skeletal problems
muscle disorders and
confidenddfdsddstiality gingival
will abnormalities
be undertaken by the(Oliveira
researchert al .2015)
and an informed
evaluateall
explaining theclinical
effectiveness of both procedures
examinations, injection botulinum
and followtoxin
up.and surgical lip
repositioning in the correction of the gummy smile due to hyperactive
upper lip according to the resulting smile and the patients' satisfaction
(Makkeiah MO et al 2021)
The technique was performed to limit the retraction of elevator muscles by

removing two strips of mucosa from maxillary buccal vestibule on both the
sides leaving the frenum and suturing the lip mucosa with mucogingival
junction, resulting in a narrow vestibule and restricted muscle pull, thereby
reducing gingival display. This technique is different from the conventional
surgical lip repositioning as labial frenum is left untouched over here as it
helps in maintain Litton the midline for lip repositioning and reduces the
morbidity associated with it. (Rao AG et al 2015)

4
The nasal septum muscle containment surgical technique has been
suggested as an alternative for the treatment of gingival smile, as this
muscle has a strong influence on the smile and has been associated with
excessive lifting of the upper lip. A technique incorporating bilateral
muscle restraint resulted in favorable lowering of the upper lip. To correct
upper lip asymmetry, where the patient raises one side more than the other
when smiling, restraint can be applied on one side only (proposed a muscle
repositioning technique to lift the upper lip and nose wing via resorbable
muscle sutures positioned close to the alveolar process for treatment of
Thepatients
present with gummy
research will smile.
be conducted after the approval of the Research Ethics
Using local anesthesia gingival recontouring technique was performed to
remove the excess gingiva followed by a containment of the elevator
musclesdental
outpatient of theclinic
lip (Storrer
of Oral et
andal.Maxillofacial
2014) Surgery Department at Suez
Published a review to investigate the scientific evidence on the long term
stability of lip repositioning surgery with or without myotomy. Based on
the available
explaining data, they
all clinical found out procedures
examinations, that lip repositioning
and followwith
up. myotomy/
muscle containment can be a successful treatment for minor discrepancies
in the gum show in selected cases, however they recommended that
further well organized controlled clinical trials should be established to
derive a conclusion about the long term stability (Ardakani MT et al
2021)
Evaluated the use of modified lip repositioning technique associated with

esthetic crown lengthening for treatment of a patient with excessive
gingival display due to multiple etiologies where in the technique the
labial frenum was left intact as it helps in maintain the midline. The author
concluded that this technique is an effective technique in reducing the
gummy smile especially when combined with esthetic crown lengthening
(Mantovani MB et al 2016)

5
Evaluated lip repositioning surgery in three cases where they concluded that
accurate case selection is the key in preventing the relapse associated with the
procedure where if followed correctly the prognosis of the technique ill be
sustainable for months. on the other hand, they advocated that there is no need
for randomized clinical trials to assess the outcomes of this surgery and to
determine the impact of variation in techniques and different patient factors
on the final outcomes (Haddadi P et al 2021)
Smile is considered unattractive when a distance of ≥ 4 mm between the lip

The
andpresent
gingivaresearch will(Kokich
is present be conducted
et al., after
1999)the approval of the Research Ethics
In this study
impacted we investigate
third molars thesurgical
that need efficiency of modified
extraction who lip
willrepositioning and zthe
be selected from
plasty frenectomy
outpatient with
dental clinic of excessive gingival display.
Oral and Maxillofacial Surgery Department at Suez
3. Research Q (RQ):
Does the modified lip repositioning surgery or z plasty frenectomy
improves the amount of gingival display in gummy smile patients ?

6
4. Research Hypothesis, Aim, Objectives & Expected
Outcomes
a. Hypothesis
Null Hypothesis: is that there is no significance difference in reduce
the amount of gingival display between The Z Plasty Frenectomy
surgery and the Modified Lip Repositioning Surgery.
Alternate Hypothesis: is that there is significance difference in reduce

the amount of gingival display between The Z Plasty Frenectomy
surgeryresearch
The present and the Modified Lip Repositioning
will be conducted Surgery.of the Research Ethics
after the approval
b. Aimon (fifteen patients with mandibular bilateral partially or totally
conducted
Improving
impacted aesthetics
third molars that and
needpatient satisfaction.
surgical extraction who will be selected from the
c. Objectives
- Modified lip repositioning surgery will be performed in the first study
group, while z plasty frenectomy surgery will be performed in the second
group.
- All patient will be evaluated clinically a postoperatively.
d. Expected Outcomes
- Significant decrease in the amount of gingival display.
- Enhance healing process in the study group consequently reduce
postoperative complications.
- Increase in the patient satisfaction rate in the study group in
comparison to control group.

