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Gummy Smile, How To Correct It

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Gummy Smile, How To Correct It

Gummy Smile, How To Correct It
June 16
11:03 2018

Article Highlights

  • A gummy smile has to do with the amount of gum visible relative to the amount of tooth that’s visible
  • Crown lengthening is the most recommended procedure
  • There are minimal post-operative complications with crown lengthening and lip repositioning

If esthetic reasons have made you self-conscious about your smile, you might feel like you are unable to truly express yourself. One such reason could be that your teeth appear shorter due to excessive gum tissue. But rest assured this condition, commonly referred to as “gummy smile,” is possible to correct with a variety of procedures, which can transform the look of your smile.

“People with this problem are hugely self-conscious about it,” said Dr. Herbert Veisman, a periodontist and founder of Periodontal Specialists in Toronto. “When they smile, they hide their mouth or they’ll smile with a closed smile, not showing teeth.”

What constitutes a gummy smile has to do with the amount of gum visible relative to the amount of tooth that’s visible, according to Dr. Veisman. Unfortunately, gummy smile is not something one can prevent, nor is it something caused by external factors. It’s simply a result of genetics.

“It’s part of how a person is created. It’s how they come out,” Dr. Veisman continued. “What happens is either something called altered passive eruption (APE) or vertical maxillary excess (VME).”

APE is a dental issue where “a person’s teeth haven’t fully erupted,” Dr. Veisman explained. “Therefore, anywhere from a half to two-thirds of the tooth is still buried in gum.” Someone with VME will likely have an issue with the position of their lip or jawbone.

“VME means it’s more of a skeletal issue where the teeth may have fully erupted but the lip above the front teeth—when the person smiles—shows a huge amount of jaw. So, a lot of the jaw has been exposed. Therefore, your entire smile looks gummy.”

To correct APE, Dr. Veisman said crown lengthening is the most recommended procedure. Crown lengthening involves removing some gum and bone tissue so that the teeth are more visible, making the smile more aesthetically appealing.

“We remove some gum tissue and a little bit of bone tissue with it so that the gum doesn’t bounce back, and expose as much of the actual crown that is supposed to be visible in a perfect world,” Dr. Veisman explained.

For someone with VME, there are normally two options: lip repositioning or a procedure called a LeFort Osteotomy. Lip repositioning involves suturing the upper lip somewhat lower to the gums so that less gum shows when the patient smiles. Both crown lengthening and lip repositioning can be performed under conscious sedation.

While crown lengthening and lip repositioning are performed by a periodontist, the LeFort is performed by an oral surgeon in a hospital and requires general anesthetic. During this procedure, the upper jaw is fractured surgically and then repositioned so that

“the entire skeletal height of the person’s mouth is decreased, so it won’t show as much gum when they smile,” said Dr. Veisman. Because this procedure is so invasive, Dr. Veisman said it’s done “only in extreme cases.”

Dr. Veisman said there are minimal post-operative complications with crown lengthening and lip repositioning. After crown lengthening, he said patients might experience minor oozing, bleeding and a little bit of swelling. According to an article in The Journal of Cosmetic Dentistry, side effects of lip repositioning include slight discomfort for several days, “a feeling of ‘tension’ when the patient smiles,” and bruising and swelling of the upper lip, but these have been shown to be minimal. The main benefit of crown lengthening and lip repositioning is “immediate gratification,” according to Dr. Veisman.

“The patient wakes up, they look in the mirror and they see a different person.” Downtime for crown lengthening and lip repositioning are also minimal, according to Dr. Veisman.

“In terms of being effective and feeling yourself again and feeling good, the effects of the crown lengthening are immediate,” said Dr. Veisman. “It’s a one-day thing. There’s no real downtime with that and the lip repositioning.”

Dr. Veisman added that patients should follow regular post-operative practices, including not cleaning their teeth as aggressively as they would otherwise because tissues need time to adapt to the tissues underneath.

“For crown lengthening and lip repositioning, basically you’re there the next day. You’re back to work, back to life,” Dr. Veisman continued. “Whereas with the LeFort, there’s some downtime.”

After a LeFort, Dr. Veisman explained that there will be major swelling and a much more painful recovery. According to the Mayo Clinic, patients stay in the hospital for one to two days after jaw surgery and complete recovery takes three to six weeks at home.

“There’s probably a week or two, or more where you’re kind of out of it,”

Dr. Veisman said, adding that because patients can have a combination of APE and VME, sometimes both a LeFort and a crown lengthening procedure are necessary. In this case, Dr. Veisman said crown lengthening would be done first since the LeFort is a much more invasive procedure and the recovery time is much longer.

If a patient has undergone crown lengthening or lip repositioning, they typically follow up with their periodontist at the one-week mark, and again at eight weeks for the final checkup, according to Dr. Veisman. For those who undergo the LeFort, Dr. Veisman said follow-ups would usually be every few weeks, then one month and two months down the road.

Dr. Veisman explained who can benefit from these procedures. “Somebody of any age group, typically between the age of 18 and 80, who is self-conscious about their teeth and gums, and wants a better proportioned smile.”


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