Etiology and treatment of gummy smile

Introduction: The gummy smile is an aesthetic complaint that alters the spontaneity of facial expression. A gingival display greater than 2mm in the smile is classified as gummy smile. Objectives: The objective of this work is to identify the etiology, classification and treatments described in the literature of the gummy smile. Methods: This literature review was carried in the Pubmed, B-on, Scielo and Science Direct databases, using the combination of the terms "gummy smile", "excessive gingival display" and "lip repositioning surgery". We selected 17 articles published between 1996 and 2017. Results: The etiological factors of the gummy smile are: upper dentoalveolar protrusion, maxillary skeletal vertical excess, dental extrusion and/or altered passive eruption, hyperactivity of the upper lip muscles, infectious and/or drug gingival hypertrophy and morphofunctional characteristics of the upper lip. The gummy smile can be caused by a set of these factors. The treatment options described in the literature are periodontal surgery, dentoalveolar intrusion, orthognathic surgery, Botox^® infiltrations, lip repositioning surgery, surgery to release the nasal septum depressor muscle and surgery with reinsertion of the elevator muscle of the upper lip and wing of the nose. Conclusions: The study and the careful evaluation of the etiology and degree of gummy smile severity are determinant in the selection of the treatment. Clinical Implications: A multidisciplinary team, involving Orthodontics, Periodontology, Oral Rehabilitation, Maxillofacial Surgery and Plastic Surgery, is necessary for the diagnosis and treatment of gummy smile, when the etiology is multifactorial. Keywords: gummy smile, excessive gingival display, lip repositioning surgery