gummy smile
{{Short description|Show of the anterior gingiva above the teeth when smiling}}
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.{{cite journal | vauthors = Monaco A, Streni O, Marci MC, Marzo G, Gatto R, Giannoni M | title = Gummy smile: clinical parameters useful for diagnosis and therapeutical approach | journal = The Journal of Clinical Pediatric Dentistry | volume = 29 | issue = 1 | pages = 19–25 | date = 2004 | pmid = 15554398 | doi = 10.17796/jcpd.29.1.y01l3r4m06q3k2x0| doi-broken-date = 2024-11-08 }}{{cite journal | vauthors = Chandrasekharan D, Balaji SM | title = Intrusion of anterior teeth to improve smile esthetics | journal = Journal of Maxillofacial and Oral Surgery | volume = 9 | issue = 1 | pages = 27–9 | date = March 2010 | pmid = 23139562 | pmc = 3453683 | doi = 10.1007/s12663-010-0009-8 }} Several treatment options have been proposed to enhance the smile display and to reduce the gingival exposure.{{cite journal | vauthors = Levine RA, McGuire M | title = The diagnosis and treatment of the gummy smile | journal = Compendium of Continuing Education in Dentistry | volume = 18 | issue = 8 | pages = 757–62, 764; quiz 766 | date = August 1997 | pmid = 9533335 }}
Treatment
Treatment option include orthodontics,{{cite journal | vauthors = Chandrasekharan D, Balaji SM | title = Intrusion of anterior teeth to improve smile esthetics | journal = Journal of Maxillofacial and Oral Surgery | volume = 9 | issue = 1 | pages = 27–9 | date = March 2010 | pmid = 23139562 | doi = 10.1007/s12663-010-0009-8 | pmc = 3453683 }} surgery (gingivectomy),{{cite journal | vauthors = Faus-Matoses V, Faus-Matoses I, Jorques-Zafrilla A, Faus-Llácer VJ | title = Lip repositioning technique. A simple surgical procedure to improve the smile harmony | journal = Journal of Clinical and Experimental Dentistry | volume = 10 | issue = 4 | pages = e408–e412 | date = April 2018 | pmid = 29750105 | pmc = 5937970 | doi = 10.4317/jced.54721 }} botulinum toxin A injections,{{cite journal | vauthors = Sucupira E, Abramovitz A | title = A simplified method for smile enhancement: botulinum toxin injection for gummy smile | journal = Plastic and Reconstructive Surgery | volume = 130 | issue = 3 | pages = 726–8 | date = September 2012 | pmid = 22929256 | doi = 10.1097/PRS.0b013e31825dc32f | s2cid = 24821837 }} and micro-autologous fat transplantation (MAFT).{{cite journal | vauthors = Huang SH, Huang YH, Lin YN, Lee SS, Chou CK, Lin TY, Takahashi H, Kuo YR, Lai CS, Lin SD, Lin TM | title = Micro-Autologous Fat Transplantation for Treating a Gummy Smile | journal = Aesthetic Surgery Journal | date = March 2018 | volume = 38 | issue = 9 | pages = 925–937 | pmid = 29566216 | doi = 10.1093/asj/sjy069 | pmc = 6317576 }}
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.{{cite journal | vauthors = Nayyar P, Kumar P, Nayyar PV, Singh A | title = BOTOX: Broadening the Horizon of Dentistry | journal = Journal of Clinical and Diagnostic Research | volume = 8 | issue = 12 | pages = ZE25-9 | date = December 2014 | pmid = 25654058 | pmc = 4316364 | doi = 10.7860/JCDR/2014/11624.5341 }} 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.{{Cite journal |last1=Chagas |first1=Taísa Figueiredo |last2=Almeida |first2=Natalia Valli de |last3=Lisboa |first3=Cinthia Oliveira |last4=Ferreira |first4=Daniele Masterson Tavares Pereira |last5=Mattos |first5=Claudia Trindade |last6=Mucha |first6=José Nelson |date=2018 |title=Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis |journal=Brazilian Oral Research |volume=32 |pages=e30 |doi=10.1590/1807-3107bor-2018.vol32.0030 |issn=1807-3107 |pmid=29742231|doi-access=free }} 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).{{cite journal | vauthors = Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, Kim ST, Kim HJ, Lee KJ | title = Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin | journal = The Angle Orthodontist | volume = 79 | issue = 1 | pages = 70–7 | date = January 2009 | pmid = 19123705 | doi = 10.2319/091407-437.1 | doi-access = free }}