GUMMY SMILE TREATMENT: SYSTEMATIC REVIEW OF THERAPEUTIC OPTIONS AND PROPOSAL OF A CLINICAL DECISION-MAKING ALGORITHM

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:
1. Altered passive eruption (APE)
2. Dentoalveolar extrusion
3. Vertical maxillary excess (VME)
4. Gingival hyperplasia
5. Short upper lip
6. Hypermobility of the upper lip4
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.