Effectiveness of Different Modalities of Lip Repositioning Surgery for Management of Patients Complaining of Excessive Gingival Display: A Systematic Review and Meta-Analysis

Table 1

Summary of the primary and secondary outcomes in each of the lip repositioning surgical modalities.

Outcomes in each type of study	Lip repositioning surgical modalities
	Modality 1: LRS with frenectomy + full thickness + with myotomy	Modality 2: LRS with frenectomy + partial thickness + with myotomy	Modality 3: LRS with frenectomy + partial thickness + without myotomy	Modality 4: LRS without frenectomy + full thickness + with myotomy	Modality 5: LRS without frenectomy + partial thickness + with myotomy	Modality 6: LRS without frenectomy + partial thickness + without myotomy
Clinical trials: ,	,	,	,	,	,	,
Mean GD change from baseline to 3rd month, mm	,; MD: -4.09; 95% CI: -4.99 to -3.19	,; MD: -3.29; 95% CI: -4.70 to -1.88	,; WMD: -2.94; 95% CI: -3.53 to -2.34	—	—	,; ^#MD: -3.57; 95% CI: -3.96 to -3.18
Mean GD change from baseline to 6th month	,; MD: -3.91; 95% CI: -4.64 to -3.18	,; MD: -2.87; 95% CI: -4.36 to -1.38	,; WMD: -2.30; 95% CI: -2.84 to -1.76	—	—	N/A (follow-up less than 6 months)
Mean GD change from baseline to 12th month	N/A (follow-up less than 12 months)	,; MD: -2.72; 95% CI: -4.29 to -1.15	,; MD: -1.58; 95% CI: -2.54 to -0.62	—	—	N/A (follow-up less than 12 months)
Success of treatment at 6 months after surgery	N/A:	N/A:	N/A:	—	—	N/A:
Success of treatment at 12 months after surgery	N/A:	N/A:	N/A:	—	—	N/A:
Stability at 6 months after surgery	N/A:	N/A:	N/A:	—	—	N/A:
Stability at 12 months after surgery	N/A:	N/A:	N/A:	—	—	N/A:
Complete relapse at 6 months after surgery	N/A:	N/A:	N/A:	—	—	N/A:
Complete relapse at 12 months after surgery	N/A:	N/A:	N/A:	—	—	N/A:
Patient’s satisfaction	Yes:	N/A:	Yes: N/A:	—	—	N/A:
Lip tension	Yes:	N/A:	Mild: N/A:	—	—	N/A:
Pain	N/A:	N/A:	N/A:	—	—	N/A:
Perioral numbness	No:	N/A:	Yes: No: N/A:	—	—	N/A:
Quasiexperimental studies without control group: ,	,	,	,	,	,	,
Mean GD change from baseline to 3rd month, mm	—	—	—	—	—	WMD: -3.92; 95% CI: -4.47 to -3.36
Mean GD change from baseline to 6th month	—	—	—	—	—	WMD: -3.22; 95% CI: -5.61 to -0.84
Mean GD change from baseline to 12th month	—	—	—	—	—	N/A (follow-up less than 12 months)
Success of treatment at 6 months after surgery	—	—	—	—	—	N/A:
Success of treatment at 12 months after surgery	—	—	—	—	—	N/A:
Stability at 6 months after surgery	—	—	—	—	—	N/A:
Stability at 12 months after surgery	—	—	—	—	—	N/A:
Complete relapse at 6 months after surgery	—	—	—	—	—	N/A:
Complete relapse at 12 months after surgery	—	—	—	—	—	N/A:
Patient’s satisfaction	—	—	—	—	—	Yes: No: N/A:
Lip tension	—	—	—	—	—	Mild: No: N/A:
Pain	—	—	—	—	—	N/A:
Perioral numbness	—	—	—	—	—	Yes: No:
Case series: ,	,	,	,	,	,	,
Mean GD change from baseline to 3rd month, mm	,; MD: -1.92; 95% CI: -2.53 to -1.31	N/A:	N/A:	—	—	N/A:
Mean GD change from baseline to 6th month	,; MD: -1.92; 95% CI: -2.53 to -1.31	N/A:	,; MD: -3.60; 95% CI: -4.66 to -2.54	—	—	N/A:
Mean GD change from baseline to 12th month	,; MD: -1.92; 95% CI: -2.53 to -1.31	N/A:	,; MD: -3.50; 95% CI: -4.60 to -2.40	—	—	N/A:
Success of treatment at 6 months after surgery	Yes: No:	N/A:	N/A:	—	—	N/A:
Success of treatment at 12 months after surgery	Yes: No:	N/A:	N/A:	—	—	N/A:
Stability at 6 months after surgery	Yes: No:	N/A:	N/A:	—	—	N/A:
Stability at 12 months after surgery	Yes: No:	N/A:	N/A:	—	—	N/A:
Complete relapse at 6 months after surgery	Yes: No:	N/A:	N/A:	—	—	N/A:
