Patients with VME usually end up having a skeletal class II relationship. Cephalometric analysis can be used to help identify VME. Many authors will agree that VME is the most common extraoral cause of the gummy smile. An increase in the ratio of the middle third of the face may indicate vertical maxillary excess (VME). The facial thirds can be evaluated in the frontal and lateral views to determine any deficiencies or excess in the midface. Facial AnalysisĪ thorough evaluation of the facial profile of the patient can provide useful information to help identify the cause of the gummy smile. The patient’s age can indicate the eruptive stage of the dentition, and the overall health can indicate to the clinician any contributing factors to the patient’s condition. Key elements include the patient’s age and overall health. Obtaining a thorough medical history is always of great importance when arriving at a diagnosis. Knowing the etiology, whether single or multiple, will dictate which treatment modality will be most appropriate for the patient.ĭental analysis: crown length and incisal margin In addition, multiple etiologies can simultaneously be responsible for the excess gingival display ( Box 1 ) and each cause must be accurately identified. When diagnosing and treating patients with a gummy smile, the clinician must accurately understand and identify the etiology. All of these anatomic structures must lie in harmony with one another to achieve an esthetic smile. The anatomic landmarks that factor into the gummy smile are the maxilla, lips, gingival architecture, and teeth. Fig. 1 shows a classic presentation of excessive gingival display while smiling. The gummy smile has been largely defined as a nonpathological condition causing esthetic disharmony, in which more than 3 to 4 mm of gingival tissue is exposed when smiling. In this article, we discuss the etiology, classification, diagnostic guidelines, and the current treatment options that can be rendered based on the etiology of the gummy smile. The etiology that plays into the gummy smile are often multifactorial, which is why an accurate diagnosis is paramount before any surgical treatment. The excessive gingival display while smiling has been largely viewed as unaesthetic, leading to many patients seeking some form of treatment to address this issue. Excessive gingival display, also known as a “gummy smile” is a common esthetic concern among dental patients.
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