Gummy smile explained

Gummy smile, also known as excessive gingival display, is a smile that shows gum under the upper lip. It is a common 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]

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]

Notes and References

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