7
5. Research Design and Methods
1- Materials :
Brand name Composition Company

Surgical Burs Fissure Cairo, Egypt
Lancet Lancet #15 Cairo, Egypt
Saline Saline Cairo, Egypt
Surgical Suture Silk Cairo, Egypt
The present
Local research will bemepivacaine
anesthesia conducted after
2 %the approval
Cairo, of the Research Ethics
Egypt

8
2- Methods :
I. Study Design :
An in-vivo randomized controlled clinical study
II. Patient Selection :

Sixteen patient adult patient will be selected from the outpatient clinic
of maxillofacial surgery in faculty of dentistry suez canal university.
All patient will be selected with no systemic or metabolic disorders, all
The presenttheresearch
patient should
will be be diagnosed
conducted with
after theanapproval
excessive
of gingival display.
the Research Ethics
CommitteeThen,
(REC) of the
each faculty
patient willof Dentistry,
sign Suez consent
an informed Canal University. It will be
impacted thirdcriteria
Inclusion molars that
: need surgical extraction who will be selected from the
outpatient dental
1- Age clinic
group of Oral
20-50 and Maxillofacial Surgery Department at Suez
years.
2- Both Genders.
3- Patients havingwill an be undertaken
excessive by the
gingival researcher and an informed
display
Exclusion criteria :
1. Poor oral hygiene patients
2. Patients with active acute infection
3. Patients with bad oral habits.
4. Pregnant or lactating women.
5. Heavy smokers.
6. Alcohol and drug addicts.

9
Sample Grouping :
16 patients with excessive gingival display
The patients will be divided into two groups (Group I and Group II):
Group I: 8 patients will be treated with conventional modified lip

repositioning technique only by doing a horizontal incision at the
mucogingival junction from the midline frenum until the premolars, at the
end of the first incision, a vertical incision will e made extending double the
amount of gingival display apically.
TheApresent
horizontal incision
research will connecting
be conducted theafter
two the
vertical lines of
approval parallel to the first
the Research Ethics
Committee
incision (REC)
will beof the faculty
made followed of by
Dentistry,
removalSuez Canal
of this stripUniversity.
of mucosa Itaswill be
a full
conducted on tissue
thickness (fifteen patients
leaving thewith mandibular
labial bilateral partially or totally
frenum intact.
Group dental
outpatient II: 8 patients will
clinic of be and
Oral treated with z plasty
Maxillofacial frenectomy
Surgery technique
Department by
at Suez
doing
Canal A verticalEthical
University). incision from the bottom
considerations of the patient
regarding frenulum to the labial
well-being and
attachment and the mucosa
confidenddfdsddstiality will be was separated
undertaken byfrom the lip muscles.
the researcher and an informed
After that two horizontal incisions were made with the same length as the
vertical incision on the left and right sides with an angle of 60𝑜. The
incision produced a triangular flap with the same shape and size. The
triangular flap was transposed to the opposite side to produce a new position
and stabilized with simple interrupted suture
Sample Size Calculation:

The sample size for this study was calculated according to Arkin (1984),
using the following equation [40]:
(𝑍𝛼 )2 ∗ (𝑆)2
N=
(𝑑)2
N= Total sample size

S = Standard diversion
𝒁𝜶 = 1.96 at significant level 95%
d =Different between factors

10
Z S D
1.96 4.12 2
(1.96)2 x(𝟒.𝟏𝟐)2
Total sample size N = =16.302 ≈ 16
(2)2
Total sample size is 16 Samples for all groups as follow in the table :
Committee (REC) of the faculty of Dentistry,
GROUPS NO. OFSuez Canal University. It will be
SAMPLE
conducted on (fifteen Group
patientsI with mandibular
8 bilateral partially or totally
impacted third molarsGroup II surgical8extraction who will be selected from the
that need
outpatient dental clinicTotal
of Oral 16
and Maxillofacial
Samples Surgery Department at Suez
III. Preoperative evaluation :
Clinial evaluation and assessment immediately preoperative.
IV. Surgical protocol:
1- Surgical procedures will be done under local anesthesia.

2- Group I : A Surgical operations will be performed as a modified lip
repositioning surgery leaving the labial frenum intact.
3- Irrigation with saline solution.
4- The flap will be sutured with (3–0 Silk).
5- In Group II: A surgical operations will be performed as z plasty
frenectomy.
6- Irrigation with saline solution.
7- The flap will be sutured with (3–0 Silk).

