Gummy smile, toothless smile: Causes and aesthetic solutions

Smile problems and their causes

Smile problems can have multiple causes, in this article, we will expose the main causes of smile problems. Secondly, we will try to show the solution or even thesolutions and the successful transformationsof gummy and toothless smiles. Finally, we will try to conclude on the subject and on the practices which together allow a complete aesthetic correction of the smile.

Labial causes

Depending on the cause, we can restore volume to lips that are too thin, lift an upper lip that is too long or reposition it to create a more voluminous mouth. Several reasons are possible to explain an asymmetry of the smile:

• Lips may have “clearance issues.”
• Asymmetries are present in 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 asymmetrical smile which until now has not been the subject of any orthodontic treatment. This asymmetrical smile is the result of an asymmetrical lip position. The photos were framed on the inter-pupillary plane, a horizontal line passing through the center of the eyes. The interpupillary plane serves as a horizontal reference for the face. On this subject, on the image on the right (B), we can see that the occlusal plane (blue line) is almost completely parallel to the so-called inter-pupillary line. The red line passing through the two corners of the upper lip denotes the asymmetrical inclination of the lip when smiling. As we can see, more teeth remain visible on the right side where the lip is higher, which creates asymmetry.

Dental and gingival causes

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

Maxillary causes

Gummy smile

Most cases of gummy smiles are characterized by excess growth of the jaw, resulting in noticeable exposure of the teeth at rest. This is why, during the smile, the gums are considered too exposed: this is what is commonly called the gummy smile (this is the most common case). It will take surgical intervention to improve a gummy smile whose cause is maxillary. This will involve raising the entire maxillary dental arch in the case of a gummy smile.

Toothless Smile

This time, unlike the gummy smile, the cause generally comes from an insufficiently developed maxilla. Resulting in a smile revealing little or no teeth giving an appearance of “toothless smile”. The treatment of this smile is also surgical. The technique is to lower the entire maxillary dental arch in the case of an edentulous smile.

What solutions? Before after

The gummy smile

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

Note: The importance of gum tissue!

Until recently, it was thought that dental parameters were predominant. But some authors (Garber and Salama,1996) have demonstrated the importance of gingival tissues which define a framework for the teeth. The tooth/gum ratio must be harmonized so that one of the two is never in excess

Another important factor to take into account is the periodontal biotype linked to the patient, which is divided into:

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

IMPORTANT: The thinner the biotype, the more scarring the surgery will leave and the higher the risk of recession. This is the reason why periodontal surgery to provide connective tissue in order to locally modify the biotype must often be associated with the placement of the implant (Pradeep and Karthikeyan, 2006).

- Has a dental malposition (the incisors are too far down and/or too far forward) then requiring orthodontic type treatment in order to obtain the desired alignment and dental leveling. - On the upper lip which can be:

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

• Too toned rising too high when smiling. Consideration should be given to injections of toxins botulinum in the lip levator muscles to weaken them and prevent the lip from rising.
  Treatment with botulinum toxin to limit the action of the levator upper lip muscles.

- Has excess vertical growth of the maxilla.

• examination at rest shows that the lips are not touching, the teeth and sometimes the gums are exposed. The gum appears much too visible when smiling.
• X-ray examinations confirm the bone abnormality.
• The treatment is surgical. The maxillary impaction osteotomy allows, by reducing the excess height of the maxillary bone, to raise the dental arch (see osteotomies). The relationships between the upper lip and the dental arch at rest and when smiling will be normalized.

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

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

To this day, it remains difficult to describe all the dysfunctional causes at the origin of excessive development of the maxilla as they are so intricate and numerous. This is why the gummy smile requires a global study of the dentition, respiratory, masticatory function and the facial skeleton. The treatment therefore 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 obtained by a maxillary lowering osteotomy which makes it possible to harmonize the upper lip/teeth relationships and reveal the smile. It may be due to other problems which are often also treated surgically. We suggest that you have a consultation with a healthcare professional to determine the possible solutions and the results achievable according to your particular case.

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

Conclusion

Often, for all of these treatments, interdisciplinary collaboration will be necessary in order to achieve an improvement in your smile. Most often, the orthodontist will plan tooth movements to meet the needs of the dentist who in turn will need to restore the teeth. It is generally difficult, if not almost impossible, for a single dentist to obtain a good result, deemed satisfactory after treatment from an aesthetic point of view, without resorting to any form of orthodontics. In the same way, orthodontics alone cannot correct all the smile problems encountered. But, we have also seen, in certain cases, as patients, you will have to call on other professionals as the smile can be complex to treat in its entirety ( maxillofacial surgeon, ENT, speech therapist). In our next article, we will see how the most famous stars (actors, actresses, presenters, etc.) and those most renowned for their beauty have themselves gone through the correction of their smile more or less late to improve significantly. spectacular harmony of their smile and their face.