Issues‎ > ‎Vol 6, issue 2‎ > ‎


Management of Gummy Smile by Surgical and Non- Surgical Techniques: A Clinical Comparative Study

Blend A. Omer*, Chenar A. Mohammad**

*MSc Student , College of Dentistry, Hawler Medical University, Erbil, Iraq.
**Department of Periodontics, College of Dentistry, Hawler Medical University, Erbil, Iraq.

Submitted: 12/11/2019; Accepted: 08/12/2019; Published 29/12/2019



Objective: Gummy smile (GS) also referred to an excessive gingival display (EGD). it’s an aesthetic disorder that can be managed by a variety of procedures include; modified lip reposition surgery (MLRS) and botulinum toxin type-A injection (BTX-A). This study aimed to evaluate and compare the effect of treatment of GS by surgical technique (MLRS) and non-surgical technique (BTX-A injection) 1 and 4 months after treatment. 

Methods: The study was conducted from November 2018 to November 2019. Forty adult patients aged 18-35 years with a EGD ≥ 4 mm caused by soft tissue disorders were recruited. Patients divided into two groups; Group 1 included 20 patients treated by MLRS and Group 2 (20 patients) treated by BTX-A injection. The amount of gingival display (GD) was evaluated after 1 and 4 months of the treatments by Autodesk AutoCAD computer program. ANOVA test used to compare changes in GD before and following treatments.

ResultsThe study showed a significant reduction in the amount of GD in both groups after 1 and 4 months of the treatment (p value < 0.05). Non-significant differences between both groups in 1 and 4 months of follow up (p value > 0.05).

Conclusions: Both MLRS and BTX-A injection technique were effective treatment modalities for patients suffering from GS.  


Keywords: Gummy smile, Gingival display, Lip reposition surgery, Botox injection                                                                                                                                                                                               Full Article - PDF                                                                                                                                                                                                                                   


