What Is a Gummy Smile?
A gummy smile is a condition where more gum tissue than usual is visible when you smile. In the English literature, it's also referred to as "excessive gingival display." It's an aesthetic finding, not a disease. However, because of its visual impact and psychosocial effects, it's considered an important treatment concern. In an ideal smile, your upper lip rests just above the gum line. Your teeth are fully or almost fully visible, and about 1 to 2 mm of gum tissue is aesthetically acceptable (it can even create a youthful, healthy smile appearance). When more than 3 mm of your upper gum tissue shows, it's classified as a gummy smile. The more this threshold is exceeded, the more pronounced the effect on facial aesthetics becomes. In very severe cases, 8 to 10 mm of gum tissue may be visible. These patients' smiles are typically perceived as "short teeth, too much gum."Aesthetic Smile Guidelines
The reference classification used clinically, based on the amount of gum tissue visible during a smile, is as follows:- 0 to 2 mm of gum visible: Considered normal, the aesthetic smile pattern seen in most people
- 2 to 4 mm of gum visible: Mild gummy smile. You may not notice it or it may not bother you
- More than 4 mm of gum visible: Noticeable gummy smile. This is a source of aesthetic concern for most patients
- More than 6 to 8 mm: Severe gummy smile. There's usually a skeletal component involved
Why Is Accurate Diagnosis Important?
Same appearance, different causes: While gummy smiles may look similar on the surface, they can stem from four different structural issues: gum tissue, alveolar bone, skeletal structure (upper jaw), or the upper lip muscle. For a gum tissue-related gummy smile, a simple gingivectomy may be sufficient. For a skeletal-based case, however, achieving lasting results without surgery isn't possible. Misclassification leads to incorrect treatment. For example, performing a gum procedure on a patient with a skeletal-based gummy smile will change the appearance very little, and the patient won't achieve the expected result. That's why a detailed smile analysis should be performed before treatment to determine which type the case falls into.
Is a Gummy Smile a Disease?
No, a gummy smile is not a disease. It can be seen in healthy individuals and does not cause any problems with tooth or gum health. It's purely an aesthetic condition. Treatment is not a medical necessity. It's shaped by your personal preference. Some people aren't bothered by a gummy smile and continue with their natural smile. Others develop behaviors like avoiding smiling, covering their mouth with their hand, or pursing their lips in photos. The decision to pursue treatment depends on this personal level of impact.Changes with Age
Gummy smiles show natural changes with age.- During childhood and adolescence, it's normal for more gum tissue to show. The eruption process may not be complete yet
- In young adulthood, the upper lip is at its tightest position and the amount of visible gum tissue is highest
- As you age, the upper lip softens and begins to sag, reducing the amount of visible gum
- In later life, your upper teeth become less visible and your lower teeth become more prominent
- For this reason, a prominent gummy smile in youth may naturally diminish somewhat over the years. However, skeletal or gum tissue-related cases don't change much
Gender Differences
Gummy smiles are more common in women than in men. The main reason is soft tissue differences between the sexes. In women, the upper lip is generally shorter and more mobile. Also, the average size of the teeth affects the perceived amount of gum tissue. This difference is biological and visual, but it also reflects in treatment requests due to cultural expectations. Most patients seeking treatment for a gummy smile are women.Relationship to Tooth Size
The actual anatomical size of your teeth is also important in evaluating a gummy smile. In some cases, your teeth are actually normal-sized, but the gum tissue covers part of the tooth. In this situation, your teeth appear "short" and the gummy smile finding becomes more prominent. The teeth are actually normal in structure. Only their visible portion is reduced. This condition is called "altered passive eruption" or "gingival excess" and is one of the most common causes of a gummy smile. By repositioning the gum tissue to the correct level (gingivectomy or crown lengthening), your teeth reach their true size and smile proportions are corrected.Psychosocial Impact
The most significant effect of a gummy smile is its psychosocial impact.- Avoiding smiling or adopting an unnatural closed smile