Complete relapse at 12 months after surgery	Yes: No:	N/A:	N/A:	—	—	N/A:
Patient’s satisfaction	Yes: No:	Yes:	Yes: No:	—	—	Yes:
Lip tension	N/A:	N/A:	Slight: No: N/A:	—	—	Slight:
Pain	Mild:	N/A:	Mild: N/A:	—	—	Mild:
Perioral numbness	No:	N/A:	No: N/A:	—	—	N/A:
Case reports: ,	,	,	,	,	,	,
Mean GD change from baseline to 3rd month, mm	—	N/A	,	—	—	,; MD: -3.25
Mean GD change from baseline to 6th month	—	N/A	,; MD: -6.75	—	—	,; MD: -6.50
Mean GD change from baseline to 12th month	—	N/A	,; MD: -6.00	—	—	N/A:
Success of treatment at 6 months after surgery	—	N/A:	Yes: N/A:	—	—	Yes: N/A:
Success of treatment at 12 months after surgery	—	N/A:	Yes: N/A:	—	—	N/A:
Stability at 6 months after surgery	—	N/A:	No: N/A:	—	—	No: N/A:
Stability at 12 months after surgery	—	N/A:	No: N/A:	—	—	N/A:
Complete relapse at 6 months after surgery	—	N/A:	No: N/A:	—	—	No: N/A:
Complete relapse at 12 months after surgery	—	N/A:	No: N/A:	—	—	N/A:
Patient’s satisfaction	—	Yes: n=1	Yes: N/A:	—	—	Yes: N/A:
Lip tension	—	N/A:	Slight: Mild: N/A:	—	—	Mild: N/A:
Pain	—	N/A:	Mild: N/A:	—	—	Mild: N/A:
Perioral numbness	—	N/A:	Yes: No: N/A:	—	—	N/A:
All studies; ,	(, )	(, )	(, )	(, )	(, )	(, )
Mean GD change from baseline to 3rd month, mm	,; WMD: -2.98; 95% CI: -5.10 to -0.85	,; MD: -3.29; 95% CI: -4.70 to -1.88	,; WMD: -2.94; 95% CI: -3.53 to -2.34	—	—	,; WMD: -3.71; 95% CI: -3.99 to -3.42
Mean GD change from baseline to 6th month	,; WMD: -2.90; 95% CI: -4.85 to -0.95	,; MD: -2.87; 95% CI: -4.36 to -1.38	,; WMD: -2.68; 95% CI: -3.49 to -1.86	—	—	,; WMD: -3.22; 95% CI: -5.61 to -0.84
Mean GD change from baseline to 12th month	,; MD: -2.53; 95% CI: -2.53 to -1.31	,; MD: -2.72; 95% CI: -4.29 to -1.15	,; MD: -2.52; 95% CI: -4.40 to -0.64	—	—	N/A
Success of treatment at 6 months after surgery	Yes: No: N/A:	N/A:	No: N/A:	—	—	Yes: No: N/A:
Success of treatment at 12 months after surgery	Yes: No: N/A:	N/A:	No: N/A:	—	—	N/A:
Stability at 6 months after surgery	Yes: No: N/A:	N/A:	No: N/A:	—	—	No: N/A:
Stability at 12 months after surgery	Yes: No: N/A:	N/A:	No: N/A:	—	—	N/A:
Complete relapse at 6 months after surgery	Yes: No: N/A:	N/A:	No: N/A:	—	—	No: N/A:
Complete relapse at 12 months after surgery	Yes: No: N/A:	N/A:	No: N/A:	—	—	N/A:
Patient’s satisfaction	Yes: No:	Yes: N/A:	Yes: No: N/A:	—	—	Yes: No: N/A:
Lip tension	Yes: N/A:	Yes: N/A:	Slight: Mild: No: N/A:	—	—	Slight: Mild: No: N/A:
Pain	Mild: N/A:	Yes: N/A:	Mild: N/A:	—	—	Mild: N/A:
Perioral numbness	No:	Yes: N/A:	Yes: No: N/A:	—	—	Yes: No: N/A:

Abbreviations: : number of studies; : number of patients; GD: gingival display; WMD: weighted mean difference; MD: mean difference; CI: confidence interval; GD: gingival display. Clinical trials included one randomized clinical trial (RCT), one nonrandomized clinical trial, and one RCT with two arms of LRS and botulinum toxin type-A injection, in which we included the LRS arm in our study. Note: . ^#Mean gingival display at month 4 minus mean gingival display at baseline. Note: stability of LRS surgery was considered only for studies with at least 6 months of follow-up. The result of LRS was considered stable if the amount of gingival display at 6 or 12 months was the same as that of obtained at 1 month. Complete relapse was considered only for studies with at least 6 months of follow-up. If the gingival display at 6 or 12 months was the same as that of baseline, we defined it as complete relapse at that time point. The result of LRS was considered a success if the amount of gingival display at 6 or 12 months was at most 3 mm at that time point.