11
V- Drug prescription protocol:
All patients will be given antibiotic drug (Augmentin 1gm tab twice daily
for one week), anti-inflammatory drug (alphintern 1 tab three times per day
for one week) and analgesic drug (Cataflam 50 mg one tab)
VI- Postoperative evaluation:
The present research

- Clinical will be of
evaluation conducted after
all patient willthe
beapproval of the Research
made immediately, Ethics
one month,
Committee (REC)
three of the
months, sixfaculty
monthsofpostoperatively
Dentistry, SueztoCanal University.
record signs likeItedema
will be
conducted oninfection
and (fifteen patients withtomandibular
in addition bilateral partially
clinical measurement or totally
of the gum show ant
impactedthe
third molars that need surgical
patient satisfaction rate. extraction who will be selected from the
Statistical plan
All data will be assessed by use of Statistical Package for Social Sciences
(SPSS) system.
Experimental design and data analysis
All data will be collected and statistically analyzed using statistical
tests as follows:
A normality test will be done to check normal distribution of the

sample.
Statistical analysis will be done using the SPSS software at

significant levels 0.05 (P- Value ≤0.5).

12
a) Descriptive data:
In the form of Mean ± Standard deviation (SD), range (Max-
Min)…etc.
b) F- test
One way ANOVA (parametric or non-parametric) will be
used to compare between the two groups for each parameter under
study. P value ≤0.05 is considered be statistically significant.
c) T- test
Independent Student’s T-test data will be performed for
comparing
The present researchthe willmean differences
be conducted between
after the two
the approval ofgroups for each
the Research Ethics
measurement .
impacted third molars
7. Ethics that need surgical extraction who will be selected from the
consideration:
Clinical
Canal StudyEthical
University). (In - vivo Study)
considerations regarding patient well-being and
The present researchwill willbebeundertaken
conducted by thethe
after researcher
approvaland an informed
of the Research
written
Ethics Committee (REC) of the faculty of Dentistry, Suez Canal study
consent will be signed by the patients before commencing the
explaining all clinical
University. It will examinations,
be conducted on procedures andwith
(16 patients follow up.
excessive gingival
display) who will be selected from the outpatient dental clinic of Oral and
Maxillofacial Surgery Department at Suez Canal University. Ethical
considerations regarding patient well-being and confidentiality will be
undertaken by the researcher and an informed written consent will be
signed by the patients before beginning the study explaining all clinical
examinations, procedures and follow up.

13
8. Time Plan
Starting After approval of Ethical Committee and Faculty Council
Ending After 24 months postoperative
Activity/Month
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
9
Patient selection ☐ ☐ ☐ ☐ ☒ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Surgical procedure ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☒ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Post-operative evaluation ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☒ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Statistical analysis ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☒ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Thesis writing ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☒ ☐ ☐ ☐ ☐
Publication ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☒
conducted on (fifteen
9. Research patients with
Estimated mandibular
Budget bilateral
in Egyptian poundspartially or totally
outpatient dental clinic of Oral and MaxillofacialPublications
Supplementary Surgery Department
Total at Suez
Canal University).
surgery Ethical considerations
drugs/ regarding patient well-being and
Others
Materials
Lab chemicalswill be undertaken by the researcher and an informed
(Instruments)
Preoperative Antibiotics, Vicryl

written consent will
admission,
be signed
analgesics,
by the patients
sutures, Syringes
before commencing the study
explaining
local all clinical
anti- examinations,
Local procedures
Muco- and follow up.
anesthesia, inflammatory anesthesia, periosteal
operation Drugs Saline, elevator
room and tissue
postoperative forceps
care
20000 2000 3000 2000 3000 30000

14
10. References
1- Bhola M., Fairbairn P.J., Kolhatkar S., Chu S.J., Morris T., de Campos
M. LipStaT: the lip stabilization technique- indications and guidelines
for case selection and classification of excessive gingival display. Int.
J. Periodontics Restorative Dent. 2015;35:549–559.
2- Ekman P., Davidson R.J., Friesen W.V. The Duchenne smile:
emotional expression and brain physiology II. J. Pers. Soc.
Psychol. 1990;58:342–353.
3- Garber D.A., Salama M.A. The aesthetic smile: diagnosis and
treatment. Periodontol 2000. 1996;11:18–28.
4- Geron patients
S., Atalia with mandibular
W. Influence of sex on bilateral partiallyofororal
the perception totally
and
impactedsmile estheticsthat
third molars with different
need gingival
surgical display
extraction whoandwillincisal plane from the
be selected
outpatientinclination. Angle.
dental clinic Orthod.
of Oral 2005;75:778–784.
and Maxillofacial Surgery10.1043/0003-
Department at Suez
3219(2005)
Canal University). 75[778:IOSOTP]2.0.CO;2.
Ethical considerations regarding patient well-being and
confidenddfdsddstiality will be undertaken
5- Humayun N., Kolhatkar byJ.,
S., Souiyas theBhola
researcher and an coronally
M. Mucosal informed
written consent will flap
positioned be signed
for thebymanagement
the patients of
before commencing
excessive gingivalthe studyin
display
explaining
theallpresence
clinical of
examinations,
hypermobility procedures and lip
of the upper follow
and up.
vertical maxillary
excess: a case report. J. Periodontol. 2010;81:1858–1863.
6- Kokich V.O., Jr., Kiyak H.A., Shapiro P.A. Comparing the perception
of dentists and lay people to altered dental esthetics. J. Esthet.
Dent. 1999;11:311–324.
7- Litton C., Fournier P. Simple surgical correction of the gummy
smile. Plast. Reconstr. Surg. 1979;63:372–373.
8- McLaren E.A., Rifkin R. Macroesthetics: facial and dentofacial
analysis. J. Calif. Dent. Assoc. 2002;30:839–846.
9- Miskinyar S.A. A new method for correcting a gummy smile. Plast.
Reconstr. Surg. 1983;72:397–400.
10- Oliveira M., Molina G., Furtado A., Ghizorin J., Pereira J. Gummy
smile: a contemporary and multidiscplinary overview. Dent.
Hypotheses. 2015:55–60.

