Treating gummy smiles
Ideally your upper lip should rest at the level where your gums meet your two front teeth when smiling. The correct diagnoses for the reason of the gummy smile and the amount of gum showing, has a mayor influence on the corrective treatment used and the final result. The visible length of incisor teeth at rest or with slight opening of the mouth is a telltale sign of the underlying problem.
There are basically three treatment options available to reduce the amount of gum shown when smiling, depending on the severity of the problem. Often combinations of treatments are used.
a. Orthognatic surgery
If more than 8/10 of the front teeth or even gum tissue is visible, and lips are apart at rest, chances are you have vertical maxillary excess (vertical overgrowth of the maxillary bone)
Best results are obtained with orthognatic surgery done by a maxillofacial surgeon. In this procedure the maxilla is positioned upward to correct a malocclusion and is used in conjunction with orthodontic treatment. The cosmetic bonus is lip closure at rest and reduced gum tissue shown when smiling. It should very seldom be considered for pure cosmetic improvement.
b. Lip repositioning
When the correct length of tooth (less than 3/10) is visible at rest, excessive elevation of the upper lip probably causes the gummy smile. This can successfully be treated with a lip repositioning procedure by your cosmetic dentist, periodontist or oral surgeon. It will generally correct a problem if the lip needs to be repositioned 10mm or less. This procedure is almost always used in conjunction with crown lengthening. A small portion of the tissue on the inside of your upper lip is removed and the lip is sutured to the gums. This limits the muscles that raise your lip from showing too much gum tissue.
c. Crown lengthening
This procedure is commonly used to re-contour the gum tissue for symmetry on the front teeth. When only gum tissue is removed above the teeth to give it a longer appearance, it is called a gingivectomy. In some cases a portion of the bone need to be sculpted to increase the crown length. This is called crown lengthening. A part of the root will be exposed and you will need crowns or veneers to cover them.