- The habit of covering your mouth with your hand when you laugh
- Discomfort in photos, pursing your lips
- Loss of confidence in social interactions
- Trying to control your upper lip when you speak
- Impact on professional life (especially in communication-focused jobs)
- Forms a significant portion of aesthetic treatment requests
The Doredent Approach
At Doredent, gummy smile evaluation isn't limited to measuring the visible amount. The actual size of your teeth, gum level, lip movements, upper jaw position, and facial proportions are all considered holistically. We determine which type it falls into and create an appropriate treatment plan accordingly. In some cases, gingivectomy alone produces sufficient results. In other cases, multidisciplinary planning involving orthodontic treatment, Botox, or jaw surgery may be necessary. For cases with an orthodontic component, the evaluation is performed by Uzm. Dt. Merve Özkan Akagündüz.Types of Gummy Smile
Gummy smile is not a uniform condition with a single cause. The same appearance can stem from four different structural sources, and each source requires a completely different treatment approach. The classification proposed by Garber and Salama is the most widely used in clinical practice and forms the foundation of treatment planning. In most patients, more than one type is present together (mixed presentations). Accurate assessment begins by identifying the dominant component.Type I: Gingival-Based (Altered Passive Eruption)
Summary: The teeth are actually normal size, but the gum tissue covers part of the tooth crown. Passive eruption (the process by which gums recede after tooth emergence) has not been completed.
Typical finding: Teeth appear short and square-shaped, yet the true anatomical crown is normal size.
Two Subtypes
- Type IA: Only the gum level is high; alveolar bone is at normal level. Simple gingivectomy is sufficient
- Type IB: Both gum tissue and alveolar bone are positioned close to the tooth crown. Gingivectomy alone is not enough; bone contouring (osseous surgery) is required
Treatment
- Gingivectomy (gum contouring) is sufficient for Type IA
- Crown lengthening surgery (gingivectomy + osseous surgery) for Type IB
- After the procedure, teeth reach their true size and smile proportions improve
- In necessary cases, after gum recontouring, completion with laminate veneers or crowns for aesthetic purposes
Type II: Dental-Based (Altered Active Eruption / Dentoalveolar Extrusion)
Summary: The upper front teeth have overerupted. The tooth position is lower than normal. The alveolar bone has also moved downward with the teeth.
Typical finding: Teeth are positioned below the occlusal plane, the chewing surface is misaligned with lower teeth, upper teeth appear "long" and are visible along with excess gum tissue.
Treatment
- Orthodontic intrusion: Moving the upper front teeth upward. Done with braces treatment or clear aligner treatment
- Mini screw (TAD) assisted intrusion in advanced cases
- Restoration of opposing teeth (replacing missing teeth, correcting deep bite)
- Segmental orthognathic surgery in severe cases
- Orthodontic intrusion time ranges from 6 to 12 months
Type III: Skeletal-Based (Vertical Maxillary Excess, VME)
Summary: The upper jaw has developed excessively long skeletally. The problem is not with the gums or teeth but directly with the bone structure.
Typical finding: The lower third of the face is long, overlapping with what is described as "long face syndrome." The upper lip strains when closed; at rest position, the mouth remains slightly open.
Associated Findings
- Long face appearance
- Difficulty closing the upper lip; mouth slightly open at rest position
- Retruded lower jaw
- May be accompanied by open bite
- History of mouth breathing is common
- Typically becomes prominent after adolescence
Treatment
- Le Fort I osteotomy with maxillary impaction (repositioning the upper jaw upward): orthognathic surgery
- Jaw surgeon and orthodontist work in a multidisciplinary approach
- Pre-surgical and post-surgical orthodontic treatment is mandatory
- Total treatment time is 1.5 to 2 years
- Provides dramatic and permanent results; it is not possible to achieve this result with other methods
- Conservative approaches such as Botox or gingivectomy provide temporary and partial improvement
Type IV: Soft Tissue-Based (Hyperactive Upper Lip / Short Upper Lip)
Summary: Teeth and gums are in normal position, but the upper lip muscle rises excessively during smiling, exposing the gum tissue. In some cases, the upper lip may be short.
