Gummy smile / Excessive gingival display

Excessive gingival (EGD) is the defined as a lack of balance between the anatomic variations within the static landmark of the gingival margins and the dynamic positioning variations of the upper lip in relation to the smile line.
While the patients subjective complains express mostly their increasing concerns about their “gummy smile” affecting their social and professional roles, the clinicians may analyse the clinical features of the excessive gingival display (EGD) in order to make a correct clinical diagnosis on the basis of which an appropriate surgical procedure can at best be planned.

Causes of gummy smile

Identifying the source of this oro-facial aesthetic concern whether of a dento-alveolar or neuro-muscular origin leads to a correct therapy plan.
Dento-alveolar aetiologies could be due to the gingival overgrowth, and/or dento-alveolar extrusion, which results in short clinical crowns and/or altered passive eruption (APE). In periodontal practice, altered passive eruption (APE) and mild vertical maxillary excess (VME) are frequently identified in gummy smile cases (GS) cases.
In cases where the clinical features of GS or EGD is caused by combined aetiologies, cause-related interdisciplinary approaches are frequently indicated in the form of periodontal surgical approaches, orthodontics, and/or surgically facilitated orthodontic treatments.
Non-dento-alveolar aetiologies include skeletal and/or facial soft tissue anomalies, including hypermobility of the upper lip, short upper lip, and/or vertical maxillary excess (VME) which is unfortunately recognizable more readily after the orthodontic treatment. These cases may only be treated by orthognathic or facial plastic surgical approaches (e.g. myotomy or resection of the smile muscles through a nasal columellar incision).
Although Botulinum toxin A could effectively rectify GS caused by hypermobile upper lip I mild VME cases, however, this approach requires repeated treatments.
To mask mild to moderate cases of VME due to hyper-mobile upper lip, lip-repositioning or reverse vestibuloplasty procedure has been popularized recently to correct such GS cases permanently.