15
11- Patel D.M.F., Trivedi R., Thakkar S., Suthar J. Botulinum toxin and
gummy smile – a review. IOSR J. Dental Med. Sci. 2013;4:2279–
10861.
12- Peck S., Peck L. Selected aspects of the art and science of facial
esthetics. Semin. Orthod. 1995;1:105–126.
13- Peck S., Peck L., Kataja M. Some vertical lineaments of lip
position. Am. J. Orthod. Dentofacial. Orthop. 1992:519–524.
14- Polo
The present M. Botulinum
research toxin A (Botox)
will be conducted forapproval
after the the neuromuscular correction
of the Research Ethics
Committee of (REC)
the excessive gingivalofdisplay
of the faculty on smiling
Dentistry, (gummy
Suez Canal smile) Am.
University. J. be
It will
conductedOrthod. Dentofacial.
on (fifteen patients Orthop. 2008:195–203.
with mandibular bilateral partially or totally
impacted third molars
15- Robbins J.W.that need surgical
Differential extraction
diagnosis who willofbeexcess
and treatment selected from the
gingival
outpatientdisplay.
dental clinic
Pract. of Oral and Maxillofacial
Periodontics Aesthet. Dent.Surgery Department at
1999;11:265–272. Suez
quiz 273.
16- Rosenblatt A., Simon
confidenddfdsddstiality will be Z. Lip repositioning
undertaken for reduction
by the researcher of excessive
and an informed
gingival display: a clinical report. Int. J. Periodontics Restorative
Dent. 2006;26:433–437.
17- Rubinstein A., Kostianovsky A. Original technique; 1973. Cosmetic
surgery for the malformation of the laugh.
18- Saadoun A. All about the smile. Quintessence. 2005:265–295.
19- Sarver D.M. Principles of cosmetic dentistry in orthodontics: Part 1.

Shape and proportionality of anterior teeth. Am. J. Orthod.
Dentofacial. Orthop. 2004;126:749–753.
20- Simon Z., Rosenblatt A., Dorfman W. Eliminating a gummy smie with
surgical lip repositioning. Cosmet. Dent. 2007:100–108.
11. Appendices (Questionnaire / Consent form)
Informed Consent

16
‫جامعة قناة السويس‬
‫كلية طب األسنان‬
‫لجنة أخالقيات البحث العلمي نموذج الموافقه المستنيرة‬
‫ألجراء بحث طبي علي مشارك متطوع‬
..................................
The present research will be :conducted
‫ النوع‬........................................
after the approval of :)‫ض‬
the‫المري‬ ( ‫المشارك‬Ethics
Research ‫اسم‬
.......................................... :‫تاريخ الميالد‬ .........................................:‫السن‬
Canal University).
‫تقنية تقويم اللجام‬Ethical
‫المعدلة و‬considerations
‫اعادة تموضع الشفة‬ regarding
‫تقييم عملية‬patient
:.‫العربيه‬well-being and -١
‫عنوان البحث باللغه‬
confidenddfdsddstiality will be undertaken by the researcher and
‫اللثوي‬ an informed
‫الظهور‬ ‫لعالج فرط‬
:‫ الخلفيه العلميه (لموضوع البحث) والهدف من اجراء البحث‬-٢

‫الهدف من هذه الدراسة هو مقارنة تقنية اعادة تموضع الشفة المعدلة وتقنية تقويم اللجام في عالج‬
.‫فرط الظهور اللثوي واالبتسامة اللثوية‬
:‫ ما سوف يتم اجراؤه بالتفصيل‬-٣

‫ اشهر و ستجرى الدراسة في العيادات الخارجية لقسم الفم‬٦ ‫ مدة البحث‬:‫ مدة البحث ومكانه‬-*
.‫ جامعة قناة السويس‬، ‫ كلية طب األسنان‬، ‫والوجه والفكين‬
‫ شخص‬١٦ :‫ عدد المشاركين في البحث‬-*
:‫تفاصيل خطوات البحث‬-*