Typical finding: At rest position, the relationship between lip and teeth is normal. During smiling, the upper lip rises to a much higher point than normal (movement over 8 mm).
Diagnostic Test
Measuring upper lip movement at rest position and during smiling is diagnostic. Normal movement is around 6 to 8 mm. In Type IV, this movement reaches 10 mm or more. Upper lip length is also measured. A short lip (for example, below 18 to 20 mm) may be a contributing factor.Treatment
- Botox (gingival Botox): Low-dose botulinum toxin injection into the levator labii superioris alaeque nasi muscle. Effect begins in 5 to 7 days and lasts 3 to 4 months. Repeat may be needed when the effect ends. In the right indication, this is the quickest and least invasive solution
- Lip repositioning surgery: An incision made inside the upper lip restricts lip movement. Provides permanent results but is a surgical procedure
- Lip filler: Increasing upper lip volume reduces the visual effect of the upper lip muscle. It has limited indications
- Myectomy: Surgical removal of part of the muscle. Rarely preferred
Mixed Types
Mixed presentations are common in practice: In the clinic, the majority of gummy smile cases are mixed presentations where more than one type comes together. Type I (gingival) + Type IV (hyperactive lip) is the most frequently encountered combination. In these cases, gum level is corrected with gingivectomy, then lip movement is restricted with Botox. The Type II (dental) + Type III (skeletal) combination creates more complex cases, requiring coordinated work between orthodontics and orthognathic surgery. Proper treatment planning begins by clearly revealing the dominance of each component. It is not possible to resolve every type with a single technique. Treatment must be tailored to the type.
Which Type Suits Which Treatment?
- Type I (Gingival): Gingivectomy, crown lengthening
- Type II (Dental): Orthodontic intrusion
- Type III (Skeletal): Orthognathic surgery (Le Fort I impaction)
- Type IV (Lip): Botox, lip repositioning
- Mixed types: Combination treatments, multidisciplinary planning
Causes
The underlying causes of gummy smile are examined in four main categories; these form the typical clinical types in the previous section. The same person may have more than one cause at the same time. Identifying the causes directly shapes the treatment plan; the answer to "why is it like this?" also largely determines the answer to "what should be done?" Causes arise from a combination of genetic predisposition, developmental patterns, and some environmental factors.1. Gingival and Dental Developmental Issues
Altered Passive Eruption
After a tooth erupts, the gum tissue retracts to expose the tooth's true anatomical crown. This process is called "passive eruption." In some individuals, this process is not completed; the gingiva permanently covers a portion of the tooth's crown. As a result, teeth appear short, gum tissue is excessively visible, and a gummy smile appears.- Genetic predisposition is a strong factor
- It becomes apparent during childhood and adolescence
- It usually does not change with age
- Most commonly seen in upper front teeth
- Clinical crown appears short, teeth appear square-shaped
Dentoalveolar Extrusion (Overeruption of Teeth)
- Missing opposing tooth: when a lower back tooth is missing for a long time, upper teeth continue to erupt because they cannot find contact
- Deep bite: upper front teeth excessively cover lower teeth and position downward
- Parafunctional habits: lip sucking, backward pushing of the lower jaw
- Congenital bite problems
- No space maintainer applied for early lost teeth
Anatomical Size Variations of Teeth
- Genetically short teeth
- Tooth shortening due to wear (bruxism history, acid erosion)
- Tooth length loss after trauma
- Enamel defects (amelogenesis imperfecta)
2. Skeletal Developmental Issues
Vertical Maxillary Excess
The upper jaw develops excessively in the vertical direction during growth. As a result, the lower third of the face lengthens, the gums remain skeletally positioned lower, and lip closure becomes difficult.- Genetic pattern is predominant
- Part of the craniofacial growth pattern
- A component of "long face syndrome"
- Becomes apparent during adolescence, remains stable once growth is complete
Upper Jaw Positioning Disorders
- Excessive forward protrusion of the upper jaw (maxillary protrusion)
- Class II skeletal relationships
- Some syndromic conditions
Craniofacial Syndromes
