Gummy smile
By The Treatment Registry editors
Excessive gingival display on smiling, typically defined as more than 3 mm of gum visible. Causes include short upper lip, vertical maxillary excess, altered passive eruption, and hyperactive upper lip elevator muscles. Treatment depends on the underlying cause and ranges from botulinum toxin through to orthognathic surgery in severe cases.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Lip-positioning exercises
Limited evidence base. Reasonable trial in mild cases before any procedural option.
Procedural
- Botulinum toxin to lip elevators
Injection of botulinum toxin into the muscles that elevate the upper lip. Effect lasts 3-6 months. The standard first-line procedural option in cases where the cause is muscular hyperactivity.
- Gingival crown lengthening
Gum-tissue recontouring (sometimes with bone removal) to expose more of the tooth crown. Permanent and effective where the cause is altered passive eruption.
- Lip-repositioning surgery
Limited mucosal resection to restrict upper-lip elevation. Reversible over time but more predictable than botulinum toxin in suitable cases.
Surgical
- Orthognathic jaw surgery · View procedure page
Maxillary impaction to address vertical maxillary excess. Major surgery; reserved for severe cases where the cause is skeletal and the patient's facial proportions are otherwise affected.