Oral Surgery Periodontology

Gummy Smile: Causes & Treatment


♦ What is a Gummy Smile?

Gummy smile is defined as the excessive display of gingiva in the upper jaw during smiling. For most people, this is really annoying aesthetically, and surprisingly this agrees with the scientific point of view which says “the upper anterior teeth should fill between 75 %– 100 % of the space between your upper and lower lip in a full smile to have a youthful smile “. This really sheds the light on this dental esthetic problem.

♦ Causes of Gummy Smile

There are many causes behind this gummy appearance. It might be due to abnormal eruption of permanent teeth which results in enlargement of gums around the tooth necks making them look shorter than they are, with too much gum display. It might be due to hyperactivity of the muscle which is responsible for lifting the upper lip during smiling (levator labii superioris muscle). In some cases it is caused by protrusion of the upper jaw, excessive downward growth of maxilla or short upper lip.


♦ Treatment of Gummy Smile

And as always, causes guides to solutions, which are simply different ways aiming to remove the cause.Treatment ranges from minor procedures like crown lengthening to extensive orthognathic surgeries, it depends on the cause and severity of the case, even sometimes it would be more effective to use a combination of two or more procedures together, and here are some of the treatment methods:

1) Crown lengthening procedure :
It simply means removing part of the gum tissue (either by laser or scalpel), or both gum and bone to expose more of the tooth, and so reducing the gum to tooth ratio.

2) Orthodontics:
Sometimes intrusion of the protruded upper teeth (maxillary teeth) is enough to correct the gummy smile .

3) Surgical contouring of gingiva (gum) and bone :
In some cases when the cause of gummy smile is the bulging contour of bone in the anterior maxillary area, it would be effective to re-contour the bone with adjustments to the overlaying mucosa .

4) Surgical lip re-positioning:
It simply means lip lengthening , it’s done by reattaching the upper lip mucosa to more inferior position, which limits the upward movement of the lip during smiling .

5) Weakening the hyperactive levator labii superioris muscle:
By Injecting botulinum toxin to the muscle , or by myotomy (making an incision through mucosa , dissecting and dividing the lateral muscle fibers).

6) Orthognathic surgery:
It is a surgery that corrects skeletal disharmonies that causes the gummy smile, like excessive downward growth of maxilla, it includes cutting bones and holding them using screws or plates.

Finally, accurate identification of the cause as well as well-studied treatment plan are the major keys to successful treatment with amazing results.