- Some syndromes associated with gummy smile (especially those with prominent skeletal component)
- Asymmetric gummy smile may develop after repair in cleft lip and palate cases
3. Upper Lip Structure and Movement
Hyperactive Upper Lip (Levator Labii Superioris Hyperfunction)
The muscles that elevate the upper lip (especially levator labii superioris alaeque nasi) contract much more forcefully than normal during smiling. The upper lip rises higher than normal and exposes the gums. The appearance looks normal at rest; the problem only becomes apparent when smiling.- Anatomical muscle structure varies from person to person
- Genetic factors are influential
- Upper lip movement can reach approximately twice the normal range
- In some cases, the nostrils also elevate during smiling
Short Upper Lip
- Anatomically shorter than normal upper lip
- Evaluated according to normal ranges of facial proportions
- Average around 22-24 mm in men, 20-22 mm in women
- Below 18-20 mm is considered a short upper lip
- It is a genetic trait
Other Soft Tissue Factors
- Upper lip volume deficiency
- Individual variations in perioral muscle patterns
- Age-related lip volume loss (conversely, reduces gum visibility because the lip droops)
4. Other Factors
After Orthodontic Treatment
- Some orthodontic movements (especially excessive extrusion of front teeth) can make a gummy smile more apparent
- Properly planned orthodontic treatment corrects gummy smile; poorly planned treatment can worsen the condition
- End-of-treatment smile analysis must be performed
Drug-Induced Gingival Enlargement
- Medications such as phenytoin, cyclosporine, calcium channel blockers (nifedipine, amlodipine) cause gingival enlargement
- The enlarged gingiva covers the teeth and creates a gummy smile appearance
- For detailed information, see the swollen gums page
- Treatment planning for drug-induced enlargement should also include management of the underlying medication
Periodontal Problems
- Some periodontal treatment outcomes can change gum level
- Chronic inflammatory conditions creating excessive gingival coverage
Mouth Breathing and Growth Pattern
- Prolonged mouth breathing during childhood affects facial development and contributes to vertical maxillary excess
- Mouth breathing due to adenoid hypertrophy, allergic rhinitis, septal deviation, and similar causes is a preventable factor
- ENT evaluation in early childhood can reduce the risk of gummy smile in later years
Combination of Genetic and Environmental Factors
Gummy smile is largely hereditary. A history of gummy smile in parents or close relatives significantly increases the likelihood of occurrence in children. Genetic patterns determine skeletal dimensions, gingival characteristics, and soft tissue structure. Environmental factors (mouth breathing, nutrition, oral habits) can shape or mitigate genetic predisposition, but alone are rarely the primary cause of gummy smile.Can It Be Prevented?
It is not possible to prevent the skeletal and genetic components of gummy smile. However, some contributing factors can be managed with early intervention. Prevention of chronic mouth breathing during childhood (ENT evaluation, allergy treatment) can have a positive effect on skeletal pattern. Maintaining space for early lost teeth with space maintainers can reduce dental component cases. Early orthodontic evaluation (first orthodontic exam around age 7) allows early detection of developmental problems; consultation can be arranged with Uzm. Dt. Merve Özkan Akagündüz on this topic. However, in most cases, gummy smile is a condition that appears or is treated in adulthood; due to its hereditary genetic component, treatment in adults is oriented toward corrective interventions.Assessment Process
The purpose of gummy smile assessment is not just to answer the question "is it present or not," but to determine which type it falls under and which treatment will be appropriate. Incorrect classification leads to incorrect treatment, and therefore failure to achieve the expected aesthetic result. Assessment is based on clinical observation, photograph and video analysis, and X-ray examination in necessary cases. Complex tests are rarely needed; an experienced clinician can largely determine the type through clinical analysis and a few photographs.Detailed History Taking
Aesthetic Complaint
- How long has the gummy smile been bothersome?
- Is there a habit of avoiding smiling or covering the mouth when laughing?
- Does it cause discomfort in photographs?
- Is there impact on professional or social life?
