Gingival smile – correction options

A gummy smile is a physiological feature in which the upper gingiva is excessively exposed. In a normal smile, 1-2 mm of gingiva is visible, if it is more, such a smile is called gingival smile or “gummy smile”. This exposure of the mucosa is not considered a pathology, does not affect diction, chewing function and does not affect the health of the teeth.

However, studies claim that excessive exposure of the mucosa leads to lower self-esteem and psychological changes. in 25% of cases ^[1].

Causes

The gingiva is overexposed, mainly due to the structure of themaxilla (maxilla). Its overdevelopment leads to the fact that even a normal upper lip appears short and is unable to cover the mucosa fully.

Another cause is excessive lifting of the upper lip. If the circular muscles of the mouth are too strong (the medical term is “overactive”), the lip rises higher than normal. The teeth and gums may be normal in size, but the lip is just pushed up too high, upsetting the proportions.

A short lip also results in a compromised smile aesthetic. This is caused by a shortened frenulum, which scuffs the lip upward.

A common cause of a gingival smile is gingival overgrowth. Hyperplasia(fibromatosis) of the tissue causes much of the crown of the tooth to be covered, and even a slight smile will expose a significant portion of the gum. Tissue overgrowth can be seen in diabetes and some blood diseases.

Bruxism, abnormal tooth erosion, tooth decay and trauma cause the crown height to decrease and the gum to be exposed. The same effect is seen with incomplete eruption of teeth.

Certain bite abnormalities, especially with the upper incisors forward, also contribute to gingival exposure.

3 steps to a beautiful smile

1. Choosing a dentist. If you are determined to remove your gum smile, it is important to choose the right clinic and doctor. Usually, doctors at large dental centers have more experience and corrective options than those at smaller clinics. In a large center, doctors study different methods of correction, in a modest dentistry there is no such opportunity. The doctor will suggest the technique with which he is more familiar, not the one that is more suitable.
2. Specialist consultation. The dentist will listen to complaints, clarify expectations, and most importantly, diagnose. It is on this depends on the treatment plan, its stages and terms. He can refer for X-ray examination, photograph the smile from different angles, conduct tests to determine the bite.
3. Direct treatment. The type of manipulation depends on the diagnosis and may be performed by a dentist or oral surgeon.

How to correct a gingival smile

Aesthetic dentistry utilizes surgical, orthodontic, orthopedic, cosmetic, and even speech therapy methods of correction. The method depends on the degree of patient involvement. With surgical, it is minimal, the effect is persistent, the patient is only required to comply with the usual recommendations. Installation of braces requires more discipline and involvement, and speech therapy exercises depend almost entirely on the patient’s responsibility, constant monitoring of articulation.

Surgical intervention

• Gingivalplasty for a gingival smile (gingivoplasty) is the most common method of correction.

It is considered an uncomplicated operation, you do not need to go to hospital for it. Takes a maximum of 2 hours, often less.

A dental surgeon performs surgery to remove excess tissue (gingivectomy) and form the contour of the gum. The mucosa is lifted to make more of the crown area of the tooth visible, and the excess tissue is removed. Gum smile makeover surgery is minimally invasive and is done with a laser beam. It immediately seals the blood vessels, preventing bleeding. Sutures are not applied, so the recovery period takes little time. In addition, the laser destroys pathogenic flora, complications after such operations are practically nonexistent.

The only thing to remember is that if you remove too much tissue, it will lead to the opposite aesthetic effect – long teeth. This result can be avoided by a special technology: “digital smile design”. Thanks to it, the result of the intervention can be seen even before the operation and it is possible to determine exactly how much tissue needs to be removed.

• Frenulum trimming (frenuloplasty)

Another simple operation that improves not only the aesthetics of the smile, but also diction. The fact is that the lips are actively involved in articulation. A short lip cannot do this 100%, which affects the pronunciation of individual sounds, makes speech unclear, smeared. In addition, people with a short frenulum tend to breathe through the mouth. This dries out the mucosa, creating conditions for colds and inflammatory processes in the nasopharynx. Frenuloplasty eliminates these problems, promoting clear articulation, the correct type of breathing while making the smile more attractive. Typically, this procedure is performed in children, but some adults also have a shortened frenulum.

• Suturing of the round muscle of the mouth

A minor surgical procedure reduces the tone of the muscle and it stops the lip from being too tight. You can get rid of a gummy smile in less than an hour.

Orthodontic treatment

For bite problems, braces or eliners help to correct the position of the jaws. Some bite disorders contribute to the upper teeth moving out of the jaw, the gum attached to them moves downward as well. Treatment with braces or mouthguards brings the teeth back, and with them the gum.

If the maxilla is severely abnormal, orthognathic surgery is needed. It is performed by a gnathic or maxillofacial surgeon under general anesthesia. Part of the bone is removed to recreate symmetry between the upper and lower jaw. As a result, the height of the upper jaw is reduced and the mucosa is not exposed excessively.

Orthopedic intervention

To visually lengthen the teeth in case of abnormal wear, for example, the orthodontist places veneers or crowns. Veneers extend the teeth by no more than 1-2 mm, if it is necessary to extend the teeth more, artificial crowns are used.

Cosmetic procedures

Surgery is not necessary to relax the muscles of the upper lip. A more gentle method is botulinum toxin injections. Botox is not only used to reduce wrinkles. It relaxes the musculature well, relieves hyperactive lip syndrome. However, this procedure is temporary, it will have to be repeated every 3-4 months. Many women prefer Botox injections because of the side effect. A lot of studies have noted that these injections soften nasolabial folds ^[2]. There is evidence that with repeated use of Botox, the duration of the effect increases ^[3] and injections are needed less and less frequently.

Another way to reduce the mobility of the upper lip is fillers. Hyaluronic acid is injected into the nasolabial folds, filling them. The cosmetic effect is to smooth the folds, and the therapeutic effect is that fillers restrict the movement of the circular muscle, reducing lip lift. They last longer than Botox, up to 8 months.

Elimination of the gingival smile is possible with different methods. The decisive word here should be the doctor, who relies on objective data, examination and diagnosis. Recovery does not take a long time, even after surgical intervention.

The cost of manipulations depends on their type. Orthodontic treatment is probably the most expensive, but the result is for life. Relatively cheap cosmetic procedures require constant repetitions, which accumulates into large sums. Gum smile correction with laser, the procedure is affordable, safe and done once and for all.

Sources:

^{[1]https://pubmed.ncbi.nlm.nih.gov/}

^{[2]https://academic.oup.com/}

^{[3]https://www.ncbi.nlm.nih.gov/}