Gummy smile

Gummy smile, also known as excessive gingival display, is a smile that shows an excessive amount of gum under the upper lip. It is a common unaesthetic clinical condition, which can be caused by an abnormal dental eruption (delayed passive eruption), hyperfunction of the upper lip elevator muscle, excessive vertical growth of the maxilla bone, over-eruption of the maxillary anterior teeth, or a combination of the above described factors.[1][2] Several treatment options have been proposed to enhance the smile display and to reduce the gingival exposure.[3]

A case of severe gummy smile as seen in a young woman

Treatment

Treatment option include orthodontics,[4] surgery (gingivectomy),[5] botulinum toxin A injections,[6] and micro-autologous fat transplantation (MAFT).[7]

Botox is considered one of the safest and most widely used injectables. Botox (BTX-A) has been successful in the treatment of gummy smiles. Botox lip flip can last for an average of 6 months.[8] The material is injected into the hyperactive muscles of upper lip, which causes a reduction in the upward movement of lip thus resulting in a smile with a less exposure of gingiva.[9] Botox is usually injected in the three lip elevator muscles that converge on the lateral side of the ala of the nose; the levator labii superioris (LLS), the levator labii superioris alaeque nasi muscle (LLSAN), and the zygomaticus minor (ZMi).[10]

References
  1. Monaco A, Streni O, Marci MC, Marzo G, Gatto R, Giannoni M (2004). "Gummy smile: clinical parameters useful for diagnosis and therapeutical approach". The Journal of Clinical Pediatric Dentistry. 29 (1): 19–25. doi:10.17796/jcpd.29.1.y01l3r4m06q3k2x0. PMID 15554398.
  2. Chandrasekharan D, Balaji SM (March 2010). "Intrusion of anterior teeth to improve smile esthetics". Journal of Maxillofacial and Oral Surgery. 9 (1): 27–9. doi:10.1007/s12663-010-0009-8. PMC 3453683. PMID 23139562.
  3. Levine RA, McGuire M (August 1997). "The diagnosis and treatment of the gummy smile". Compendium of Continuing Education in Dentistry. 18 (8): 757–62, 764, quiz 766. PMID 9533335.
  4. Chandrasekharan D, Balaji SM (March 2010). "Intrusion of anterior teeth to improve smile esthetics". Journal of Maxillofacial and Oral Surgery. 9 (1): 27–9. doi:10.1007/s12663-010-0009-8. PMC 3453683. PMID 23139562.
  5. Faus-Matoses V, Faus-Matoses I, Jorques-Zafrilla A, Faus-Llácer VJ (April 2018). "Lip repositioning technique. A simple surgical procedure to improve the smile harmony". Journal of Clinical and Experimental Dentistry. 10 (4): e408–e412. doi:10.4317/jced.54721. PMC 5937970. PMID 29750105.
  6. Sucupira E, Abramovitz A (September 2012). "A simplified method for smile enhancement: botulinum toxin injection for gummy smile". Plastic and Reconstructive Surgery. 130 (3): 726–8. doi:10.1097/PRS.0b013e31825dc32f. PMID 22929256. S2CID 24821837.
  7. Huang SH, Huang YH, Lin YN, Lee SS, Chou CK, Lin TY, Takahashi H, Kuo YR, Lai CS, Lin SD, Lin TM (March 2018). "Micro-Autologous Fat Transplantation for Treating a Gummy Smile". Aesthetic Surgery Journal. 38 (9): 925–937. doi:10.1093/asj/sjy069. PMC 6317576. PMID 29566216.
  8. Nayyar P, Kumar P, Nayyar PV, Singh A (December 2014). "BOTOX: Broadening the Horizon of Dentistry". Journal of Clinical and Diagnostic Research. 8 (12): ZE25-9. doi:10.7860/JCDR/2014/11624.5341. PMC 4316364. PMID 25654058.
  9. Chagas, Taísa Figueiredo; Almeida, Natalia Valli de; Lisboa, Cinthia Oliveira; Ferreira, Daniele Masterson Tavares Pereira; Mattos, Claudia Trindade; Mucha, José Nelson (2018). "Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis". Brazilian Oral Research. 32: e30. doi:10.1590/1807-3107bor-2018.vol32.0030. ISSN 1807-3107. PMID 29742231.
  10. Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, Kim ST, Kim HJ, Lee KJ (January 2009). "Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin". The Angle Orthodontist. 79 (1): 70–7. doi:10.2319/091407-437.1. PMID 19123705.
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