Treatment of Gummy

smile

Dr.Hussain Al-Sarhan
HHD Perio-Implant
Types of smile
• Mainly three types
• A
Spontaneous smile
• B
Posing smile ( social smile )
• C
Commissure smile
Smile lines classification
 Low smile line
Less than 75% of
MCI

Gummy smile more

than 2mm of
gingival display

Average (normal)
smile line
100% of MCI
 o f t h e
n iti o n
Defi m il e
m y S
G u m e
c e s s iv
E x l ay
a l D is p
Gi n g iv n g
S m il i
g
Durin neous
o n ta
(sp le )
sm i
 14%

female
7%

male
Prevalence

Prevalence :
7% of young adult males
14% of young adult females
Etiological factor

Dento– Muscular
Skeletal Type
Alveolar Type Type

Short Upper Dento-

Lip Type gingival Type
 Soft tissue
of lip

Common
Cause of Gingival
gummy soft tissue
smile
Skeletal
problem
 Normal parameter
of the lip
• Lip length and size
• Lip movement
Average lip
length I about
23mm in male
and 20mm in
female
At rest position : 3-4mm of maxillary central
incisors are displayed
• At full smile the Upper lip translates 6-8mm
exposing entire clinical crown (10-11mm)
 Most common problems
with the lip soft tissue

short small lip ,

(

hyperactive lip)
Short lip gummy smile can be
treated by surgery for moderate
to sever cases
• (a) Intraoperative diagrams showing vertical inverted V incision (with the apex
upward) in the mucosal side of the upper lip. (b) Separation of the two orbicularis
oris muscles from each other and the underlying median cleft notch between them.
(c) The orbicularis oris muscle dissected on both sides and united in the midline using
horizontal mattress sutures. (d) The V-shaped mucosal flap sutured into position as Y
shaped, giving an additionally mucosal length
Son-surgical treatment is Soft
filler for simple to moderate cases
Hyperactive lip
At rest position : 3-4mm of maxillary
central incisors are displayed
• At full smile the Upper lip translates
6-8mm exposing entire clinical crown
(10-11mm)
• In a patient with hyperactive upper
lip ,the lip may translate 1.5 to 2 times
more than the normal distance
Treatment of
Hypermobile Upper Lip
Surgical Lip Repositioning
Botox Injection
Or both
Objective : To Decrease the amount of lip
elevation on smiling . - Lowering the
height of the gingivolabial sulcus .
Botox injection

• Botox is injected in the area

between your upper lip and nose
to temporarily freeze the muscles
that contract or elevate when you
smile which allows you to smile
without showing your gums
1
3
2
Lip repositioning
•Lip repositioning is a simple surgical
procedure to treat ‘gummy smile’. The
procedure restricts the muscle pull of the
elevator lip muscles by reducing the
vestibular mucosa
• thereby reducing the gingival display
while smiling.
 Most common problems
with the Soft tissue of the
gingiva

•Gingival over growth (hyper aplasia)

Short clinical
crown
•Due to gingival hyperplasia
(gingival inflamtion )
•Altered passive eruption
•Or can be due to loss of tooth
structure
•Can be treated with gingivoplasty
or crown lengthening with
osteotomy
gingivoplasty
Used to shape and contour the gums in an
aesthetically pleasing way
Gingivectomy
 • Surgical procedure to increase
Crown the crown when bone margin is
lengthening near the CEJ we have to do
osteotomy and gingivoplasty
Skeletal problems
 Deep bite

Orthodontic
treatment
• Overeruption of the maxillary
incisors with their dentogingival
complex leads to a more coronal
position of the gingival margins and
excessive gingival display.
• • This condition may be associated
with tooth wear at the anterior
region (compensatory incisor over
eruption) or with anterior deep bite.
• • In cases with deep bite
VERTICAL MAXILLARY
EXCESS can be treated by
Orthognathic surgery

•When the patent have passed the growth period

Thank
you