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Gingival smile: treatments for designing your smile

Gingival smile: treatments for designing your smile

The appeal of a smile has to do with both esthetics and perception. When people seek  orthodontic treatment for esthetic purposes, because they are not happy with their smile, chances are the problem is a real one. Some people feel that they show too much gum when they smile, or their gums are too prominent. Either their teeth appear too small, or so much gum tissue shows that it downplays their teeth. This esthetic problem is what we call gingival smile.

So, what is the definition of a gingival smile or gummy smile? It is a matter of perception, and therefore varies from person to person. It has been shown that a smile is perceived as a gingival smile or gummy smile when 4mm of gum tissue is showing. Smiles look gummy when the proportions of teeth, gum tissues, and upper jaw are not in harmony with each other.

Ortodoncia Frieldander Barcelona autoligado Damon Invisalign Invisible Lingual Transparente Incognito estetica (5)

Patient treated with crown lengthening and restorative dentistry with porcelain veneers

Many patients are unaware that there are options to correct or improve the appearance of a gingival smile. If a gingival smile has a negative impact on your quality of life, your confidence and well-being, perhaps now is the right time to act and do something about it, and a lot can be done. First, we need to study, diagnose and determine exactly why your smile looks gummy; understanding the cause always directs us towards the right solution for each case.

What produces a gingival smile?

A more or less gingival smile depends not only on the proportions of teeth, gum tissue and upper jaw, but also on the position of the upper lip and its movement when you smile.

In summary, the factors to consider when studying possible solutions for a gingival smile, are:

1. The amount of gum that is exposed

2. The size and shape of the teeth

3. The length and degree of movement of the upper lip

4. The vertical position of the upper jaw and teeth in relation to the rest of the face and skull.

The Tooth/Gum complex

At the heart of the problem is the proportionality of teeth to gums. Tooth eruption is an active process whereby teeth move through the gum and supporting bone, the alveolar bone, until they appear in the mouth and occupy their place in the dental arch. Eruption ceases in adulthood, when growth has completed and when the permanent teeth meet their antagonists, that is, the corresponding teeth in the opposite arch. However, the process does not stop at this phase. The gum and bone shrink back slightly and stabilize in their final position in adolescence, for women, and around the age of 20, for men. The ideal length of an upper incisor crown, what is considered normal, is about 10mm. The width-to-length ratio is approximately 75-85%, also considered to be the normal relationship.

Certain natural variations in eruption can give rise to discrepancies in the normal proportions and relationships within the tooth-gum complex, possibly resulting in teeth that are shorter than normal, and a more gingival smile.

Gumminess caused by excess gum tissue that obscures part of the crowns of the teeth is correctable with periodontal surgery (“peri” – around; “odont” – tooth), using one procedure called gingivectomy, and another called “crown lengthening”. During crown lengthening, the excess gum tissue is eliminated (sometimes a small part of bone as well) and it is reshaped to expose the full length of the crown of the teeth.

Complejo encía/diente como orígen de la sonrisa gingival

A gingivectomy is a procedure whereby one eliminates excess gum tissue that covers the teeth.

Excessive tooth wear can also cause an alteration in the tooth-to-gum ratio. This produces compensatory eruption, a process whereby teeth erupt (move toward the teeth in the opposite arch), very slowly, in order to compensate for the part that is worn. This is your body’s way of maintaining a properly functioning bite with shorter teeth.  This process increases exposure of the gum in the gingival smile because the gum that is attached around the tooth moves along with the tooth as it is erupting. This is ideally corrected with an orthodontic treatment, whether with invisible lingual brackets, with Invisalignesthetic brackets or some other technique. The worn teeth are pushed back to their correct position (leveling the gum) and after orthodontic work, they are restored by adding back the lost tooth structure with crowns or with esthetic porcelain or composite veneers.

The influence of the lip

The act of smiling involves many muscles that are used in facial expressions, especially those that retract the upper lip (pull it up) and reveal the teeth and gums.

The average movement of a normal lip is 6-8mm from its normal resting position to a complete smile. If the lip is “hypermobile”, meaning that it goes way up, the smile might reveal more gum than normal and result in a gingival smile. There are several ways to modify the action of these muscles; from treating with Botox infiltrations in order to temporarily paralyze these muscles or diminish their action, to repositioning the muscular attachments to prevent excessive movement. (The Botox treatment is repeated approximately every 6 months depending on the patient, since its action diminishes.) Surgery to restrict the lip from rising more than normal can bring about a dramatic change. This surgery is carried out by a maxillofacial surgeon or plastic surgeon, and its big advantage is that the results are permanent. A person’s lip may have normal movement, but the lip is just short and therefore shows a lot of gum when smiling. In this case, modifying the movement of the lip would not improve the gingival smile because the degree of movement is not the reason for the gum tissue showing.

Ortodoncia Frieldander Barcelona autoligado Damon Invisalign Invisible Lingual Transparente Incognito estetica

Patient treated with braces and crown lengthening in order to diminish a gingival smile; this patient also presented a short lip, but she rejected any kind of surgery to improve it.

A long upper jaw

When the proportionality of the tooth-gum complex is normal, but still there is too much gum exposed when smiling, it may be that the upper jaw is too “long” for the face. This is called vertical maxillary excess because the upper jaw (maxilla) is excessively long relative to the base of the skull. This problem is treated with orthognathic surgery (“ortho” – straight; “gnathos” – jaw), by which the jaw is repositioned upward in order to decrease its height and diminish the amount of gum that is exposed when smiling. If the teeth themselves are the cause because they hang down too much, they can intruded or moved up with just a quick orthodontic treatment.

Ortodoncia Frieldander Barcelona autoligado Damon Invisalign Invisible Lingual Transparente Incognito estetica (1)

Virtual image before and after a surgical correction of vertical upper maxillary excess.

 

Ortodoncia Frieldander Barcelona autoligado Damon Invisalign Invisible Lingual Transparente Incognito estetica

Gingival smile treated only with Damon self-ligating braces.

A strategy for success

As you can see, gummy smiles exist for a variety of reasons that sometimes exist in combination, and proper diagnosis is critical for solving the problem. There may be a variety of ways to treat a gummy smile; however, it is very important not to make the treatment worse than the problem. That’s why correct identification of what’s causing the problem is so important. Normally, a team of specialists will work together on a common strategy to create a smile beautifully suited to your personality and emotional well-being.

For further information please contact us by telephone (+34) 93 832 72 81.

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