gummy smile correction

1. MANAGEMENT OF GUMMY SMILE –
AGOLDEN WAY FOR A PERFECT
SMILE

2. INTRODUCTIO
N
A wonderful smile is an essential feature of beauty to which
society gives an increasing importance currently .
Exposing the gingiva when smiling
up to some extent (1-2)mm provides
a youthful look and is cosmetically
appealing.
.

3. Excessive gingival display also known as ‘ GUMMY
SMILE’ is the over exposure of the maxillary gingiva while
smiling
The critical element in
managing a gummy smile is
identifying it’s etiology which
determines the treatment plan
and outcomes.

4. PRIMARY FACTORS AFFECTING
SMILE
GINGIVAL
SCAFFOL
D
LIP
FRAMEWORK
TEET
H

5. SMILE LINE
CLASSIFICATION
HIGH
:
display all of the interdental papilla and more than
2mm of tissue above the crevices of papilla of the teeth .
prevalance is 11%
AVERAGE: 75% to 100% cervicoincisal length of
maxillary anterior teeth and interdental papilla
exposed.(69%)
LOW: <75% cervico incisal length of maxillary anterior
teeth exposed
.(20%)

6. HIGH SMILE
LINE 100%
AVERAGE SMILE
LINE 75-100%
LOW SMILE LINE
< 75%

7. ETIOLOGY OF GUMMY SMILE
A gummy smile is multifactorial in etiology .Common
etiologies include ;
 Altered passive eruption
 Vertical maxillary excess
 Hyperactive upper lip
 Short upper lip
 Gingival overgrowth

8. ALTERED PASSIVE
ERUPTION
The term altered passive
eruption is used to describe
clinical situation in which the
gingival margin fails to migrate
in an apical direction towards
the CEJ after permanent tooth
eruption is complete.
INCIDENCE-12%

9. VERTICAL MAXILLARY
EXCESS
Vertical maxillary excess is a skeletal etiology.
It is a condition in which there is an elongated middle third of
the face also known as
LONG FACE SYNDROME
 This etiology can be diagnosed by
facial analysis as well as cephalometric
analysis .
There are three categories of VME which
is determined by how much gum is shown
while smiling broadly.
 VME I – 2 to 4 mm of gingival exposure
 VME II – 4to 8 mm of gingival exposure
 VME III – 8mm or more gingival exposure

10. HYPERACTIVE UPPER LIP
At repose : 3-4 mm of maxillary
central incisors are displayed.
At full smile : entire clinical crown
(10-11)mm is exposed
Upper lip translates 6-8mm from
repose to full smile.
In a patient with hyper active upper
lip ; the lip may translate 1.5 to 2 times
more than the normal distance.

11. SHORT UPPER LIP
The average lip length is measured from subnasale to
most inferior portion of the upper lip in midline.
Normal upper lip length is about 23mm in males and
20mm in females.
Lip length should be roughly
equal to commissure height.

12. GINGIVAL OVERGROWTH
Gingival enlargement can be the result of microbial plaque
induced chronic inflammation and medications such as
cyclosporine ,calcium channel blocker,and phenytoin .
Hormonal changes seen in pregnancy and puberty as well
as with the use of oral contraceptives have been
associated with gingival enlargement.

13. CLASSIFICATION OF EXCESSIVE GINGIVAL DISPLAY BASED
ON
ETIOLOG
Y
+
EGD(A
)
EGD(B
)
EGD(C
)
EGD(D) EGD(E)
ALTERE
D
PASSIVE
ERUPTIO
N
BONY
MAXILLAR
Y EXCESS
CONDITIONS
CAUSING
GINGIVAL
ENLARGEMEN
T
DEFICIENT
MAXILLARY
LIP
LENGTH
EXCESSIVE
MOBILITY
OF
MAXILLARY
LIP

14. DIAGNOSIS AND
TREATMENT
NORMAL CLINICAL CROWN
MEASUREMENT
NO YES
EGD(A)
ALTERED PASSIVE ERUPTION
GINGIVECTOMY
APICALLY
POSITIONED
FLAP

15. EQUAL THIRDS OF
FACE
NO YES
EGD(B)
BONY MAXILLARY EXCESS
LIPSTAT,ESTHETIC CROWN
LENGTHENING,ORTHODONTIC INTRUSION,BOTILINUM
TYPE A TOXIN ,ORTHOGNATHIC SURGERY

16. NORMAL GINGIVAL CONTOUR
AND CONSISTENCY
NO
YES
EGD(C)
CONDITIONS CAUSING
GINGIVAL
ENLARGEMEN
T
ORAL HYGEINE MODIFICATION,INITIAL
PERIODONTAL THERAPY,MANAGEMENT OF
PLAQUE RETENTIVE
FACTORS,GINGIVECTOMY,GINGIVOPLASTY

17. NORMAL LIP LENGTH
NO
YES
EGD(D
)
DEFICIENT LIP LENGTH
LIP TRAINING
EXCERCISE

18. NORMAL LIP MOBILITY
NO
YES
EGD(E)
EXCESSIVE MOBILITY OF
THE
UPPER LIP
LIPSTAT,BOTILINUM TYPE
ATOXIN

19. COMMON TREATMENT MODALITIES FOR EGD
The common treatment options include
o Gingivectomy
o Crown lengthening with apical repositioning flap
o Prosthetic rehabilitation
o Orthodontic correction
o Orthognathic surgery
o Lip repositioning surgery
o Botulinum toxin A injection

20. CONCLUSIO
N
A PERFECT SMILE IS DICTATED BY THE
BALANCE AMONG 3 PARAMETERS ,THE
WHITE(TEETH),THE PINK(GUM),AND THE LIPS.
THE AIM OF THE PERIODONTAL MANAGEMENT IN
CASE OF EGD IS NOT ONLY TO IMPROVE
ESTHETICS BUT ALSO TO RESTORE PERIODONTAL
HEALTH BY RE ESTABLISHING THE NORMAL
RELATIONSHIP BETWEEN THE GINGIVAL
MARGIN,ALVEOLAR BONE CREST, AND CEMENTO
ENAMEL JUNCTION .

21. THANK YOU