17
‫بعد التشخيص الدقيق ويعتبر المريض مؤه ًل سيتم اجراء العملية الجراحية و متابعة النتيجة من‬
‫حيث التئام الجرح و الظهور اللثوي ورضا المريض‪.‬‬
‫بالنسبة لمجموعة الدراسة‪:‬‬
‫سيتم اجراء عملية اعادة تموضع الشفة بالطريقة المعدلة‪.‬‬
‫بالنسبة للمجموعة الضابطة‪:‬‬
‫سيتم اجراء عملية قطع اللجام‬
‫ونقوم بخايطة الجرح باستخدام خيط حرير حجم ‪٣-0‬‬
‫نصف للمرضى مضاد حيوي وهو األوجمنتين ‪ ١‬جرام بمعدل قرص كل ‪ ١٢‬ساعة لمدة ‪ 5‬ايام‬
‫كذلك نصف لهم النوع المناسب والجرعة والكمية من مضادات االلتهاب‪.‬‬
‫‪The present‬‬
‫‪research‬سرعة‬ ‫‪will‬‬
‫إلى زيادة في‬ ‫‪be conducted‬‬
‫سيؤدي‬ ‫جراء‪after‬‬
‫عملية قطع اللجام‬ ‫أن ا‪the‬‬
‫‪approval‬‬ ‫‪of the‬‬
‫البحث ‪ :‬هي‬ ‫‪Research‬‬
‫المتوقعه من‬ ‫‪Ethics‬‬
‫الفوائد‬ ‫‪-٤‬‬
‫‪Committee (REC) of the faculty of Dentistry,‬‬ ‫االلتئام و تقليل الظهور اللثوي ورضا المريض‪.‬‬
‫‪Suez‬‬ ‫‪Canal‬‬ ‫‪University.‬‬ ‫‪It‬‬ ‫‪will‬‬ ‫‪be‬‬
‫‪conducted on (fifteen patients with mandibular bilateral partially or totally‬‬
‫‪ -5‬المخاطر المحتمل حدوثها من اجراء البحث تنميل في الشفاه العلوية و الم ووذمة ما بعد‬
‫‪impacted third molars that need surgical extraction who will be selected from the‬‬
‫الجراحة ‪.‬‬
‫‪outpatient dental clinic of Oral and Maxillofacial Surgery Department at Suez‬‬
‫‪Canal University).‬‬ ‫الجراحة‪.‬‬ ‫ما بعد‬
‫‪Ethical‬‬ ‫‪ regarding‬جميع مضاعفات‬
‫‪considerations‬‬ ‫مخاطر معالجة‬ ‫‪ well-being‬حدوث‬
‫‪patient‬‬ ‫التعويضات في حالة‬
‫‪and -٦‬‬
‫‪confidenddfdsddstiality‬‬
‫‪will‬الرئيسي‪ .‬بعد انتهاء‬ ‫سوي‪be‬‬
‫الباحث‬ ‫‪undertaken‬‬
‫‪the‬ولن‪by‬يطلع عليها‬ ‫‪researcher‬‬
‫كامله‬ ‫‪and an‬‬
‫معلوماتك بسريه‬ ‫‪informed‬‬
‫تعامل‬ ‫‪ -٧‬سوف‬
‫‪written consent will be signed‬‬‫الدراسه سيتم ابالغك بالنتائج وأي نتائج خاصه تتعلق بحالتك الصحيه‪.‬‬
‫‪by‬‬ ‫‪the‬‬ ‫‪patients‬‬ ‫‪before‬‬ ‫‪commencing‬‬ ‫‪the‬‬ ‫‪study‬‬
‫‪explaining all clinical examinations, procedures and follow up.‬‬
‫‪ -٨‬حقك في األنسحاب من البحث في أي وقت دون ابداء أسباب ودون أي عواقب سلبيه‬
‫عليك‪.‬‬
‫‪ -٩‬في حالة أخذ أي عينه‪ :‬فسوف ال تستخدم في أي بحث آخر‪.‬‬
‫‪ -١0‬عند وجود أي استفسار لديك يمكنك االتصال ب‪:‬‬
‫الباحث الرئيسي‪:‬د‪ /‬لين عبد الرحمن صوماف تليفون‪+٢0١5578١800٣ :‬‬
‫من ينوب عنه‪ :‬د‪ /‬محمد ناجح تليفون‪+٢0١00٢0٦١808 :‬‬
‫مقرر لجنة األخالقيات‪....................................... :‬‬
‫تليفون‪............................................... :‬‬
‫**أقر أنني اطلعت وفهمت األجراءات التي ستتم خالل هذا البحث ووافقت عليها‪.‬‬
‫الباحث الرئيسي‬ ‫المشارك في البحث‬
‫األسم‪........................................................:‬‬
‫التوقيع (البصمه)‪...........................................:‬‬
‫‪Tel: 015578188003‬‬ ‫‪E-mail:pgs.230132@dent.suez.edu.eg‬‬