1. Ker AJ, Chan R, Fields HW, Beck M, Rosenstiel S. Esthetics and smile characteristics from the lay person’s perspective: a computer-based survey study. J Am Dent Assoc. 2008;139(10):1318–27.
2. Patel, Thakkar SA, Suthar JR. Adjunctive treatment of gummy smile using botulinum toxin Type-A (case report). J Dent Med Sci. 2012;3(1):22–9.
3. Van der Geld P, Oosterveld P, Van Heck G, Kuijpers-Jagtman AM. Smile attractiveness. Self-perception and influence on personality. Angle Orthod. 2007;77(5):759–65.
4. Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2008;133(2):195–203.
5. Hwang W-S, Hur M-S, Hu K-S, Song WC, Koh K-S, Baik H-S, et al. Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod. 2009;79(1):70–7.
6. Rosenblatt A, Simon Z. Lip repositioning for reduction of excessive gingival display: a clinical report. Int J Periodontics Restorative Dent. 2006;26(5):433–7.
7. Kokich VO, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent. 1999;11(6):311–24.
8. Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000. 1996;11:18–28.
9. Bhola M, Fairbairn PJ, Kolhatkar S, Chu SJ, Morris T, de Campos M. LipStaT: the lip stabilization technique- indications and guidelines for case selection and classification of excessive gingival display. Int J Periodontics Restorative Dent. 2015;35(4):549–59.
10. Silberberg N, Goldstein M, Smidt A. Excessive gingival display--etiology, diagnosis, and treatment modalities. Quintessence Int Berl Ger. 2009;40(10):809–18.
11. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod. 1992;62(2):91– 100.
12. Fish LC, Epker BN, Sullivan CR. Orthognathic surgery: the correction of dentofacial deformities. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 1993;51(1 Suppl 1):28–41.
13. Gupta KK, Srivastava A, Singhal R, Srivastava S. An innovative cosmetic technique called lip repositioning. J Indian Soc Periodontol. 2010;14(4):266–9.
14. Srivastava S, Kharbanda S, Pal US, Shah V. Applications of botulinum toxin in dentistry: A comprehensive review. Natl J Maxillofac Surg. 2015;6(2):152–9.
15. Miskinyar SA. A new method for correcting a gummy smile. Plast Reconstr Surg. 1983;72:397– 400.
16. Makkiah MO. Assessment of the efficiency of botox and lip reposition in the correction of the gummy smile according to the patients' satisfaction. Oral Health Dental Sci. 2017; 1(1): 1-4.
17. Dayakar MM, Gupta S, Shivananda H. Lip repositioning: An alternative cosmetic treatment for gummy smile. J Indian Soc Periodontol. 2014;18(4):520–3.
18. Vyas. Clinical PhotogrAPHy in Dentistry. 1 edition. New Delhi: Jaypee Brothers Medical Publishers Private Limited; 2008. 112 p. Management of gummy smile Sulaimani Dent J. December 2019 66.
19. Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol. 2010;1:55(1):8.
20. Silva CO, Ribeiro-Júnior NV, Campos TVS, Rodrigues JG, Tatakis DN. Excessive gingival display: treatment by a modified lip repositioning technique. J Clin Periodontol. 2013;40(3):260–5.
21. Roe P, Runcharassaeng K, Kan J, Patel R, Campagni W, Brudvik J. The influence of upper lip length and lip mobility on maxillary incisal exposure. Am J Esthet Dent. 2012 1;2:116–25.
22. Allen EP. Use of mucogingival surgical procedures to enhance esthetics. Dent Clin North Am. 1988;32(2):307–30.
23. Carruthers A, Carruthers J. Prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type A in men with glabellar rhytids. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2005;31(10):1297–303.
24. Carruthers A, Carruthers J, Flynn TC, Leong MS. Dose-finding, safety, and tolerability study of botulinum toxin type B for the treatment of hyperfunctional glabellar lines. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2007;33(1 Spec No.):S60-68. 25.
25. Litton C, Fournier P. Simple surgical correction of the gummy smile. Plast Reconstr Surg. 1979;63(3):372–3.
26. Simon Z, Rosemblatt A, Dorfman W. Eliminating a gummy smile with surgical lip repositioning. Cosmet Dent. 2007;23(1):100–8.
27. Grover HS, Gupta A, Luthra S. Lip repositioning surgery: A pioneering technique for perio-esthetics. Contemp Clin Dent. 2014;5(1):142–5.
28. Gaddale R, Desai SR, Mudda JA, Karthikeyan I. Lip repositioning. J Indian Soc Periodontol. 20141;18(2):254.
29. Pandey V. Correction of gummy smiles with botulinum toxin case report and review. J Adv Med Dent Sci Res. 2014;2(3):137–41.
30. Polo M. Botulinum toxin type A in the treatment of excessive gingival display. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2005;127(2):214–8.
31. Suber JS, Dinh TP, Prince MD, Smith PD. Onabotulinumtoxin A for the treatment of a “gummy smile.” Aesthet Surg J. 2014;34(3):432–7.
32. Dinker S, Anitha A, Sorake A, Kumar K. Management of gummy smile with Botulinum toxin type-A: A case report. J Int Oral Health JIOH. 2014;6(1):111–5.
33. Rao AG, Koganti VP, Prabhakar AK, Soni S. Modified lip repositioning: A surgical approach to treat the gummy smile. J Indian Soc Periodontol. 2015;19(3):356.
34. Dannan A, Al Saraf I. Treatment of gummy smile appearance using the modified lip repositioning technique: A pilot study. JBR J Interdiscip Med Dent Sci. 2017;5(3):1–4.
35. Mantovani MB, Souza EC, Marson FC, Corrêa GO, Progiante PS, Silva CO. Use of modified lip repositioning technique associated with esthetic crown lengthening for treatment of excessive gingival display: A case report of multiple etiologies. J Indian Soc Periodontol. 2016;20(1):82–7.
36. Ribeiro-Júnior NV, Campos TV de S, Rodrigues JG, Martins TMA, Silva CO. Treatment of excessive gingival display using a modified lip repositioning technique. Int J Periodontics Restorative Dent. 2013;33(3):309–14.
37. Sánchez IM, Gaud-Quintana S, Stern JK. Modified lip repositioning with esthetic crown lengthening: a combined approach to treating excessive gingival display. Int J Periodontics Restorative Dent. 2017;37(1):e130–4.
38. Humayun N, Kolhatkar S, Souiyas J, Bhola M. Mucosal coronally positioned flap for the management of excessive gingival display in the presence of hypermobility of the upper lip and vertical maxillary excess: a case report. J Periodontol. 2010;81(12):1858–63.
39. Jaspers GWC, Pijpe J, Jansma J. The use of botulinum toxin type A in cosmetic facial procedures. Int J Oral Maxillofac Surg. 2011;40(2):127–33.
40. Sucupira E, Abramovitz A. A simplified method for smile enhancement: botulinum toxin injection for gummy smile. Plast Reconstr Surg. 2012;130(3):726–8.

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