Gummy Smile is excessive show of gingiva / gums on full smile. In the majority of people during a full smile, the upper lip exposes 2/3rd of the upper central teeth. This is considered aesthetically pleasing.
Causes of Gummy Smile:
It can be due to following conditions or combinations of these conditions:
Vertical maxillary excess- This is due to overgrowth of upper jaw or maxillary bone in vertical direction. Short upper lip or Hyperdynamic lip elevators- patients with short upper lip and strong dynamic levator muscles of the upper lip can also have Gummy smile Deep upper buccal sulcus- Due to vertical maxillary excess the space between upper lip and the gums is deep that causes exposure of the sulcus on smiling. Proclination of Upper Incisors- it is also called as fanning of teeth. The teeth are angle forward causing the lip to retract on smiling Hypertrophy of Gingivae- Thickening of gum tissue can also cause Gummy smile
What tests are required to identify the problem?
- A thorough consultation and examination by Facial Plastic surgeon
- Consultation and assessment by Orthodontists
- Consultation and assessment by General Dentist
- Orthopantomogram and lateral cephalometry- these are X rays that helps us to identify the problem
- Botulinum Toxins: Botox injection in the selected muscles of the upper lip can help to release the lip to some extent. These muscles are levator labi superioris alaeque nasi and depressor septae nasi. In extensive cases it can be injected in Levator anguli oris, zygomaticus major and minor.If it is injected excessively or in orbicularis oris it can lead to weakness of upper lip and unnatural smile.
- Filler Injections for Upper Lip: In some selected patients upper lip volume can be increased to cover some part of the gum. Commonly used fillers are Juvederm, Restylane, Teosyal etc. Excessive filler can cause unnatural results.
- Dental Procedures: Dental procedures such as gingivectomy and orthodontics to change the angle of teeth can help improve the gummy smile
- Le Forte I Osteotomy or Maxillary Reduction or Maxillary Impaction: This is an extensive surgical procedure performed in selected individuals. It involves intraoral approach and osteotomy of maxilla bone and removal of desired amount of bone to shorten the height of maxilla. This gives a dramatic improvement but has a long healing period.
- Upper Bulcus Sulcus Reduction: It is also called as gingivobuccal advancement. It is performed under local anaesthesia. The upper buccal cavity is reduced by removal of buccal mucosa and part of gingival. The leavtor muscles are partially released and the mucosa is advanced to the new gingival margin. The wound is closed with dissolvable vicryl sutures. The patient can resume work from 2-5 days depending upon the healing process.