Gummy Smile: Understanding the Condition and the Latest Treatment Options

Diagnoses of Gummy smile or Excessive Gingival Display has been classified to: Altered Passive Eruption (APE); Increased Maxillary Height (IMH); Hypermobile Labial Elevators (HLE). Based on this diagnostic approach, the proposed treatment options have been adopted as the following Treatments:

1. Gingival hyperplasia

For cases involving short clinical crowns or altered passive eruption, crown lengthening is often recommended. Modern laser-assisted crown lengthening is a minimally invasive procedure that removes excessive gum tissue with minimal discomfort, providing immediate aesthetic results.

Treatment: Gingival contouring

2. Altered Passive Eruption (APE)

Dento-alveolar factors are related to “Gingival overgrowth” or dentoalveolar extrusion, known as altered passive eruption, where excessive gum tissue covering part of the enamel make the clinical teeth crown appear shorter than their due to.

Treatment: Orthodontic intrusion and ostectomy

3. Vertical Maxillary Excess (VME)

Skeletal factors includes vertical maxillary excess (VME), where there is an increased height of the upper maxillary jaw. This condition is usually recognised during the course of orthodontic cephalometric analysis.

Treatment > Maxillary Le-Fort II

Orthognathic Surgery: In more severe cases of vertical maxillary excess, jaw surgery (orthognathic surgery) may be needed. While more invasive, this surgical correction can provide a permanent and dramatic improvement in facial harmony.

4. Hypermobile Labial Elevators

Soft Tissue (Muscular) Causes:

A short or hypermobile upper lip may result in the lip rising excessively when smiling, revealing more gum than usual. Most of our patients would like to start with Stage 1. Gingivectomy followed by Stage 2. Lip-repositioning

Treatment > BTX-A or Lip-repositioning

Lip Repositioning Surgery: For cases caused by short or hyperactive upper lip, lip repositioning or reverse vestibuloplasty is undertaken by an oral surgeon or periodontist to lower the upper lip’s resting position and reduce the gum visibility more permanently.

Botulinum Toxin (Botox):

Continuous Botulinum toxin-A (BTX-A) injections may temporarily denervate the upper lip elevator muscles, passivate and prevent the uplifting of its position during a smiling. The need to repeat the treatment every 4 to 6 months is the most back-draw of this treatment strategy.

How to identify the root causes of the Gummy smile?

Most competent clinicians implement Digital facial analysis, Dental imaging or intra-oral scanning (IOS), and sometimes 3D radiographic scans or Cone Beam Computer Tomographic (CBCT) to substantiate the presence of any dento-alveolar, skeletal, or neuromuscular risk components to reach an appropriate foundation for effective therapy.

Digital Smile Design (DSD) employs the latest 3D facial scanning and digital planning software, patients can now preview their expected results before undergoing surgical treatment. This technology assists clinicians in achieving customised and more accurate results according to each person’s facial features.

What could the soft-tissue crown lengthening procedure involve?

Gingivo-plasty or Gingivectomy is performed to expose most of the anatomical crown structure just about the CEJ. That could be also combined with aesthetic gingival recontouring before and after the provisional restorative smile design. This procedure involves the removal of excess gum by laser-assisted gum surgery or gum-reduction combined with bone-recontouring.

The healing time may be completed after 6 weeks to 6 months dependent on the nature of gum versus bone removal. The restorative work can be commenced approximately after 6 weeks to 6 months dependent on the nature of gum versus bone removal.

Expected Benefits: Periodontal surgery aims to establish a healthy and improved foundation for any restorative care to improve the appearance while perfection is not achievable. The surgery may promote the practice of oral hygiene, but in some circumstances,

What are the principal Risks and Possible Complications of crown lengthening?

• Some patients may not respond completely to periodontal surgery and periodontal surgery may not always be the most successful approach in achieving the appearance and function due to each patient’s unique condition. The long-term success may also be impacted by drugs, post-surgical infection, oral habits, etc.
• The post-operative complication of gingivectomy may involve infection, bleeding, swelling and pain, facial discolouration, tooth sensitivity, gum shrinkage upon healing leading to unsightly dark spaces between the teeth of elongation of some teeth.
• Unpredictable accurately of gum and bone healing and final cosmetic result may require the need for a second procedure if the initial results are unsatisfactory.

What are the principal complications of lip-repositioning?

• The post-operative complication of lip-repositioning may involve infection, bleeding, swelling and pain, facial discolouration, transient but on occasion permanent numbness of the lip or gum, transient muscle spasm, or bruising, restricted ability to open the mouth for several days or weeks, impact on speech.
• – In addition, the success of periodontal procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, inadequate oral hygiene, and medications that I may be taking.

Treatment Options: Traditional and Modern Approaches

Treatments for a gummy smile are selected based on its specific cause and severity:

Consultation and Personalised Care

Every case of gummy smile is unique. An experienced clinician must assess the exact cause of the clinical presentation and recommend a personalised treatment plan. Treatments may involve a single procedure or a combination of therapies for optimal results.

We invite you to book a consultation with Dr. Nico Kamosi, an expert in crown lengthening and smile enhancement, to discuss your options and start your journey to a more confident, harmonious smile.