- Has treatment been sought for this before? What was the outcome?
- What is the treatment expectation?
Medical and Dental History
- Family history: is there a similar smile pattern in parents or siblings?
- History of orthodontic treatment in childhood
- History of missing teeth
- Medications used: phenytoin, cyclosporine, calcium channel blockers (drugs that cause gingival overgrowth)
- Systemic diseases
- History of mouth breathing, ENT problems
- History of bruxism and tooth wear
- Previous dental treatments
- Smoking status
Clinical Examination
Static Assessment (Resting Position)
- Facial proportions (upper, middle, lower facial thirds)
- Are the lips closed in resting position?
- How much of the teeth are visible in resting position?
- Upper lip length measurement
- Facial symmetry
Dynamic Assessment (Smile Analysis)
- Amount of upper lip movement during smile (lip mobility): 6-8 mm normal, over 8 mm hyperactive
- Amount of gum tissue visible when smiling (measurement in mm)
- Smile arc: harmony of teeth with lower lip
- Buccal corridor width
- Midline harmony
- Presence of asymmetry
- Between which teeth is more gum visible (localized or widespread)
Intraoral Examination
- Gum health, presence of inflammation
- Gum levels (right and left symmetry)
- True anatomical size of teeth (clinical crown measurement)
- Probing depth (palpation of the enamel-cement junction within the pocket)
- Gum tissue type (thick or thin biotype)
- Position of upper front teeth (amount of eruption)
- Bite relationship: presence of deep bite, open bite
- Presence of wear
- Missing tooth or restoration status
Photograph Analysis
A standard photograph set is a fundamental part of gummy smile assessment.- Frontal portrait photograph (resting position)
- Frontal smile photograph
- Side profile photograph (resting and smiling)
- 45-degree angle photographs
- Close-up oral photographs (full smile, social smile, laughter)
- Retracted lips (front and side intraoral photographs)
- Upper and lower occlusal photographs
Video Analysis
In some cases, video recording is taken for dynamic analysis of the smile. Lip movements, gum display pattern, and asymmetries during the patient's natural speech and smile are evaluated through video. Dynamic information that cannot be captured in static photographs is revealed.Smile Type Analysis
Three different smile types are defined from a sociological and aesthetic analysis perspective.- Low smile line: Less than 75% of upper teeth visible. Very little gummy smile
- Average smile line: 75-100% of upper teeth and interdental papillae visible. Ideal aesthetic
- High smile line (gummy): All teeth and more than 3 mm of gum tissue visible. Treatment candidate
X-ray and Advanced Imaging
Periapical and Bite-Wing X-rays
- Assessment of bone level of upper front teeth
- Relationship between enamel-cement junction and alveolar bone
- For distinguishing Type IA and Type IB (assessment of bone level)
Panoramic X-ray
- General dental and skeletal assessment
- Missing teeth, impacted teeth
- General bone condition
Cephalometric X-ray (Lateral)
- Assessment of skeletal dimensions
- Precise measurement of vertical maxillary excess
- Numerical analysis of facial proportions
- Always requested in suspected Type III (skeletal) gummy smile
- Forms the basis for orthognathic surgery planning
CBCT (Cone Beam Computed Tomography)
- Three-dimensional skeletal assessment
- In complicated cases
- If surgical planning is required
- Detailed examination of tooth-bone relationships
Digital Smile Design (DSD)
In modern aesthetic dentistry, digital smile design (Digital Smile Design) is a widely adopted tool. The treatment result is simulated on the patient's high-resolution photographs using special software. The advantages of this method are:- Patient can see the treatment result in advance
- Alignment of expectation with reality is ensured
- Communication of treatment planning is facilitated
- A common visual reference is created among the multidisciplinary team
- Comparison can be made with the end-of-treatment result
Differential Assessment: Determining the Type
A practical summary: To determine the patient's type, answers to a few questions are sufficient. Is the true size of the teeth short, is the clinical crown inadequate (Type I)? Have the upper teeth erupted excessively downward, are they below the occlusal plane (Type II)? Is the lower third of the face long, is there VME on cephalometry (Type III)? Is upper lip movement over 8 mm, does the picture appear normal at rest (Type IV)? In most cases, more than one answer is yes; in this situation, dominant types are ranked and treatment is planned accordingly in stages.
