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14 Dec 2021

Gingival smile

Gingival smile or also known as high smile, is defined as a gingival exposure of 2-4mm when smiling, that is, it is the excessive visualization of the gum when someone smiles. It is more common than it seems, with a prevalence of 43.6% being more common in women and young people.

what is a gummy smile?gingival smile

What is the reason for the appearance of the gingival smile?

The gingival smile can be given by various factors:

Excess of maxilla

Such as an excess of vertical dimension due to an excess of maxilla (usually in long faces).

Hypermobile lip

when the upper lip moves more than normal (hypermobile lip) or is shorter than normal.

Overbite

When there is an excess of overbite or overjet.

Abnormalities of the dental anatomy

It can also occur when there is a compensatory over-eruption, which occurs when the teeth erupt more from the occlusal plane because they keep looking contact with the antagonist tooth (can happen in cases of lost of the antagonist tooth), when there are abnormalities of the dental anatomy, for example very small teeth, when there is an excessive interlabial gap at rest and when there is an altered passive eruption.

In which areas does it happen?

As dentists, it is essential to evaluate in which areas an excess of smile is observed and in which areas is not observed to be able to discover the cause of the gingival smile and offer the best treatment.

Anterior area

If it only occurs in the anterior area, it may be because of the presence of a short or hypermobile lip or because of a compensatory over-eruption or  of a lip incompetence (when there is a “gap” between the lips at rest).

Posterior area

If the gingival smile only occurs in the posterior area, it may be due to an alteration of the occlusal plane, which could be that it is inverted.

Both

Finally, if this excessive gum exposure is located both in the anterior and posterior region then it is suspected that there is an excessive amount of maxilla.

Correct diagnosis

In order to make a correct diagnosis, it is also important to evaluate the incisal plane and the occlusal plane since these two may coincide or there may be a dentoalveolar extrusion, which occurs when, in general, the upper incisors are more inclined forward than normal. If both planes coincide it can indicate that the problem comes because of the presence of a short or hypermobile upper lip or because there is an excess of maxilla.

On the other hand, if there is a dentoalveolar extrusion, it should be suspected that the cause may be due to an over-eruption of the upper central incisors.

Finally, the dentist must differentiate certain pathologies or alterations of the gingival smile such as active or passive eruption altered, a gingival hyperplasia or even an excessive gingival coating caused by inflammation due to plaque. These cases can be distinguished from the gingival smile since the teeth usually have short clinical crowns (less than 9mm).

Treatments

Once the gingival smile has been diagnosed and the cause is known, then a successful treatment can be reached, because if the origin is not discovered no matter how much the gingival smile is treated it will continue to appear and because each cause has its specific treatment. 

Gingivectomy

One of the most common treatments for this type of alteration is gingivectomy, which consists of removing leftover gum tissue and reforming the one left so that there is a greater exposure of teeth.

Orthodontic

When the gingival smile is due to orthodontic problems, such as an excess of overbite, then it may be useful to use orthodontic braces to correct the problem.

Crown enlargement surgery

An excess of gum visualization may also appear when there is a short clinical crown due to a gingival enlargement or when there is an altered passive eruption, in these cases, the best option is usually to do a crown enlargement surgery. This surgery involves reshaping the contour of the soft tissue and often also involves modifying the underlying bone to expose enough dental structure. 

Lip repositioning surgery

In case of having a short or hypermobile upper lip it can be treated with lip repositioning surgery. There is also the possibility of placing veneers or crowns on the upper incisors to achieve greater visualization of the teeth and less gum.

gingival smile treatmentgingival smile treatment like gingivectomy

Finally, the gingival smile is usually treated for aesthetic factors, since it often causes the loss of the harmony of the smile, but in most cases it is not considered a pathology. It is also very important that the dentist is able to recognize where this gingival smile comes from in order to correct it in the best way

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    Dr. José Nart Molina

    Dr. Jose Nart received his dental degree in 2001 from Universitat Internacional de Catalunya (UIC), Barcelona, Spain, and his Advanced Certificate in Periodontics and Implant Surgery from Tufts University in 2007. Dr. Nart was awarded Diplomate status by the American Board of Periodontology on May 2008, and he obtained his PhD in Dentistry in 2010 with the highest degree. Currently, he is Professor, Chairman and Program Director at the Department of Periodontology at UIC-Barcelona, and President for the Spanish Society of Periodontology and Osseointegration (SEPA). He maintains, with his family, a well-known multispecialty private practice in Barcelona, Nart Dental Clinic, as medical director. Dr. Nart is author of many international high-impact JCR publications (+110), worldwide speaker and reviewer of the highest impact factor Periodontology and Implant Dentistry journals.

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