22 Nov Gummy smile, what is it and how is it treated?
GUMMY SMILE:
The first impression we receive from a person is their smile. Through the mouth and facial expressions, we can determine the mood of people.
In general, patients with gummy smiles have low self-esteem because they are not satisfied with their facial aesthetics. The gummy smile, also known as a high smile, is defined as a 2-4mm gingival exposure when smiling, in other words, it is the excessive visualization of the gums when one smiles. It is very common, specifically, it has a prevalence of 43.6% and is more frequent in women and young people.
The gummy smile can be caused by various factors:
– Excess vertical dimension due to maxillary excess (usually patients with long faces).
– Excessive mobility of the upper lip (hypermobile lip) or it is shorter than normal , when there is an excess of overbite or overbite.
– Compensatory overeruption, happens when the teeth overerupt (erupt beyond the occlusal plane seeking antagonistic contact). It can occur due to loss of the antagonist’s tooth, dentin anomalies (microdontia), excessive interlabial space at rest, and due to
last when there is an altered passive eruption.
The altered passive eruption (APE), mentioned above, occurs when the gingiva surpasses the cemento enamel junction (CEJ) and invades the coronal space of the tooth. It can cause a feeling of a gummy smile or excess gum. This type of morphology variant can occur either due to an excessive amount of gingiva or because the mucogingival line (MGL) is at the level of the CEJ (the MGL would have to be apical to the CEJ).
TREATMENT OF THE GUMMY SMILE
To treat gummy smiles it is important to know the etiology:
Gingivectomy is one of the most common treatments to treat gummy smiles. It consists of removing excess tissue from the gum. It is usually a simple surgery that is performed on the same day, with local anesthesia and without complications.
When there is gingival enlargement or altered passive eruption, crown lengthening is usually done. This surgery involves recontouring the soft tissue and often also involves modifying the underlying bone to expose enough tooth structure. This technique is performed under local anesthesia and does not usually present a complicated postoperative period.
Another cause of the gummy smile is lip hypermobility: an unfavorable relationship between the length of the upper lip, causing excessive visualization of the gingiva. It is treated with infiltrations of botulinum toxin (Botox).
When the cause of the gummy smile is maxillary excess, it is usually treated with bimaxillary orthognathic surgery, repositioning the uppermost maxilla in order to eliminate the gummy smile. This technique is performed under general anesthesia and presents more postoperative complications such as edema, inflammation, skin erythema, among others.
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