Multidisciplinary Assessment
Gummy smile assessment may not fit within a single specialty. Depending on the complexity of the case, collaboration with the following specialties may be required.- Periodontics: Gum level, gingivectomy, crown lengthening
- Orthodontics: Intrusion for Type II, orthodontic preparation before and after orthognathic surgery
- Oral and maxillofacial surgery: Le Fort I osteotomy for Type III
- Aesthetic dentistry: Post-treatment restoration (laminate veneer, crown)
- Aesthetic medicine / dermatology: Botox and lip filler applications for Type IV
- Plastic surgery: Lip repositioning and some soft tissue interventions
- ENT: Early follow-up of childhood mouth breathing-related cases
Frequently Asked Questions
Is gummy smile a disease? What happens if I don't get treatment?
No, gummy smile is not a disease. It does not pose a direct threat to tooth or gum health, does not impair oral function, and does not lead to other health problems on its own. In most cases, it is purely an aesthetic finding.
For this reason, not treating gummy smile carries no medical risk. Living with gummy smile is safe. The decision to seek treatment usually stems not from medical necessity but from the individual's aesthetic expectations and how satisfied they are with their smile.
Some people are not bothered by their gummy smile appearance, continue with their natural smile, and feel no need for treatment. In this case, treatment is not necessary.
For others, gummy smile can lead to behaviors such as avoiding smiling, closing their lips in photos, covering their mouth with their hand, or reduced self-confidence. If this situation affects your social life, professional life, or how you express yourself, treatment options may be considered.
In some cases, there may be an underlying dental or orthodontic problem behind gummy smile. For example, deep bite, excessive eruption of teeth due to missing teeth, or bite disorders can increase gum visibility. In such cases, the underlying issue is evaluated separately, and gummy smile appearance may improve during the treatment process.
In rare cases, gum overgrowth caused by certain medications can also create a gummy smile appearance. Medications such as phenytoin, cyclosporine, or some calcium channel blockers can cause gum overgrowth. In this situation, medical follow-up is recommended not only for aesthetics but also for gum health.
In conclusion, whether or not to get treatment for gummy smile is entirely a personal choice. If it does not affect your quality of life, treatment is not essential. However, if you are uncomfortable with your smile, it is possible to achieve a more balanced and aesthetic smile with different treatment options.
Before making a decision, the most appropriate approach is to determine your gummy smile type through a detailed examination, clarify your expectations, and evaluate the treatment options that are suitable for you.
Does Botox really work for gummy smile?
Yes, but it is only effective for a specific type of gummy smile. Botox can provide quite successful results in gummy smile cases caused by excessive upper lip movement, typically classified as "Type IV."
In these patients, the relationship between teeth and gums often appears normal at rest. The problem only becomes apparent when the person smiles; the upper lip lifts more than normal and more gum tissue becomes visible than it should.
In such cases, the treatment goal is to reduce the activity of the muscles that excessively pull the upper lip upward. Low doses of botulinum toxin (Botox) are applied to muscles, particularly the levator labii superioris alaeque nasi. Because muscle activity is temporarily weakened, the upper lip rises less during smiling and gum visibility decreases.
Botox effects typically begin within 5 to 7 days, reaching maximum level in approximately 2 to 3 weeks. The average duration of effect is 3 to 4 months; afterward, muscle activity gradually returns and reapplication may be necessary.
With regular applications at intervals, some patients may experience more controlled muscle movement over time and longer-lasting effects.
The advantages of Botox treatment include:
- Does not require surgery
- Application time is short (approximately 15 to 20 minutes)
- No recovery period
- Person can return to normal life the same day
- Can provide highly effective and natural results in the right patient group
However, Botox is not effective in every gummy smile case. Because the cause of gummy smile can differ in each patient.