‫‪18‬‬
......................................................:‫التاريخ‬
.‫ من حق المتطوع الحصول علي صورة من األقرار‬:‫**ملحوظه‬
:‫هذا البحث‬
) * ( ‫توطئه لرسالة ماجستير‬
) ( ‫توطئه لرسالة دكتوراه‬
) ( ‫بحث غير ممول‬
) ( ‫مشروع بحثي ممول‬
‫تمت الموافقه علي هذا البحث من قبل لجنة أخالقيات البحث العلمي‬
The present research will be conducted after the ............................................

approval of the Research:‫بتاريخ‬ Ethics
Committee (REC) of the.......................................................
faculty of Dentistry, Suez Canal University. :‫الموافقه سارية حتي‬
It will‫هذه‬
be
‫خاتم اللجنة‬ ‫رئيس اللجنة‬

19
Suez Canal University
Faculty of Dentistry
Research Ethics Committee (REC)
----------------------------------------------------------------------------------------
Investigator Application Form
1- Name of researcher: Leen Abd Alrhman Somaf
The present
2- Nameresearch will be conducted
of Department: Oral andafter the approval
Maxillofacial of the Research Ethics
Surgery
3- Address patients with
of researcher: mandibular
ismailia, Egypt. bilateral partially or totally
a- Email: leensomaff@gmail.com
b- University).
Canal Phone number: +201557818003
Ethical considerations regarding patient well-being and
4- Name
explaining (s) of Co-investigator
all clinical examinations, (s):
procedures and follow up.
Prof. Dr. Mohamed ahmed elshalkamy
Dr. Mohamed nageh
5- Grade of protocol:
*M.D.Sc. ( * ) *Ph.D. ( ) *Doctorate degree (D.D.Sc) ) (
*Other) (
*Domestic ( ) *Multi-Centre within Egypt) (
*International) (
٦- Title of the research: Assessment of modified lip repositioning

surgery and z plasty frenectomy for treatment of excessive gingival
display

20
7- Type of the research:
*Drug trial ( ) *Surgical technique (*) *Investigative technique) (

*Devise study ( ) *Survey study ( ) *Blood sampling ( )*Review
Of old records) (
1- Subjects of research: Efficacy of Titanium PRF Placement in
Mandible following Impaction Extraction.
* Children (˂ 18 years): ( ) *Adults (>18 years) :)*(
*Vulnerable
Committee (REC)groups
of the (yes) orof
faculty noDentistry,
(*) Suez Canal University. It will be
conducted
If yes,on (fifteen
please patients
describe: N/Awith mandibular bilateral partially or totally
2- Request is being made to waive(give-up) informed consent: Yes) (
No)*(
If yes, please explain will be undertaken
why? N/A by the researcher and an informed
3-
explaining The researchexaminations,
all clinical is for the good of society:and
procedures Yes)*( up.(
followNo)
4- Study design:
A-Phase type I: ( ) II: ) ( III: ) (
B-Randomization: Yes)*( No) (
C-Placebo: Yes ) ( No)*(
D-Genetic sampling: Yes ) ( No)*(
E-Other: Yes ( ) No)*(
5- Facilities for the research are available: Yes)*( No) (
6- List the risks of the study: Post-operative pain ,swelling
7- List the potential benefits, if any, to the subjects: Using z plasty
frenectomy and modified lip repositioning will reduce gingival
display in gummy smile.
8- Are the risks reasonable to the potential benefits to the subjects, if
any, or to the knowledge to be gained? Yes: (*) No: ( )
9- Privacy and confidentiality of subjects are assured Yes: (*) No: ( )

21
10- The subject of the research could quit at any time without penalty
or loss of any benefits to which they would otherwise be entitled Yes :
)*( No) (
----------------------------------------------------------------------------------------
Signature of the principal investigator: Date:

22
‫تقييم عملية اعادة تموضع الشفة المعدلة و تقنية تقويم اللجام‬
‫لعالج فرط الظهور اللثوي‬
‫خطة بحث مقدمة توطئة للحصول على‬

‫درجة الماجستير في جامعة قناة السويس‬
‫كود البحث ‪HE-11 :‬‬
‫مقدمة من‬
‫لين عبدالرحمن صوماف‬
‫كلية طب الفم و االسنان جامعة حماه ‪٢0١9‬‬
‫المشرفين‬
‫التوقيع‬ ‫الجامعة‬ ‫الوظيفة‬ ‫االسم‬ ‫اللقب‬
‫جامعة قناة‬ ‫أستاذ جراحة الفم‬ ‫محمد أحمد الشلقامي‬ ‫ا‪.‬د‪./‬‬
‫السويس‬ ‫والوجه والفكين‬
‫جامعة قناة‬ ‫مدرس جراحة الفم و‬ ‫محمد ناجح‬ ‫د‪/.‬‬

