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A gummy smile — clinically called excessive gingival display — occurs when a significant amount of gum tissue is visible above the upper teeth when smiling. The threshold varies by individual and cultural perception, but clinically, more than 3–4mm of gum visible above the tooth margin during a natural smile is generally considered the range where patients notice it and where treatment may improve the aesthetic balance.
Treating a gummy smile correctly requires correctly diagnosing its cause first, because the cause determines the treatment. A gummy smile can arise from four distinct anatomical situations, and they require different interventions.
Cause 1: Altered Passive Eruption (Excess Gum Over Normal-Length Teeth)
In altered passive eruption, the gum margin has not receded to its normal final position during dental development, leaving excess gum tissue covering the coronal portion of otherwise normal-length teeth. The teeth appear short — but the tooth is actually full-length underneath the excess gum. Removing the excess gum tissue exposes the full tooth crown, immediately improving the tooth-to-gum ratio.
Treatment: laser gingivectomy or conventional gingivoplasty. At Dazzle, the Fotona laser is used for this procedure — bloodless, no sutures, healing within 1–2 weeks, and immediate visible improvement. In cases where the bone margin is too high (alveolar crest is within 2–3mm of the desired gum margin), crown lengthening with osseous recontouring is required to create adequate biological width for the repositioned gum margin to be stable long-term.
Cause 2: Hyperactive Upper Lip
Some patients have normal tooth length, normal gum levels, and normal bone, but the upper lip elevator muscles (levator labii superioris alaeque nasi) contract excessively during smiling, pulling the lip higher than average and exposing more gum than would otherwise be visible. This is not a dental problem — it is a muscular one.
Treatment options: botulinum toxin (Botox) injections into the upper lip elevator muscles temporarily reduce their contractile range, limiting how high the lip rises during smiling. Effect duration: 3–6 months, requiring repeat injections. Lip repositioning surgery is a permanent surgical alternative — the inner mucosa of the upper lip is resected and resutured to limit lip elevation. It is appropriate for patients who want a permanent solution and have adequate lip mucosal tissue.
Cause 3: Vertical Maxillary Excess (Jaw-Level Problem)
In vertical maxillary excess, the upper jaw itself is longer than normal vertically, pushing the tooth-gum complex lower and increasing gum display regardless of gum margin position or lip mobility. This is a skeletal issue. Gingivectomy alone will not correct it — the underlying jaw anatomy remains unchanged. Definitive correction requires orthognathic surgery (maxillary Le Fort I impaction — surgically moving the upper jaw upward). A pre-surgical orthodontic phase typically precedes the surgery.
Most patients with mild vertical maxillary excess can achieve significant improvement with the combination of conservative gum recontouring and Botox lip repositioning without jaw surgery. Orthognathic surgery is reserved for moderate-to-severe skeletal excess where softer interventions cannot achieve the desired outcome.
Cause 4: Short Clinical Crowns from Wear or Genetics
When teeth are shorter than normal due to incisal edge wear (bruxism, acid erosion) or developmental short crowns, the ratio of visible tooth to visible gum is unfavourable without any actual excess gum being present. Gingivectomy here would remove needed gum and is inappropriate. The correct treatment is restoration of the teeth to their proper length — veneers or crowns to build the incisal edges back to a normal tooth length, restoring the correct proportion.
Assessment at Dazzle
Every gummy smile case at Dazzle is assessed with facial photography, digital smile design, clinical measurement of crown lengths and gum margin positions, and where indicated, CBCT to assess bone levels. The assessment determines which cause (or combination of causes) is driving the excessive gingival display, and the treatment plan addresses the specific cause rather than applying a default intervention.
FAQs
Q1: Is gummy smile correction permanent?
Laser gingivectomy and crown lengthening are permanent — the gum does not grow back to its pre-treatment level if the procedure is correctly performed with biological width maintained. Botox is temporary (3–6 months). Lip repositioning surgery is permanent. Orthognathic surgery is permanent.
Q2: Is the Botox option safe for gummy smile?
Yes. Botulinum toxin injections into the upper lip elevator muscles are a standard, well-documented procedure for gummy smile management. The dose used (typically 2–4 units per side) is very small and the effect is local — only the targeted muscle activity is reduced. Recovery is immediate; patients can return to normal activities the same day.
Q3: Does gummy smile treatment hurt?
Laser gingivectomy is performed under local anaesthesia — no pain during the procedure. Post-operative discomfort is mild (typically 1–2 days). Botox injections are mildly uncomfortable (small needle, minimal volume). Crown lengthening under local anaesthesia: similar to gum surgery, 3–5 days post-operative soreness.
Q4: Can a gummy smile be treated without surgery?
Yes, if the cause is a hyperactive upper lip. Botox alone, without any surgical procedure, is effective for lip-driven gummy smiles and produces results in 5–7 days after injection. If the cause is excess gum tissue or abnormal bone levels, some level of surgical or laser intervention is required. The appropriate treatment depends entirely on the cause.
