Gummy smile, toothless smile: Causes and aesthetic solutions

Problems with Smiles and Their Causes

Smile problems can have multiple causes; in this article, we will outline the main causes of smile problems. Secondly, we will attempt to present the solution as well as the solutions and successful transformations of gummy and edentulous smiles. Finally, we will attempt to conclude on the subject and on the practices that together allow for a complete aesthetic correction of the smile.

The labial causes

Depending on the cause, it will be possible to restore volume to lips that are too thin, lift an overly long upper lip, or reposition it to provide a fuller mouth. Several reasons are possible to explain an asymmetry of the smile:

• The lips may present "clearance issues".
• Asymmetries are present at the level of the face: the nose, lips, teeth, and sometimes the chin are aligned in such a way that they create or accentuate the effect of asymmetry.

(A and B) These two identical images represent a so-called asymmetric smile that has not yet been subjected to any orthodontic treatment. This asymmetric smile is the result of an asymmetric lip position. The photos were framed on the inter-pupillary plane, a horizontal line passing through the center of the eyes. The inter-pupillary plane serves as a horizontal reference for the face. On this subject, in the image on the right (B), it can be distinguished that the occlusal plane (blue line) is almost completely parallel to the so-called interpupillary line. The red line passing through the two corners of the upper lip denotes the asymmetric inclination of the lip during smiling. As can be seen, more teeth remain visible on the right side where the lip is higher, creating the asymmetry.

Dental and gingival causes

Dental and gingival causes often require rather classic treatments: Dental (such as care or prosthetics..), implantology (dental implants), veneers, crowns, prostheses, treatments of orthodontic and/or periodontal types (gingival sanitation, gingivectomies, etc...).

The maxillary causes

Gingival smile

Most cases of gummy smiles are characterized by an excess growth of the maxilla, resulting in a notable exposure of the teeth at rest. Thus, during a smile, the gums are considered too exposed: this is commonly referred to as a gummy smile (this is the most common case). A surgical intervention will be necessary to improve a gummy smile caused by maxillary issues. It will involve lifting the entire maxillary dental arch in the case of a gummy smile.

Toothless Smile

This time, unlike the gummy smile, the cause generally stems from an underdeveloped maxilla. This leads to a smile that reveals little to no teeth, giving the appearance of a 'toothless smile.' The treatment of this smile is also surgical. The technique involves lowering the entire maxillary dental arch in the case of an edentulous smile.

What solutions? Before / After

The gingival smile

The request for correction/improvement of a gingival dentition is quite common. The analysis by a smile professional is a crucial step in determining its multiple causes and proposing the appropriate treatment. The gummy smile may be due to: - To a gum hypertrophy. The excess gum will be resected (gingivectomy).

Note: The importance of gingival tissues!

Until recently, it was believed that dental parameters were predominant. However, some authors (Garber and Salama, 1996) have demonstrated the importance of the gingival tissues that define a framework for the teeth. The tooth/gum ratio must be harmonized so that neither one is ever in excess.

Another important factor to consider is the periodontal biotype related to the patient, which is divided into:

• • biotype fin;
  • thick biotype;
  • intermediate biotype

IMPORTANT: The finer the biotype, the more scarring the surgery will leave and the higher the risk of recessions will be. This is why it is often necessary to combine the placement of the implant with a periodontal surgery for connective tissue grafting in order to locally modify the biotype (Pradeep and Karthikeyan, 2006).

- A dental misalignment (the incisors are too low and/or too far forward) requiring orthodontic treatment to achieve the desired dental alignment and leveling. - To the upper lip which can be:

• Too short, revealing the gums and teeth at rest and even more when smiling. One must then consider one surgical repositioning of the upper lip. This procedure is performed under local anesthesia and aims to limit the elevation of the lip during smiling. There will be a short healing period. It is indicated in moderate forms of gummy smile.

• Too tonic rising too high during the smile. It is necessary to consider injections of toxin botulique in the levator muscles of the lip to weaken them and prevent the lip from rising.
  Treatment with botulinum toxin to limit the action of the muscles that elevate the upper lip.

- An excess of vertical growth of the maxilla.

• The resting examination shows that the lips do not touch, the teeth and sometimes the gums are exposed. The gums appear much too visible when smiling.
• The radiographic examinations confirm the bone anomaly.
• The treatment is surgical. The maxillary osteotomy of impaction allows, by reducing the excess height of the maxillary bone, to elevate the dental arch (see osteotomies). The relationships between the upper lip and the dental arch at rest and during smiling will be normalized.

Note: a brief reminder about the maxilla and its function. The maxillary bone tissue is primarily alveolar, its growth is quite limited and, moreover, largely depends on other localized factors such as: dental growth, the position of the tongue (both during swallowing and at rest), breathing, muscle tone, vertical growth of the mandible, etc. Example 1: Correction of a gummy smile by osteotomy known as "maxillary impaction" Example 2: Correction of a gummy smile by osteotomy known as "maxillary impaction" associated with a reduction in chin height.

Gingival smile before and after correction of the vertical height of the chin

Even to this day, it remains difficult to describe all the dysfunctional causes behind excessive maxillary development, as they are so intertwined and numerous. This is why gingival smile requires a comprehensive study of the dentition, respiratory function, masticatory function, and facial skeleton. Therefore, management remains multidisciplinary: most often dental, orthodontic, when necessary maxillofacial, and sometimes also speech therapy and ENT.

The toothless smile

Its correction can only be surgical. It is achieved through a maxillary osteotomy for lowering which allows for the harmonization of the upper lip/teeth relationship and reveals the smile. It may be due to other issues that are often also treated surgically. We suggest you have a consultation with a healthcare professional to determine the possible solutions and achievable results based on your particular case.

Before / After of a toothless smile in a woman in her forties.

Conclusion

Often, for all these treatments, an interdisciplinary collaboration will be necessary in order to successfully improve your smile. Most often, the orthodontist will plan the dental movements to meet the needs of the dentist who, in turn, will have to restore the teeth. Generally, it is difficult, if not nearly impossible, for a dentist alone to achieve a good result, deemed satisfactory after treatment from an aesthetic standpoint, without resorting to any form of orthodontics. Similarly, orthodontics alone cannot correct all the smile issues encountered. But, as we have also seen, in some cases, as patients, you will need to consult other professionals since treating the smile can be complex in its entirety (maxillofacial surgeon, ENT specialist, speech therapist). In our next article, we will see how the most renowned stars (actors, actresses, presenters, etc.) and those most reputed for their beauty have themselves undergone smile correction, more or less late, to dramatically improve the harmony of their smile and face.