‘Gummy Smile’ Treatment Options
Here our Specialist Orthodontist, Dr. Taheri, will start this off by talking about “Gummy smiles” and their treatment options.
Patients often present to our practice with an aesthetic concern regarding their smile. The chief complaint is often stated as, “My teeth are too short or the wrong size” or “I show too much gum when I smile.”
There are different factors that can contribute to what is an increased incisor display and in this short article, we will discuss the most common causes of this and how they can be treated.
The most frequent factors causing a “gummy smile” are:
- Delayed Passive Eruption (DPE).
- Vertical Maxillary Excess (VME).
- Upper lip hypermobility.
Delayed Passive Eruption (DPE)
This is where delayed passive eruption does not take place. The biological width and alveolar bone height, remains the same but sulcular epithelium depth is increased. Normally the sulcular epithelium recedes to a residual height of 1mm. This can be identified clinically by using a periodontal probe.This manifests as having a reduced clinical crown height, so the tooth appears shorter in height. Gingivectomy is the treatment of choice and you can see the result of this treatment carried out by Dr George Bourne:
Vertical Maxillary Excess (VME)
This is a skeletal condition where the relationship between the periodontium and tooth is normal. Normally these patients present with a normal tooth length, but they show an excessive gingival display due to excess vertical growth of the maxilla. This also creates an excessive lower anterior facial height.
There are 2 ways this can be dealt with. Either orthodontic treatment combined with orthognathic surgery to impact the maxilla or alternatively orthodontic treatment together with Temporary anchorage devices (TAD’s).
Upper lip hyper mobility is simply excessive gingival display during lip movement, especially when smiling. Teeth length and skeletal features are normal. Upon high smile, the lip is able to reach the pinnacle that displays excessive gingival tissue. Botox injections are useful to reduce muscle pull, but they yield transient result.Surgical lip positioning is a method to restrict the muscle pull.
The example of using Botox injections to reduce an excessive gingival display can be seen below:
Aesthetically, our patients often desire longer, bigger and whiter looking teeth. All of these treatments can be utilized alone or in conjunction to create an outcome the patient desires. Determining the etiology of a gummy smile can be challenging and usually involves a team approach between dentists and orthodontists and sometimes surgeons. If you have any patients you would like for us to help you evaluate, please feel free to refer or reach out to our practice to discuss further treatment options.
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