Assessment of a Esthetic Smile
There are many contributing factors to weather or not a smile is considered esthetic or pleasing to the eye. One of the major factors is the amount of gingiva that is displayed when a patient smiles. Research has found that a gingival display of 4 mm or greater when a patient smiles is considered unaesthetic. When a excessive amount of gingiva is displayed in a full smile “Gummy Smile Correction” may be required. This condition can have negative effects on a patients self esteem and personal interactions. Initial assessment of a smile should start with the patient in repose or rest. Approximately, 1 to 2 mm of the incisal edge of the maxillary teeth should be visible. As the patient goes into a full smile the upper lip will mimic the curvature of the incisal edge of the maxillary teeth and the curvature of the gingival contour. At the peek of a full smile, 1-2 mm of gingiva will be displayed. Deviation from the ideal amount of gingiva displayed can be attributed to one or multiple etiologies. These include vertical maxillary excess, hypermobile upper lip, altered passive eruption, and deficient upper lip length.
Clinical Measurements & Diagnosis
Upper Lip Length: Averages approximately 22-24 mm for males and 20-22 mm for females in length when measured from base of the nose. A measurement shorter than averages means that the patient has deficient lip length.
Lip Mobility: Averages 7-8 mm from repose to full smile. A measurement greater than the average means that the patient has a hypermobile lip caused by hyperfunction of the lip elevator muscles.
Central Incisor Length: Averages approximately 10-11 mm from incisal edge to cemental enamel junction. If the Central incisor is shorter than average without incisal wear than altered passive eruption is the diagnosis. The CEJ will not be able to be located if the diagnosis is correct.
Gingival Display: Averages 1-2 mm in full smile. A measurement of >3 mm indicates a diagnosis of excess gingival display.
Fascial Dimensions: Hairline to eyebrow = eyebrow to base of nose = base of nose to chin. Vertical maxillary excess is indicated when a patient presents with the lower third fascial measurement greater than the upper or middle third. Cephalometric analysis can be used as an additional aid.
Treatment
Options for treating excessive gingival display “Gummy Smile Correction” starts with proper diagnosis of all contributing factors. Once the factors are identified the correct treatment modalities can be performed. Altered passive eruption can be corrected with esthetic crown lengthening. Hypermobile lip, deficient lip length, and vertical maxillary excess can be corrected with orthognathic surgery, botulinum toxin injections, and lip repositioning surgery. Esthetic crown lengthening and lip repositioning procedures seem to the most appropriate procedures. This is due to the severity and post operative complications of orthognathic surgery and the temporary benefits of Botulinum Toxin injections. I provide esthetic crown lengthening and lip repositioning procedures to many of my patients for treatment of excess gingival display “Gummy Smile Correction”.
Gingival Contour Assessment Form
This form to help clinicians correctly diagnosis a patients smile.
Gingival Contour Assessment Form
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