Gummy smile: proposal of a clinical decision-making algorithm
Authors
Giulia Ciciarelli, Tommaso Pizzolante, Anna Pia Saggiomo, Michele Rinaldi, Liliana Ottria, Alessandro Dolci, Beatrice Marzo, Mattia Mema, Alberto Gasbarri, Antonio Capogreco, Ettore Lupi, Stefano Mummolo
Abstract
Gummy Smile, or excessive gingival display, is a clinical condition characterized by an overexposure of the maxillary gingiva during smiling, typically exceeding 3 mm. Although not pathological, this condition can lead to aesthetic discomfort and negatively impact the patient's self-esteem.
In a normal, aesthetically pleasing smile, gingival exposure—defined as the distance between the lower margin of the upper lip and the cervical area of the upper central incisors—should not exceed 1–2 mm. [1]
Gummy Smile affects approximately 10% of individuals aged 20–30, with a higher prevalence among females. [2]
This condition has a multifactorial etiology, with each causative factor potentially acting independently or in combination with others, thereby complicating both the clinical presentation and case management. [3]
The main causes of excessive gingival exposure include:
- Altered passive eruption (APE)
- Dentoalveolar extrusion
- Vertical maxillary excess (VME)
- Gingival hyperplasia
- Short upper lip
- Hypermobility of the upper lip [4]
This study presents a systematic review of the scientific literature on therapeutic approaches for the treatment of Gummy Smile, offering a qualitative analysis of clinical indications, procedural techniques, aesthetic and functional outcomes, duration of results, post-treatment recovery, possible complications, and patient satisfaction.
Based on the emerging evidence, a clinical decision-making algorithm has been developed to guide clinicians in the selection and management of Gummy Smile cases, according to their etiological profile. This algorithm is proposed as a practical tool aimed at enhancing therapeutic appropriateness and improving clinical outcomes
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