Efficiency and Stability of Gummy Smile Correction Using a Minimally Invasive Technique

Abstract

Background:
Excessive gingival display (gummy smile) represents a common esthetic concern and a therapeutic challenge in oral and maxillofacial surgery. Its etiology may include vertical maxillary excess, dentoalveolar extrusion, short upper lip, hyperactivity of the upper lip elevator muscles, or altered passive eruption. Various surgical and non-surgical treatment modalities have been described. An evaluation of a minimally invasive surgical approach based on selective myotomy and detachment of the upper lip elevator muscles is presented.

Objective:
 To assess the efficiency and stability of gummy smile correction using selective myotomy of the upper lip elevator muscles (levator labii superioris, zygomaticus major, and zygomaticus minor) with repositioning of muscle fibers near the anterior nasal spine.

Materials and Methods:

This prospective clinical work was conducted between January and September 2023 at the Department of Oral and Maxillofacial Surgery, Al-Wasity Hospital, Baghdad. Fifteen female patients (mean age: 28 years) with excessive gingival display of mixed soft- and hard-tissue etiology were treated under local anesthesia. Gingival display was assessed preoperatively and during follow-up for up to 9 months, and pre- and postoperative outcomes were statistically analyzed.

Results:
A significant reduction in gingival display was observed in 14 patients, while one patient demonstrated partial relapse during the follow-up period between 1 and 9 months. Statistical analysis revealed a highly significant reduction in gingival display at 9 months compared with preoperative measurements (t = −4.10, df = 21.23, p = 0.0005).

Conclusion:
Selective myotomy and detachment of the upper lip elevator muscles is a simple, minimally invasive, and effective technique for the correction of gummy smile. The procedure offers satisfactory esthetic outcomes with minimal morbidity, preservation of neuromuscular function, and good short-term stability.

Keywords:

Gummy smile, Excessive gingival display, Myotomy, Upper lip elevator muscles, Minimally invasive surgery, Oral and maxillofacial surgery

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