Table of Contents
Gummy Smile | Meaning, 8 Diagnosis,Treatment | Lip lowering surgery
What is the Meaning of Gummy Smile/Excessive Gingival Display..??
What is the meaning of SMILE & different Smile lines..??
KEYWORDS
Gummy smile, Excessive gingival display, Short upper lip, Altered Passive eruption, Altered Active eruption, Wear with secondary eruption, Vertical maxillary excess, Lip repositioning, Lip lowering surgery
KEY POINTS
- Gummy Smile/Excessive gingival display is a common Esthetic concern for many patients and may be related to self-esteem and confidence of an individual.
- It is paramount for the dentist to identify the actual cause, as there may be multiple underlying etiologies, which will further provide assistance in treatment plan.
- Differential Diagnosis may include lip length, lip activity, clinical crown length, altered passive and active
eruption, wear with secondary eruption & vertical maxillary excess. - Several treatment options have been proposed to treat Gummy smile and to reduce the gingival exposure including Periodontal surgery, Orthodontics, Orthognathic surgery for skeletal issues and some Nontraditional methods like Botox and Lip Repositioning surgery.
INTRODUCTION:
What do you mean by Gummy Smile/Gingival Smile..??
- Gummy Smile/Gingival Smile also known as Excessive Gingival Display (EGD) is a smile that shows an excessive amount of gum under the upper lip.
- The unpleasant and disfiguring exposure of upper gum in a retracted upper lip during a spontaneous smile has been a major psychological problem for many people.
- Although the incidence of excessive gingival display has not been established, it is fairly common.
- Etiologic factors can be skeletal, gingival, muscular, iatrogenic, or some combination of these.
- Several treatment options have been proposed to treat Gummy smile and to reduce the gingival exposure including Periodontal surgery, Orthodontics, Orthognathic surgery for skeletal issues and some Nontraditional methods like Botox and Lip Repositioning surgery.
- After the treatment of the gummy smile/gingival smile, the esthetic change is spectacular. The smile seems to be more sweeter and more balanced with a proper harmony between teeth, lips, maxilla and gingiva/gums.
SMILE:
Mainly 3 types of Smile
1. Mona-Lisa Smile : Zygomaticus Major Muscle is more dominant
2. Canine Smile: Levator labii superioris is more dominant
3. Full Denture Smile: All muscles are equally dominant including Zygomaticus Major & Minor, Levator labii superioris & Orbicularis oris
Duchenne Smile or Spontaneous Smile
- Although 18 types of smiles have been recorded but we as a Dentist are mostly interested in the one that expresses joy and excitement called as a Duchenne smile or a Spontaneous Smile.
- Duchenne smile, in which the Orbicularis oculi, Pars lateralis muscle that orbits the eye is contracted in addition to the Zygomaticus major muscle’s pull on the lip corners, is a better sign of enjoyment than other kinds of smiles.
- Duchenne smile is the True smile or Dynamic smile or Spontaneous Smile.
- There is contraction of eyes muscles including Orbicularis oculi, Pars lateralis muscle
- Combined with the traction of the corner of the lip by Zygomaticus major muscle
- Best demonstrates joy, satisfaction and happiness
THE EIGHT CAUSES OF GUMMY SMILE OR EXCESSIVE GINGIVAL DISPLAY :
- Short upper lip (if a patient has an extremely short upper lip it’s not going to cover gingiva and their upper teeth)
- Hypermobile lip (lip moves too much)
- Vertical maxillary excess (VME) (short ramus and overgrowth of maxilla)
- Anterior over-eruption (excess overbite)
- Wear and compensatory eruption
- Altered active eruption (the teeth don’t make it out of bone)
- Altered passive eruption (gingiva doesn’t recede as the person matures)
- Combination of above
MANAGEMENT OF GUMMY SMILE:
A. Traditional methods
1.Orthodontics intrudes over erupted teeth levelling them to their correct position.
2.Periodontal surgery (Crown lengthening) in cases of short teeth.
3.Orthognathic surgery (Le Fort Type 1 Maxillary Intrusion Osteotomy) treats gummy smile by moving the maxilla in an apical direction impacting the maxilla.
A bimaxillary Orthognathic Surgery to impact the maxilla, that is, to reposition it upwards and eliminate excess gums. Normally this type of patients will also receive orthodontic treatment.
B. Non Traditional Methods
1. Lip Repositioning Surgery
2. BOTOX
CROWN LENGTHENING PROCEDURE FOR GUMMY SMILE/ CONCEPT OF BIOLOGIC WIDTH
8 causes of Gummy Smile or Excessive Gingival Display (INFOGRAPHIC)
Posed Vs Spontaneous Smile
Most of our Gummy Smile cases get used to give a Posed Smile (we cannot see the contraction of eye musculature) because they are conscious of their high smile line.
Once you crack some jokes or the patient is asked to read something funny they start giving a Spontaneous Smile which do involve contraction of eye musculature.
