The ideal smile shows 90-95% tooth and 5-10% gingiva. Patients with a gummy smile show 25+ % gingiva. People with this condition are often self conscious and typically dont seek treatment because they are unaware of the possibilities of their treatment options. Periodontal plastic surgery has not been promoted to the extent of other plastic surgery procedures.
There are different modalities for treating a gummy smile. Most of them involve removing excessive gum tissue away from the tooth. This is referred to as crown lengthening. There are ideal proportions and visible lengths for the anterior teeth that can be achieved with crown lengthening.
However sometimes the teeth are already at their ideal proportions, yet when the patient smiles they show excessive gingiva. This can be due to a hyper-mobile lip or to a skeletal maxillary discrepancy. Jaw surgery is one way to correct that discrepancy. For patients unwilling to go through with that, the lip lowering procedure is an alternative and much less invasive approach.
The lip lowering procedure reduces the movement of a hyper-mobile lip by reattaching the lip mucosa and musculature lower toward the teeth. A frenectomy is a common procedure performed by a Periodontist, and the lip lowering procedure is essentially the reverse of a frenectomy. The first incision is made at the intersection between the gingiva and lip mucosa called the mucogingivaljunction. The next incision runs parallel toward the teeth in the gingiva. The width of that zone determines how much lowering is desired, the wider the zone the more lowering is achieved. The top incision margin, lip side, is then resutured to gingiva. The results are immediate, though some rebound is expected over the next few weeks. The post operative pictures for this case were taken immediately after the surgery while the patient was still numb and recovered from sedation.
Another application of this procedure is to help mask a dental implant restoration, where there has been substantial ridge resorption prior to implant placement. The restorations often result in longer looking teeth and or exposure of the tooth implant interface. Restricting a hypermobile lip can mask that interface.