Excessive gingival display

22 February 2019 by Nico Kamosi

Excessive gingival display

Excessive gingival (EGD) is 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 analyze 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.

Cause of gummy smile 

Identifying the source of this oro-facial aesthetic concern whether of a dentoalveolar or neuro-muscular origin leads to a correct therapy plan. 
Dento-alveolar aetiologies could be due to the gingival overgrowth, and/or dentoalveolar extrusion, which result 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-dentoalveolar 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 lip I mild VME cases, however, this approach requires repeated treatments. 
To mask mild to moderate cases of VME due to hypermobile upper lip, lip-repositioning/ reverse vestibulopathy procedure has been popularized recently to correct such GS cases permanently.

See the position of the upper lip causing gummy smile (EGD)

See the corrected position of the upper lip by surgical lip-repositioning)