Gummy smile

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A case of severe gummy smile as seen in a young woman Gummy Smile Woman.jpg
A case of severe gummy smile as seen in a young woman

Gummy smile, also known as excessive gingival display, is a smile that shows an excessive amount of gum under the upper lip. It is a common unaesthetic clinical condition, which can be caused by an abnormal dental eruption (delayed passive eruption), hyperfunction of the upper lip elevator muscle, excessive vertical growth of the maxilla bone, over-eruption of the maxillary anterior teeth, or a combination of the above described factors. [1] [2] Several treatment options have been proposed to enhance the smile display and to reduce the gingival exposure. [3]

Treatment

Treatment option include orthodontics, [4] surgery (gingivectomy), [5] botulinum toxin A injections, [6] and micro-autologous fat transplantation (MAFT). [7]

Botox is considered one of the safest and most widely used injectables. Botox (BTX-A) has been successful in the treatment of gummy smiles. Botox lip flip can last for an average of 6 months. [8] The material is injected into the hyperactive muscles of upper lip, which causes a reduction in the upward movement of lip thus resulting in a smile with a less exposure of gingiva. [9] Botox is usually injected in the three lip elevator muscles that converge on the lateral side of the ala of the nose; the levator labii superioris (LLS), the levator labii superioris alaeque nasi muscle (LLSAN), and the zygomaticus minor (ZMi). [10]

Related Research Articles

<span class="mw-page-title-main">Botulinum toxin</span> Neurotoxic protein produced by Clostridium botulinum

Botulinum toxin, or botulinum neurotoxin (BoNT), is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It is also known as Botulin, the density of which is predicted to be 1.5±0.1 g/cm3. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. The toxin causes the disease botulism. The toxin is also used commercially for medical and cosmetic purposes.

<span class="mw-page-title-main">Lip</span> Visible body part at the mouth

The lips are the visible body part at the mouth of many animals, including humans. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be an erogenous zone when used in kissing and other acts of intimacy.

<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Platysma muscle</span> Human neck muscle

The platysma muscle is a superficial muscle of the human neck that overlaps the sternocleidomastoid. It covers the anterior surface of the neck superficially. When it contracts, it produces a slight wrinkling of the neck, and a "bowstring" effect on either side of the neck.

<span class="mw-page-title-main">Depressor labii inferioris muscle</span> Facial muscle that helps to lower the bottom lip

The depressor labii inferioris is a facial muscle. It helps to lower the bottom lip.

<span class="mw-page-title-main">Zygomaticus minor muscle</span> Facial muscle that draws the upper lip upwards and backwards during smiling

The zygomaticus minor muscle is a muscle of facial expression. It originates from the zygomatic bone, lateral to the rest of the levator labii superioris muscle, and inserts into the outer part of the upper lip. It draws the upper lip backward, upward, and outward and is used in smiling. It is innervated by the facial nerve (VII).

<span class="mw-page-title-main">Mentalis</span> Muscle that raises the central portion of the lower lip

The mentalis muscle is a paired central muscle of the lower lip, situated at the tip of the chin. It originates from the mentum of the mandible, and inserts into the soft tissue of the chin. It is sometimes referred to as the "pouting muscle" due to it raising the lower lip and causing chin wrinkles.

<span class="mw-page-title-main">Blepharospasm</span> Abnormal contraction or twitch of the eyelid

Blepharospasm is any abnormal contraction of the orbicularis oculi muscle. The condition should be distinguished from the more common, and milder, involuntary quivering of an eyelid, known as myokymia, or fasciculation. In most cases, blepharospasm symptoms last for a few days and then disappear without treatment, but in some cases the twitching is chronic and persistent, causing life-long challenges. In these cases, the symptoms are often severe enough to result in functional blindness. The person's eyelids feel like they are clamping shut and will not open without great effort. People have normal eyes, but for periods of time are effectively blind due to their inability to open their eyelids. In contrast, the reflex blepharospasm is due to any pain in and around the eye.

<span class="mw-page-title-main">Modiolus (face)</span> Chiasma of facial muscles

In facial anatomy, the modiolus is a dense, compact, mobile, fibromuscular tissue mass of facial muscles formed by the interlacing of a number of muscles just lateral to the angle of the mouth opposite the second upper premolar tooth.

<span class="mw-page-title-main">Marginal mandibular branch of the facial nerve</span>

The marginal mandibular branch of the facial nerve passes forward beneath the platysma and depressor anguli oris, supplying the muscles of the lower lip and chin, and communicating with the mental branch of the inferior alveolar nerve.

<span class="mw-page-title-main">Buccal fat pad</span>

The buccal fat pad is one of several encapsulated fat masses in the cheek. It is a deep fat pad located on either side of the face between the buccinator muscle and several more superficial muscles. The inferior portion of the buccal fat pad is contained within the buccal space. It should not be confused with the malar fat pad, which is directly below the skin of the cheek. It should also not be confused with jowl fat pads. It is implicated in the formation of hollow cheeks and the nasolabial fold, but not in the formation of jowls.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

Synkinesis is a neurological symptom in which a voluntary muscle movement causes the simultaneous involuntary contraction of other muscles. An example might be smiling inducing an involuntary contraction of the eye muscles, causing a person to squint when smiling. Facial and extraocular muscles are affected most often; in rare cases, a person's hands might perform mirror movements.

