Introduction
Gummy smile is excessive gingival appearance during smiling. It is a major esthetic concern in young people. Gingival display of more than 4 mm is generally considered unesthetic. Prevalence of gummy smile is 7% in males and 14% in females, as reported according to a face aesthetic survey.
Ideal smile
For an ideal smile appearance, a normal gingival display between inferior border of upper lip and gingival margins of maxillary anterior teeth, during a posed smile, should be 1 to 2 mm only.
Etiology of gummy smile
Etiology of gummy smile is multifactorial including soft tissue excess and hard tissue excess. Unesthetic smile appearance also includes dental malalignments and gingival overgrowth.
(Chart 1: Etiology of gummy smile)
Treatment options
Surgical esthetic procedure is always art work. Treatment of gummy smile depends on etiology, perceptions and expectations of patients along with surgical esthetic limitations.
- Gingivectomy
- Crown lengthening
- Lip repositioning
- Orthodontics
- Prosthetic tooth positioning
- Botox
- Orthognathic surgery
Surgical strategic treatment planning
(Flow chart 1 : Etiology and treatment options relationship)
Surgical procedures for gummy smile correction
1) Gingivectomy
Gingival hyperplasia is a common etiology for gummy smile. Gingival hyperplasia can be effectively treated with gingival reshaping and gingivectomy surgery. When marginal gingiva is more than 2 mm, then gingivoplasty should be considered.
Steps:
- Surgery can be done under maxillary local anesthesia.
- Then bleeding points can be marked with a marker/probe and the points can be joined to prepare a line of excision.
- After that, an external bevel gingivectomy incision should be placed, in the anterior region on the facial surface only, using surgical blade no 15, placed 45° angle to the tooth’s long axis, apically to the bleeding points.
- Then, forceps with the help of Orban knife can be used to remove the excised gingival segment.
- Afterwards, the gingiva should be contoured and scraped to remove residual tissue tags.
- Finally, a periodontal dressing should be applied to gingiva.
(Image 1: Gingivectomy for gummy smile management )
2) Crown lengthening with osteoplasty
For maxillary anterior short crown cases, this procedure is useful.
Steps:
- After local anesthesia for maxilla, a full thickness mucoperiosteal flap should be raised.
- Then the desired vertical osteoplasty required interdentally can be done.
- Gingival flap repositioning with sutures can be done.
- Osteoplasty underneath the gingival flap is key to prevent gingival relapse.
(Image 2: Crown lengthening for gummy smile correction)
3) Lip repositioning
Lip repositioning is a simple surgical procedure to treat gummy smile. The procedure restricts the muscle pull of the elevator lip muscles, thereby reducing the gingival display while smiling.With the help of this procedure, 4 to 5 mm gummy smile can be corrected. Surgery can be done for upper lip reposition only.
Steps:
- Lip repositioning surgery can be planned under local anesthesia.
- After local anesthesia, the surgical site should be marked with an indelible pencil, from maxillary right first molar to maxillary left first molar vestibular mucosa.
- A partial thickness flap should be raised from mesial line angle of left maxillary first molar to the mesial line angle of right maxillary first molar at the mucogingival junction.
- A second incision, 10–12 mm above the first incision, should be made in the labial mucosa.
- The two incisions should be joined on either side and a strip of partial thickness flap should be removed, exposing the underlying connective tissue .
- The two incisions should then be approximated using continuous interlocking sutures.
(Image 3: Lip repositioning surgery)
4) Orthognathic surgery (Maxillary Superior positioning)
Free for members
Keep reading — it's free
The rest of this article is open to DentalReach members. Create a free account, or sign in, and every article on the site opens in full.