Periodontology

A gummy smile may be caused by:

• orthodontic defects,
• genetic determinants (thick gum phenotype),
• hyperactivity of facial muscles of expression,
• short upper lip
• incomplete tooth eruption

Correction of such a smile can be obtained by orthodontic treatment, surgical procedures or aesthetic medical treatments using botulinum toxin. Often the defect is so severe that it requires the cooperation of specialists in all these fields.

The correction of a gummy smile performed by a periodontist is a procedure called a gingivectomy or sometimes also osteoplasty.

Gingivectomy

Gingivectomy is the procedure to cut the excess gingiva covering the clinical crown, the part of the tooth visible in the mouth, so that the gum line is higher and less visible during smiling. This procedure lengthens the clinical crowns of teeth, so that the ratio of their length to width is consistent with the aesthetic principles adopted. On the basis of the determined proportions and the width of the attached gingiva, the scope of correction is planned. Surgical splints are helpful in designing the range of the surgical procedure, thanks to which the course of gingival excision during the surgery is controlled. A gingivectomy alone is possible when the edge of the alveolar ridge is separated from the gingival margin by at least 3 mm. The excess gingiva is cut with a sharp scalpel or electrosurgical knife, which provides simultaneous hemostasis, i.e. stopping the bleeding.

Osteoplasty

Osteoplasty is additionally performed when during gingivectomy, the alveolar bone is too close to the gingival margin when cutting the gingiva. The procedure consists of making a flap to reveal the bone and make the osteoplasty, i.e. preparing and reshaping the bone with drills. The flap is placed apically in relation to its previous position, so as to leave the planned distance between the gingiva and the bone. The treatment ends with sutures stabilizing the flap for a week. After the procedure, the patient must maintain proper hygiene, with the added use of mouthwashes recommended by the doctor and avoiding the surgical area during tooth brushing. After about 6 months, the teeth may be covered with prosthetic restorations.

Interestingly, excessive exposure of the gingiva during smiling is often the result of hyperactivity of the facial muscles responsible for lifting the upper lip. In this case, esthetic medicine can help. Injections of botulinum toxin, commonly referred to as botox in the region of the nasal ala, cause muscle relaxation. As a result, this lowers the upper lip while smiling, and the gums are not exposed anymore. The effects of the treatment are visible after a few days and last for about 6 months.