<span class="mw-page-title-main">Levator ani syndrome</span> Medical condition

Levator ani syndrome is a condition characterized by burning pain or tenesmus of the rectal or perineal area, caused by spasm of the levator ani muscle. The genesis of the syndrome is unknown; however, inflammation of the arcus tendon is a possible cause of levator ani syndrome.

Jaw reduction or mandible angle reduction is a type of surgery to narrow the lower one-third of the face—particularly the contribution from the mandible and its muscular attachments. There are several techniques for treatment—including surgical and non-surgical methods. A square lower jaw can be considered a masculine trait, especially in Asian countries. As a result, whereas square lower jaws are often considered a positive trait in men, a wide mandible can be perceived as discordant or masculine on women, or sometimes in certain men, particularly when there is asymmetry.

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Botulinum toxin therapy of strabismus is a medical technique used sometimes in the management of strabismus, in which botulinum toxin is injected into selected extraocular muscles in order to reduce the misalignment of the eyes. The injection of the toxin to treat strabismus, reported upon in 1981, is considered to be the first ever use of botulinum toxin for therapeutic purposes. Today, the injection of botulinum toxin into the muscles that surround the eyes is one of the available options in the management of strabismus. Other options for strabismus management are vision therapy and occlusion therapy, corrective glasses and prism glasses, and strabismus surgery.

The management of strabismus may include the use of drugs or surgery to correct the strabismus. Agents used include paralytic agents such as botox used on extraocular muscles, topical autonomic nervous system agents to alter the refractive index in the eyes, and agents that act in the central nervous system to correct amblyopia.

William J. Binder is an American facial plastic and reconstructive surgeon. He is best known for his 1992 discovery of the use of Botox to alleviate chronic migraine.

Alan Brown Scott was an American ophthalmologist specializing in eye muscles and their disorders, such as strabismus. He is best known for his work in developing and manufacturing the drug that became known as Botox, research described as "groundbreaking" by the ASCRS.

References

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  2. Chandrasekharan D, Balaji SM (March 2010). "Intrusion of anterior teeth to improve smile esthetics". Journal of Maxillofacial and Oral Surgery. 9 (1): 27–9. doi:10.1007/s12663-010-0009-8. PMC   3453683 . PMID   23139562.
  3. Levine RA, McGuire M (August 1997). "The diagnosis and treatment of the gummy smile". Compendium of Continuing Education in Dentistry. 18 (8): 757–62, 764, quiz 766. PMID   9533335.
  4. Chandrasekharan D, Balaji SM (March 2010). "Intrusion of anterior teeth to improve smile esthetics". Journal of Maxillofacial and Oral Surgery. 9 (1): 27–9. doi:10.1007/s12663-010-0009-8. PMC   3453683 . PMID   23139562.
  5. Faus-Matoses V, Faus-Matoses I, Jorques-Zafrilla A, Faus-Llácer VJ (April 2018). "Lip repositioning technique. A simple surgical procedure to improve the smile harmony". Journal of Clinical and Experimental Dentistry. 10 (4): e408–e412. doi:10.4317/jced.54721. PMC   5937970 . PMID   29750105.
  6. Sucupira E, Abramovitz A (September 2012). "A simplified method for smile enhancement: botulinum toxin injection for gummy smile". Plastic and Reconstructive Surgery. 130 (3): 726–8. doi:10.1097/PRS.0b013e31825dc32f. PMID   22929256. S2CID   24821837.
  7. Huang SH, Huang YH, Lin YN, Lee SS, Chou CK, Lin TY, Takahashi H, Kuo YR, Lai CS, Lin SD, Lin TM (March 2018). "Micro-Autologous Fat Transplantation for Treating a Gummy Smile". Aesthetic Surgery Journal. 38 (9): 925–937. doi:10.1093/asj/sjy069. PMC   6317576 . PMID   29566216.
  8. Nayyar P, Kumar P, Nayyar PV, Singh A (December 2014). "BOTOX: Broadening the Horizon of Dentistry". Journal of Clinical and Diagnostic Research. 8 (12): ZE25-9. doi:10.7860/JCDR/2014/11624.5341. PMC   4316364 . PMID   25654058.
  9. Chagas, Taísa Figueiredo; Almeida, Natalia Valli de; Lisboa, Cinthia Oliveira; Ferreira, Daniele Masterson Tavares Pereira; Mattos, Claudia Trindade; Mucha, José Nelson (2018). "Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis". Brazilian Oral Research. 32: e30. doi: 10.1590/1807-3107bor-2018.vol32.0030 . ISSN   1807-3107. PMID   29742231.
  10. Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, Kim ST, Kim HJ, Lee KJ (January 2009). "Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin". The Angle Orthodontist. 79 (1): 70–7. doi: 10.2319/091407-437.1 . PMID   19123705.