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 gum under the upper lip. It is a common 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">Botulism</span> Human and animal disease

Botulism is a rare and potentially fatal illness caused by botulinum toxin, which is produced by the bacterium Clostridium botulinum. The disease begins with weakness, blurred vision, feeling tired, and trouble speaking. This may then be followed by weakness of the arms, chest muscles, and legs. Vomiting, swelling of the abdomen, and diarrhea may also occur. The disease does not usually affect consciousness or cause a fever.

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

Botulinum toxin, or botulinum neurotoxin, is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. 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. Botulinum toxin is an acetylcholine release inhibitor and a neuromuscular blocking agent.

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

Piriformis syndrome is a condition which is believed to result from nerve compression at the sciatic nerve by the piriformis muscle. It is a specific case of deep gluteal syndrome.

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

The lips are a horizontal pair of soft appendages attached to the jaws and are the most visible part of the mouth of many animals, including humans. Vertebrate lips are soft, movable and serve to facilitate the ingestion of food and the articulation of sound and speech. Human lips are also a somatosensory organ, and can be an erogenous zone when used in kissing and other acts of intimacy.

<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">Facial artery</span> Artery to portions of the superficial face

The facial artery, formerly called the external maxillary artery, is a branch of the external carotid artery that supplies blood to superficial structures of the medial regions of the face.

<span class="mw-page-title-main">Superior tarsal muscle</span>

The superior tarsal muscle is a smooth muscle adjoining the levator palpebrae superioris muscle that helps to raise the upper eyelid.

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

The marginal mandibular branch of the facial nerve arises from the facial nerve in the parotid gland at the parotid plexus. It passes anterior-ward deep to the platysma and depressor anguli oris muscles. It provides motor innervation to muscles of the lower lip and chin: the depressor labii inferioris muscle, depressor anguli oris muscle, and mentalis muscle. It communicates with the mental branch of the inferior alveolar nerve.

<span class="mw-page-title-main">Ptosis (eyelid)</span> Drooping of the upper eyelid over the eye

Ptosis, also known as blepharoptosis, is a drooping or falling of the upper eyelid. This condition is sometimes called "lazy eye", but that term normally refers to the condition amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism, so it is especially important to treat the disorder in children before it can interfere with vision development.

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.

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 surgeon. He is best known for his 1992 discovery of the use of Botox to alleviate chronic migraine.

Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.

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.

Lip flip is a cosmetic procedure that modifies the shape of the lips using botulinum neurotoxin type A and occasionally adding hyaluronic acid fillers. The procedure is performed in order to increase the size of the lips. The procedure typically involves injection of the neurotoxin along the vermilion border of the lips. This leads to a relaxation of the underlying muscle and eversion of the lip. Hyaluronic acid fillers are sometimes added in order increase volume in the lips.

References

  1. Monaco A, Streni O, Marci MC, Marzo G, Gatto R, Giannoni M (2004). "Gummy smile: clinical parameters useful for diagnosis and therapeutical approach". The Journal of Clinical Pediatric Dentistry. 29 (1): 19–25. doi:10.17796/jcpd.29.1.y01l3r4m06q3k2x0 (inactive 2024-10-31). PMID   15554398.{{cite journal}}: CS1 maint: DOI inactive as of October 2024 (link)
  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.