Gummy smile

Gummy smile, also known as excessive gingival display, is a smile that shows gum under the upper lip. It is a common clinical condition, which can be caused by an abnormal dental eruption (delayed passive eruption), hyperfunction of the upper lip elevator muscle, excessive vertical growth of the maxilla bone, over-eruption of the maxillary anterior teeth, or a combination of the above described factors.^[1][2] Several treatment options have been proposed to enhance the smile display and to reduce the gingival exposure.^[3]

A case of severe gummy smile as seen in a young woman

Treatment

Treatment option include orthodontics,^[4] surgery (gingivectomy),^[5] botulinum toxin A injections,^[6] and micro-autologous fat transplantation (MAFT).^[7]

Botox is considered one of the safest and most widely used injectables. Botox (BTX-A) has been successful in the treatment of gummy smiles. Botox lip flip can last for an average of 6 months.^[8] The material is injected into the hyperactive muscles of upper lip, which causes a reduction in the upward movement of lip thus resulting in a smile with a less exposure of gingiva.^[9] Botox is usually injected in the three lip elevator muscles that converge on the lateral side of the ala of the nose; the levator labii superioris (LLS), the levator labii superioris alaeque nasi muscle (LLSAN), and the zygomaticus minor (ZMi).^[10]