The Patient With Excessive Gingiva

Dr. Charles Sutera is recognized as an artist for gummy smile treatment in the Waltham area due to his advanced continuing education in periodontics, prosthodontics, and facial aesthetics. When we evaluate a patient that feels they show excessive gums, we determine how their smile best harmonizes with the beauty of their entire face. At consultation, Dr. Sutera will review models and photos of the patient, discuss patient goals, and offer treatment recommendations. There are a few conditions that cause gummy display and they each require different treatment. Patients who feel they show too much gum when they smile generally fall into the following categories:

  • The Patient with Proper Tooth/Gum Position but their Lip is Hypermobile: For this patient, the teeth and gums are generally at the correct position to harmonize in the lower third of the face, but upon smiling their muscle contraction raises the lip excessively causing too much gum and teeth display. The correction for this issue is simply to reduce the amount of lip movement upon smiling. For this patient, Dr. Sutera may recommend a lip repositioning procedure to correct the excessive lip rise. The procedure, also known as a reverse vestibuloplasty, is an innovative technique which reduces excessive gingival display by a periodontal incision on the inner surface of the lip. The result is decreased lip rise, and longer/fuller looking lips. Dr. Sutera is one of only a few cosmetic dentists on the east coast with expertise in lip lowering surgery.
  • The Patient with Proper Tooth Position and Lip Movement, but Incorrect Gum Position: For this patient, the gums extend too far down the crowns of the teeth. The classic appearance for a patient in this category is teeth which appear short and stubby. The excessive gingiva can usually be recontoured to expose more tooth by procedures called gingivectomy or crown lengthening, also known commonly as a gum lift. A gum lift will make the teeth appear longer with reduced gum display.
  • The Patient with Incorrect Gum and Tooth Position: This patient has an upper jaw known as the maxilla which is too low on their face for their facial proportions. The smile essentially needs to be shifted up to harmonize with the facial aesthetics. This type of patient typically may be treated with crown lengthening followed by veneers if their case is mild or moderate. For severe cases where the patient has drastic gingival display or issues with their occlusion, Dr. Sutera may recommend a consultation with an oral surgeon for a surgery called a Lefort osteotomy.

Sometimes a combination of the above treatments may be recommended to achieve the most aesthetic result. Gummy smile reduction is one of Dr. Sutera’s most fulfilling procedures due to the improvement in the patients’ self-esteem by the result achieved. Correction of these types of aesthetic issues can be quite dramatic in harmonizing the beauty of a patient’s face. By correcting a gummy smile, it helps to enhance the overall facial proportions. After treatment patients often say their smile confidence has changed. They had not noticed they previously covered their mouth when smiling or avoided laughing to prevent their lips from revealing their smile. Patients often describe treatment as liberating. They feel they can be proud to laugh with their smile being the focal point of happiness.