‫السويس‬ ‫الوجه و الفكين‬
‫جامعة قناة السويس‬
‫‪2024‬‬
‫الملخص العربي‪:‬‬
‫‪ )١‬المقدمة‪:‬‬
‫تعتبر االبتسامة اللثوية من المشاكل التجميلية التي تنتشر بشكل شائع لدى كثير من الناس‬
‫وباألخص السيدات يمكن عالج هذه المشكلة بعدة طرق مثل حقن البوتوكس في جزء من‬
‫عضالت حول الفم والشفة العلوية‪ ،‬ومن الممكن عالج االبتسامة اللثوية من خالل حقن الفيلر لكن‬
‫هذه الطرق تعتبر مؤقتة‬
‫اما عملية اعادة تموضع الشفة تتميز انها ال تحتاج الى تخدير كلي بجانب قلة المضاعفات‬
‫المصاحبة للجراحة وسهولتها بالمقارنة مع جراحات اخرى‪.‬‬
‫تم اضافة تعديالت على هذه الجراحة بهدف الحصول على نتائج أفضل و مرضية للمريض مع‬
‫يوجد نقص في‬
‫‪The present‬‬ ‫‪research‬‬ ‫مؤخراً‬
‫‪will‬اال انه‬ ‫العملية‪be‬‬ ‫تداول تلك‬
‫‪conducted‬‬ ‫الرغم من‬
‫‪after‬‬ ‫فترة‪of‬ممكنة وعلى‬
‫‪the approval‬‬ ‫ألطول‪the‬‬ ‫‪Ethics‬النتائج‬
‫‪Research‬‬ ‫ثبات‬
‫‪Committee (REC) of the faculty‬‬‫المدى البعيد ‪.‬‬ ‫‪ Suez‬نتائجها على‬
‫‪of Dentistry,‬‬ ‫‪ Canal‬وثبات‬
‫مدى نجاحها‬ ‫المعلومات‪It‬الكافية عن‬
‫‪University.‬‬ ‫‪will be‬‬
‫‪conducted on (fifteen patients with mandibular bilateral partially or totally‬‬
‫االصالح‪impacted‬‬ ‫‪that‬مع عملية‬
‫‪third molars‬‬ ‫مقارنتها‬
‫‪ surgical‬و‪need‬‬
‫الشفة المعدلة‬ ‫اعادة تموضع‬
‫‪extraction‬‬ ‫‪who‬‬ ‫عملية‬
‫لتقييم‪will‬‬
‫نسعى ‪be‬‬ ‫الدراسة‬
‫‪selected‬‬ ‫‪from‬‬‫‪the‬بهذه‬
‫‪outpatient dental clinic of Oral‬‬ ‫االبتسام‬
‫اثناء‪and‬‬ ‫‪ Surgery‬الظهور اللثوي‬
‫‪Maxillofacial‬‬ ‫‪ Department‬على تقليل‬
‫الجراحي‪at‬للجام في تأثيرها‬
‫‪Suez‬‬
‫‪Canal University). Ethical considerations regarding patient well-being and‬‬
‫‪ )٢‬الهدف من البحث‪:‬‬
‫‪confidenddfdsddstiality will be undertaken by the researcher and an informed‬‬
‫الشفة ‪written consent will be signed by the patients‬‬ ‫تموضع‬
‫‪before‬‬ ‫السريري لعملية اعادة‬
‫‪commencing‬‬ ‫‪the study‬‬ ‫التقييم‬
‫‪explaining all clinical examinations, procedures and follow up.‬‬
‫‪ )٣‬أسئلة البحث‪:‬‬
‫هل عملية اعادة تموضع الشفة المعدلة و عملية تقويم اللجام الجراحي تؤدي الى انخفاض كمية‬
‫الظهور اللثوي أثناء االبتسام ؟‬
‫‪ )٤‬خطة البحث ومنهجية الدراسة‪:‬‬

‫سوف يتم عالج ‪ ١8‬مريض وسيتم تقسيم المرضى إلى مجموعتين (المجموعة ‪ I‬والمجموعة‬
‫‪(II‬المجموعة ‪ :I‬سيخضع المريض لعملية اعادة تموضع الشفة المعدلة ‪،‬‬
‫المجموعة ‪ :II‬سيخضع المريض لعملية تقويم اللجاح الجراحي باستخدام تقنية على شكل حرف‬
‫‪ z‬وسوف تتم الخياطة وتقييم الحاالت سريريا ً يوم العملية وبعد شهر و ‪ ٣‬شهور و ‪ ٦‬شهور‪.‬‬
‫‪Tel: 015578188003‬‬ ‫‪E-mail:pgs.230132@dent.suez.edu.eg‬‬

