References
Treating a gummy smile
Abstract
A person's smile frames the face and, arguably, is the most pleasing and meaningful facial expression, as well as a universal sign of happiness. A gummy smile can be a significant aesthetic concern. Its treatment can have a huge impact on a patient's confidence and, consequently, is highly rewarding for practitioners. A substantial improvement in a gummy smile can be achieved with both non-surgical and surgical interventions. The choice of treatment depends on the underlying aetiology, of which there can be multiple. Treatment modalities include botulinum toxin type A, dermal filler, surgical repositioning of the lip, gingivectomy, crown lengthening or a combination of the aforementioned. For each of these methods, it is important to consider its suitability depending on the underlying causes of the gummy smile and the patient's aesthetic goals, as well as any risks or downtime involved.
The smile is a focal feature of the face. Studies across the world repeatedly demonstrate that smiling is the most common means of communication and, hence, all elements of a smile are crucially important (Thomas et al, 2014).
A gummy smile (GS) is defined as excessive maxillary gingival display (the amount of gingivae showing from the zenith of the crown to the lower curtain of the upper lip) during smiling or laughing, which can be considered aesthetically undesirable (Chang et al, 2011; Springer et al, 2011). This can be a significant aesthetic concern for some patients, as it may interfere with their self-confidence and psychological status. As a result, they often camouflage or restrict their smiles (Brizuela and Ines, 2022). It can also be referred to as a high gingival smile line, lip line or short upper lip (Peck et al, 1992). A gingival display of 1–2mm is considered normal (Brizuela and Ines, 2022). Some authors state a GS is 3–4mm of exposed gingival tissues, whereas others consider over 2mm to be a GS; however, there is no unanimous agreement regarding classification (Suber et al, 2014; Rao et al, 2015; Mostafa, 2017; Mercado-Garcia et al, 2021; Brizuela and Ines, 2022). It is subjective to both cultural and ethnic preferences, between males and females, and between professionals and laypeople. In some European countries, gingival display of up to 4mm or more is considered acceptable, whereas, in the US, gingival exposure greater than 2–3mm is considered unsightly (Mercado-Garcia et al, 2021).
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