How to treat gummy smiles

This month, Manrina Rhode discusses all the different ways you can treat gummy smiles and how to choose the right treatment plan. 

So often patients come in with gummy smiles and there’s so many different options available of how to treat them.

Let’s go through all of them and talk a little bit about diagnosis and treatment options.

Gummy smile Botox

Gummy smile Botox is small amounts of Botox that are placed on either side of the nose that stop the elevator muscles that lift the lip on smiling.

So, when you’re talking or your mouth is at rest, there’s no change to your lip movement. But when you smile, the lip doesn’t smile quite as much.

With a maximum dose of gummy smile Botox, you get about three millimetre reduction of elevation. So, when someone comes to you with a really gummy smile, you need to have a look at how much you want to reduce the smile for them.

What’s not aesthetic is to reduce the gummy smile too much as they can end up with a really weird fake smile where they can’t lift their upper lip appropriately.

The other thing to consider with gummy smile Botox is it’s not a long term solution unless they want to come and see you every three or four months for the rest of their life to manage that gummy smile. But some patients don’t mind that and if they’re older, it might not be such an issue. But if you’re starting quite young in life, patients might want to look at other solutions.

Removing gingiva

What is causing the gummy smile? Is it due to a skeletal discrepancy?

Is it because they have an elongated maxilla? In this case, you might want to think about surgical options to reduce that.

Is it because they have a decreased crown length of their tooth size? Quite often in patients with gum overgrown over the tooth, when you remove gingiva from the tooth, it gives them their correct tooth proportions back. There is usually healthy enamel underneath the gums, so you unveil a beautiful tooth underneath, and you also reduce that unaesthetic gummy smile – it’s a win-win solution for a lot of patients.

To know how to treatment plan, you need to know what the ideal length and width size of the central incisors should be. An average length of an ideal  upper central incisor is 11 millimetres long. So, you take your ruler, measure from the gingival zenith – the highest point on the gum margin – to the incisal edge of the tooth and see how much enamel is visible.

If you only have nine millimetres, for example, you know by elongating the tooth by about two millimetres that you’ll get a much better tooth proportion. Also, central incisors should be longer than they are wide in a one to 0.8 ratio. So, have a look at the root of the tooth and see how that will get the tooth closer to ideal proportions.

Understanding smile design

It’s really worth spending some time learning about the rules behind smile design. Smile designs are not something that we’re taught at dental school, but it really puts us in good stead moving forward and understanding patients smiles. It’s worth spending some time getting to know them if you’re going to lengthen a tooth or minimise a gummy smile.

You will also want to have a look at the incisal edge of the tooth because, if the gingiva is overgrown, it may be because we have an anterior blinding habit and they’ve worn away their enamel there. So as a dentist doing full mouth dentistry, it’s something else to keep an eye on and and have a look at.

Removing the frenal attachment

In addition, the frenal attachment can play its part in your gummy smile. With patients who have a low attachment, there can be some benefit in removing it so that when they’re smiling, the lip doesn’t lift quite as much. This can be done with a laser, electrosurgery or with a scalpel.

The frenal has a tendency to regrow, so you need to give your patient exercises, such as puffing out their mouth a couple of times a day for about seven to 10 days after you remove the attachment. This will ensure it doesn’t come back and will give you more long term results in the cases where you’ve got a lower frenal attachment.

So, that’s a whole bunch of different suggestions about gummy smile treatment. I hope you’re looking out for your patients gummy smiles and talking to them about them and maybe giving them some food for thought about how to help them treat it.

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