1. At Rest 2.Posed smile 3.Spontaneous smile
GUMMY SMILE OR EXCESSIVE GINGIVAL DISPLAYLIP REPOSITIONING SURGERY/ LIP LOWERING SURGERY & GINGIVAL DEPIGMENTATION OR BLEACHING
Frequently Asked Questions FAQ’s for Gummy Smile
1. What does a gummy smile mean?
- Gummy smile also known as Excessive Gingival Display (EGD) is a smile that shows an excessive amount of gum under the upper lip.
- The unpleasant and disfiguring exposure of upper gum in a retracted upper lip during a spontaneous smile has been a major psychological problem for many people.
- Although the incidence of excessive gingival display has not been established, it is fairly common.
- Etiologic factors can be skeletal, gingival, muscular, iatrogenic, or some combination of these.
- Several treatment options have been proposed to treat Gummy smile and to reduce the gingival exposure including Periodontal surgery, Orthodontics, Orthognathic surgery for skeletal issues and some Nontraditional methods like Botox and Lip Repositioning surgery.
2. Is Gummy smile genetic?
- Gummy smiles occur for a variety of reasons, most commonly a short upper lip, short teeth, skeletal issues all of which are genetic.
- According to Dr. Somit Jain a Periodontist & Cosmetic dentist in Raipur (Chhattisgarh, India) whose Dental office treated a Gummy smile case with a Lip Repositioning surgery show up only to about two millimeters of gum tissue with a spontaneous smile.
3. Does an overbite cause a Gummy smile?
- We know that Anterior Tooth Overeruption can lead to Gummy Smile. What do I mean by that is you don’t have to have the whole Maxilla overerupted, you can just have the anterior teeth overerupt. When does that usually occur? when we have excess overjet.
- If we think about normal tooth eruption process, the anterior teeth come into occlusion, we end up with 3 mm of overbite roughly. But what happens if you are skeletal Class II or you are missing lower premolars, now you have too much overjet, the maxillary anterior teeth erupt down, the mandibular incisors erupt up, we end up with a deep overbite but because the maxillary teeth overerupted down we end up with a gummy smile.
Braces or Invisalign – If the positioning of the teeth and jaw are making your gums stick out and look more prominent, such as in the case of an anterior overeruption , braces or Invisalign can be helpful.
5. How to Fix a Gummy Smile or Management/ Treatment for Gummy Smile
MANAGEMENT OF GUMMY SMILE:
A. Traditional methods
1.Orthodontics intrudes over erupted teeth levelling them to their correct position.
2.Periodontal surgery (Crown lengthening) in cases of short teeth.
3.Orthognathic surgery treats gummy smile by moving the maxilla in an apical direction impacting the maxilla.
B. Non Traditional Methods
1. Lip Repositioning Surgery
2. BOTOX
7. What helps a gummy smile?
Reduce a Gummy Smile
Many a times the teeth are the proper length, they are just covered by too much gum tissue. (Altered PASSIVE eruption) or too much bone (Altered ACTIVE eruption) To make the smile look better, excess bone or gum tissue is removed (often times with a laser) to expose the enamel nature gave you.
8. Why do gums show when smiling?
When we smile, muscles cause our lips to retract 6-8 mm from the lip’s resting position. If the amount of movement is greater (meaning the lip is hypermobile), it may show too much of the gums. Periodontal plastic surgery known as Lip repositioning surgery can be done to correct hypermobile lip cases.
9. Is lip repositioning surgery permanent?
Lip repositioning surgery is a relatively simple procedure, which has few post-op complications and may be a permanent treatment for excessive gingival display. This procedure also is successful in increasing lip volume and for the correction of an asymmetrical smile.
What is Upper Lip Lowering surgery for Gummy smile ??
How to reduce/treat/fix Gummy Smile ??
Gummy Smile Surgery/Operation before and after (Images)
What is Gummy Smile treatment/correction/surgery
During a Lip Lowering Surgery or Reverse Vestibuloplasty procedure, Periodontal surgeon is going to follow those dotted lines (image) from mucogingival junction (MGJ) to the inner border of the lip and then dissect small band of gum tissue. The inner border of lip is finally sutured to the mucogingival junction.
What are the causes of Gummy Smile ??
- Gummy smile also known as Excessive Gingival Display (EGD) is a smile that shows an excessive amount of gum under the upper lip.
- The unpleasant and disfiguring exposure of upper gum in a retracted upper lip during a spontaneous smile has been a major psychological problem for many people.
THE EIGHT CAUSES OF GUMMY SMILE :
- Short upper lip (if a patient has an extremely short upper lip it’s not going to cover gingiva and their upper teeth)
- Hypermobile lip (lip moves too much)
- Vertical maxillary excess (VME) (short ramus and overgrowth of maxilla)
- Anterior over-eruption (excess overbite)
- Wear and compensatory eruption
- Altered active eruption (the teeth don’t make it out of bone)
- Altered passive eruption (gingiva doesn’t recede as the person matures)
- Combination of obove
GUMMY SMILE (LIP LOWERING SURGERY)
