Surgical Correction of the "Gummy Smile"

A Review of Current Techniques in Lip Reposition Surgery for Treating Excessive Gingival Display

Excessive gingival display (EGD), commonly known as a gummy smile (GS), is a cosmetic concern that involves exposing a significant area of gum tissue during a smile, rendering it unaesthetic. Gingival exposure greater than 3 mm is deemed aesthetically displeasing and often necessitates treatment to mask the gummy smile. The causes of EGD are multifactorial, including altered passive eruption (APE), hypermobile upper lip (HUL), short lip length, increased vertical maxillary component, gingival hyperplasia, dentoalveolar extrusion, and more. As each aetiology requires different treatment modalities, patients with EGD should be thoroughly evaluated and individualized treatment plans should be developed. Lip repositioning surgery (LRS) is a minimally invasive conservative technique that decreases gummy smiles in patients with increased lip mobility and mild vertical maxillary excess. If the aetiology is multifactorial, LRS can be combined with other treatment modalities such as crown lengthening and gingivectomy for improved aesthetic outcomes. This review discusses the recent modifications and current techniques that have evolved from traditional LRS.

Esthetic Crown Lengthening Associated With Modified Lip Repositioning Surgery (Modified LipStat) in the Treatment of Excessive Gingival Display: A 6-Year Follow-Up Case Report

Smiling expresses emotions and affects interpersonal relationships, influencing self-esteem and social life. Nowadays, concerns about aesthetics and access to the Internet have made people more informed and demanding about treatments for gingival smile. Excessive gingival display (EGD) is caused by a variety of factors that can act alone or in combination. These factors may include altered passive eruption (APE), vertical maxillary excess, a short upper lip, and hyperactive upper lip, among other factors that cause gingival hyperplasia. In this case report, the EGD was caused by vertical maxillary excess, hypermobility of the upper lip, and APE. The proposed treatment included two procedures: the Modified Lip Repositioning Surgery (Modified LipStat) Technique, with internal sutures to attempt to restrict the traction of the upper lip elevator muscles, and Esthetic Crown Lengthening (ECL) from the right first premolar to the left first premolar for the treatment of APE. The result provided an aesthetic improvement of the smile, with harmonization in relation to the size of the teeth. The mobility of the upper lip in spontaneous smiles remained reduced up to 6 months of follow-up; however, there was a partial relapse in the position of the upper lip during spontaneous smiling at the end of 6 years of follow-up.

An Approach for Gummy Smile Treatment Using Botulinum Toxin A: A Narrative Review of the Literature

Excessive gingival exposure (gummy smile) is a non-aesthetic condition characterized by excessive exposure of the gingiva during smiling. The most common cause of gummy smiles was reported to be the hyperfunction of the muscles of the upper lip. Previous reports showed that botulinum toxin (Botox) is effective in the treatment of gummy smiles with a reversible effect, rapid initial action, safe application, low risk, and satisfactory outcome. The effect of Botox is usually observed between one and two weeks. This study aims to review the recent updates and guidelines for gummy smile treatment using botulinum toxin. A literature review was conducted involving relevant studies discussing gummy smile treatment using botulinum toxin with no time restriction. The PubMed and Google Scholar databases were used to gather the most relevant studies. The initial screening revealed 62 studies, and after removing the out-of-scope studies, the final review included 28 studies. Botulinum toxin can be used effectively for the treatment of gummy smile caused by lip dynamics with rarely reported complications. However, the most observed limitation was the temporary duration, which was reported to range from four to six months, and the re-injection of botulinum toxin is usually needed.

Smile Management: A Discussion with the Masters

Smile design is an ongoing challenge in both dentistry and facial cosmetics surgery. Herein, some very common smile design scenarios are shared with six world known masters. Each case will be reviewed by 2 cosmetic dentists, 2 periodontists, and 2 oral and maxillofacial surgeons. At the end, contributors will describe current advances and future prospects of this evolving field.

Orthognathic Surgery for Management of Gummy Smile

Excessive gingival show is mainly caused by hypermobility of the upper lip, altered passive eruption, gingival hyperplasia, and bony maxillary vertical excess. Orthognathic surgery is the optimal treatment option for patients with moderate and severe vertical maxillary excess. Surrounding anatomic structures and soft tissue changes such as alternation in the nasal morphology confine the amount of impaction. Therefore, Le Fort 1 may be performed in conjunction with horseshoe osteotomy or partial turbinectomy. The possible necessity of further mandibular orthognathic surgeries and chin repositioning has to be considered. No common major complication and long-term relapse have been reported for maxillary impaction.