User:Globalorthodontist/Gummy smile

Gummy smile is known as excessive display of gingiva (gums) above the upper teeth on smiling. The normal value is

It is essential to observe a normal incisor display at rest on a patient during the time of diagnosing. The normal incisor display at rest is around 3-4. This can be observed on photographs taken frontally, however, patients are known to sometimes close their lips during the photograph. Therefore, another way to diagnose the incisor display at rest is to look at a Cephalometric radiograph where vertical distance from the the Stomion Inferioris point to the incisal edge of maxillary central incisor is measured.

Etiology
Gummy smile can be caused due to following factors mentioned below. It is essential to observe a normal incisor display at rest on a patient during the time of diagnosing. The normal incisor display at rest is around 3-4. This can be observed on photographs taken frontally, however, patients are known to sometimes close their lips during the photograph. Therefore, another way to diagnose the incisor display at rest is to look at a Cephalometric radiograph where vertical distance from the the Stomion Inferioris point to the incisal edge of maxillary central incisor is measured. For example, if the incisor display at rest is normal or 3-4mm and a patient has a gummy smile, then the patient has a diagnosis of hypermobility of the upper lip or altered passive eruption. However, if the patient has incisal display at rest more than 3-4mm and has a gummy smile, the patient would have short upper lip height, over-erupted maxillary incisors or vertical maxillary excess. This can be further diagnosed by looking at Lower Anterior Facial Height on a Cephalometric Radiograph. If the skeletal LAFH is increased, then the problem is with vertical maxillary excess and if LAFH is normal, then the problem is at the short upper lip.

Treatment Options
Different diagnosis will require different treatment to
 * Growth Modification
 * High Pull Headgear
 * Intrusion (orthodontics)
 * Impaction of Maxilla via surgery
 * Gingivectomy
 * Apically Repositioned Flap
 * Lip Repositioning Surgery
 * Botulin Toxin Injections