A perfect balanced smile is the ultimate goal of both patients and dentists as the mean time can be considered as the era of esthetics. A smile is composed of three main components namely; the lip, the teeth, and the gingiva which should be in harmony to achieve an esthetically pleasing smile. Any disorder in one of these components would compromise the esthetics of the patient’s smile. Examples of these disorders are tooth discoloration, malalignment of teeth, abnormalities in tooth morphology, and clefts of the lip.
One of the most common disorders affecting a large percentage of patients is the excessive gingival display during smiling, commonly known as “gummy smile”. Although, some gingival display on smiling usually gives a youthful appearance, excessive gingival display is agreed upon as being “unattractive” among different populations. According to various researchers, a gummy smile can be defined as gingival display of more than 2-3 mm on smiling. Furthermore, it was found to have a female predominance.
A gummy smile may have one of several etiologies. Moreover, in many cases several etiologic factors could interplay resulting in a gummy smile. Firstly, altered passive
eruption can be considered as one of the common causes. Altered passive eruption occurs when the dento-gingival junction fails to migrate apically far enough thus a part of the tooth crown remains covered with the gingiva resulting in a short clinical crown. Such cases are managed best with esthetic crown lengthening procedures where the excess soft tissue is resected with or without bone removal according to individual situations.
Another common etiologic factor for gummy smiles is the hypermobile lip where on smiling the lip moves too far apically exposing the dentition and excessive gingival display. Such cases, in turn, are usually managed with lip repositioning surgeries. These surgeries aim at reduction of the labial retraction effect of the lip elevator muscles.
On the other hand, some cases are complicated by the presence of a short upper lip. Minimally invasive lip lengthening procedures done using lasers help to improve the esthetic appearance of such cases especially when the procedure is compounded with minimal laser gingivectomy to achieve an optimum gingival margin appearance.