‫‪1‬‬
:‫الخطة اإلحصائية‬
‫ وتنظم النتائج في‬، ‫سوف يتمم تجميع البيانات ومعالجتها باستخدام برنامج ميكروسوفت اكسيل‬
‫جداول ورسوم بيانية لتوضيح الفروق بين النقاط المتابعة المختلفة لتقييم كفاءة عملية اعادة‬
‫بعد‬،‫ شهور‬٣ ‫بعد‬،‫تموضع السفة المعدلة في عالج تزايد الظهور اللثوي وذلك بعد اجراء الجراحة‬
. ‫ شهور‬٦
‫سيتم تحليل التوزيع الطبيعي للنتائج لتحديد اذا كانت البيانات قياسية او غير قياسية‬
:‫الجدول الزمني‬
The present research will‫التاريخ‬
‫المتوقع‬ be conducted after the approval of the Research Ethics
‫رقم‬
‫(مالحظات‬REC) of the faculty of Dentistry, Suez Canal University.
Committee ‫وصف المرحلة‬It will be
‫لالنتهاء من العمل‬ ‫المعيار‬
impacted third molars that ‫شهر‬ ٢ surgical extraction who will be selected
need ‫ اإلعداد‬from ١ the
Canal University). Ethical‫شهور‬ ٣
considerations ‫المساعدة للبحث‬
regarding patient‫الخامات‬ ‫ شراء‬and ٢
well-being
‫تحضير الكيماويات‬
‫ شهر‬١٣
explaining all clinical examinations, procedures and follow ‫العملي‬
up. ‫الجزء‬ ٣
‫ شهر‬١5 ‫تجميع البيانات‬ ٤
‫ شهر‬١٦ ‫التحليل اإلحصائي‬ 5
‫ شهر‬١8 ‫تغيير النتائج‬ ٦
‫ شهر‬١9 ‫كتابة المراجعة األدبية‬ 7
‫ شهر‬٢0 ‫كتابة طرق البحث‬ 8
‫ شهر‬٢0 ‫كتابة المناقشة‬ 9
‫ شهر‬٢٢ ‫تجميع الرسالة كاملة‬ ١0

2

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Assessment of Modified Lip Repositioning Surgery

and Z Plasty Frenectomy

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Introduction: Excessive gingival display is a cosmetic problem where

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

The technique was performed to limit the retraction of elevator muscles by

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Evaluated the use of modified lip repositioning technique associated with

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Smile is considered unattractive when a distance of ≥ 4 mm between the lip

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Alternate Hypothesis: is that there is significance difference in reduce

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Brand name Composition Company

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

II. Patient Selection :

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

16 patients with excessive gingival display

Group I: 8 patients will be treated with conventional modified lip

Sample Size Calculation:

N= Total sample size

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

IV. Surgical protocol:

1- Surgical procedures will be done under local anesthesia.

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

VI- Postoperative evaluation:

The present research

A normality test will be done to check normal distribution of the

Statistical analysis will be done using the SPSS software at

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Ending After 24 months postoperative

Preoperative Antibiotics, Vicryl

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

19- Sarver D.M. Principles of cosmetic dentistry in orthodontics: Part 1.

11. Appendices (Questionnaire / Consent form)

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

:‫ الخلفيه العلميه (لموضوع البحث) والهدف من اجراء البحث‬-٢

:‫ ما سوف يتم اجراؤه بالتفصيل‬-٣

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

‫‪Tel: 015578188003‬‬ ‫‪E-mail:pgs.230132@dent.suez.edu.eg‬‬

The present research will be conducted after the ............................................

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

1- Name of researcher: Leen Abd Alrhman Somaf

٦- Title of the research: Assessment of modified lip repositioning

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

*Drug trial ( ) *Surgical technique (*) *Investigative technique) (

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

Tel: 015578188003 E-mail:pgs.230132@dent.suez.edu.eg

‫خطة بحث مقدمة توطئة للحصول على‬

‫جامعة قناة‬ ‫مدرس جراحة الفم و‬ ‫محمد ناجح‬ ‫د‪/.‬‬

‫‪ )٤‬خطة البحث ومنهجية الدراسة‪:‬‬

‫‪Tel: 015578188003‬‬ ‫‪E-mail:pgs.230132@dent.suez.edu.eg‬‬

‫ شهر‬١5 ‫تجميع البيانات‬ ٤

‫ شهر‬١٦ ‫التحليل اإلحصائي‬ 5

‫ شهر‬١8 ‫تغيير النتائج‬ ٦

‫ شهر‬١9 ‫كتابة المراجعة األدبية‬ 7

Drug trial ( ) Surgical technique () Investigative technique) (