Prof. Dr. Ligia Vaida
Professor, PhD, University of Oradea, Faculty of Medicine and Pharmacy, Department of Dentistry, Oradea, Romania
Gummy smile: A literature review. Case report.
Gingival smile has been widely studied in the literature, several authors such as Morley (2001), Kokich (2006) and Geron trying to set a couple of limits on the most aesthetic gingival exposure. Gingival smile can be caused by various factors: short upper lip, altered tooth eruption, maxilla excessive vertical growth, the hyper-contraction of the upper lip muscle, heredity, congenital or acquired through gingival hyperplasia drug-induced or caused by orthodontic appliances, plaque etc.
Our study aimed to assess appropriate therapeutic alternatives according to the causing factors of the gingival smile and according to patients` wishes.
Materials and methods
The patients included in the study showed a symmetrical or asymmetrical gingival smile with a gingival exposure of 3-7mm. Additional examinations were carried out such as lateral cephalometric, panoramic radiography, photographic examination of the smile from frontal view evaluating the gingival exposure (the exposed gingiva between the gingival insertion on the upper central incisor and the lower edge of the upper lip). All patients were treated with fixed orthodontic appliances associated with TAD-s for intrusion, reverse curve of Spee NiTi arch-wires or hyaluronic acid injections.
Depending on the treatment plan and according to patient`s age, the gummy smile was reduced up to 2 to 4.3mm. The best and stable results were found in young patients and where the treatment plan included TAD`s in association with or without gingivectomy.
Great gingival exposure (gummy smile) is a smile feature that is more or less perceived by patients, but it can be easily identified by specialists who can choose from a large variety of treatments in order to achieve a smile that meets all aesthetics standards.