For example, in Type I cases where there is excessive gum tissue, Botox does not change the amount of gum; therefore, it does not provide the expected result. In such cases, gingivectomy or gum contouring procedures may be more appropriate.
In Type II cases caused by tooth position, Botox cannot change the position of teeth. In this situation, clear aligners or orthodontic treatment may be needed.
In skeletal Type III cases, the position of the upper jaw bone is the underlying problem. In these patients, the effect of Botox is usually limited.
For this reason, accurately determining the gummy smile type before deciding on Botox is critically important. When applied to the wrong patient, it may not meet expectations.
In some patients, the problem is caused by more than one factor. In such mixed cases, Botox can be combined with other treatments. For example, first the gum level is adjusted with gingivectomy, then lip movement is controlled with Botox, and a more balanced result is achieved.
When applied with the correct indication, Botox can be a quick, minimally invasive, and effective gummy smile solution. However, for successful results, the most important point is accurate analysis of the source of the problem and planning treatment accordingly.
How long does gingivectomy take, and is the result permanent?
Gingivectomy is a procedure performed in a single session under local anesthesia. The procedure duration varies by case; if only the gum level of the upper front six teeth is being corrected, it takes 30 to 45 minutes, and if a larger area is being treated, it can take 1 to 1.5 hours. You do not feel pain during the procedure; local anesthesia is effective. Mild discomfort and sensitivity are expected for the first 24 to 48 hours after the procedure; this is controlled with simple pain relievers. Soft and warm foods are recommended, and direct pressure on the area is avoided. Swelling is usually minimal. The healing process takes 7 to 14 days for soft tissue, and 6 to 8 weeks if bone contouring (crown lengthening) was performed; during this time, the gums take their final shape. The full aesthetic result becomes apparent within 3 to 6 months; this time is necessary for the gum tissue to mature and settle into its final position. What you need to know about result permanence: in cases performed with correct indication and sufficient alveolar bone presence, the result is largely permanent. The gum does not regrow or return to its previous position. However, two important factors can affect the outcome. First, in cases where only gingivectomy is performed but the underlying bone level is also high (Type IB), the gum may regrow slightly over time; this is why bone level should also be corrected in such cases (crown lengthening). Second, maintaining gum hygiene is important; inflammation can cause changes in gum level. Regular professional cleaning (every 6 months) and good home care (brushing, flossing) ensure result preservation. Like no treatment method, gingivectomy does not provide a one hundred percent unchangeable result; small natural changes may occur over the years. But in clinical practice, satisfaction rates are high and patients generally obtain a result they can maintain for many years with a single procedure. For details, you can refer to the gingivectomy page.
My gummy smile is very pronounced. Is gum intervention alone sufficient?
The answer to this question depends on your type, and the answer may always be "no." Very pronounced gummy smile (for example, more than 6 to 8 mm of gum visibility) is often not caused by gum alone; there may be a skeletal component (Type III, vertical maxillary excess) or multiple types together. In these cases, when only gum intervention (gingivectomy) is performed, the change is limited and the patient does not get the expected result. Gingivectomy alone may be sufficient in this situation: your gummy smile is gum-based (Type I), your teeth are actually normal size but the gum covers the crown of the tooth, your upper lip movement during smiling is within the normal range, and your facial proportions appear balanced skeletally. This is the classic Type I presentation, and gingivectomy provides very satisfying results. However, gingivectomy alone is not sufficient in the following situations: if the lower third of your face is long (skeletal component), if lip movement exceeds 8 mm (Type IV), if teeth have over-erupted (Type II), or if more than one of these is present together. In these cases, combination treatment is required. For example, in a Type I plus Type IV combination, the gum is corrected with gingivectomy, lip movement is limited with Botox; the result is significantly better than with a single treatment. In Type III skeletal cases, orthognathic surgery (Le Fort I osteotomy) may be necessary for permanent improvement; gingivectomy in this case provides only cosmetic improvement and does not solve the main problem. This is why the evaluation phase is very important. An approach of just "there is gummy smile, let's remove the gum" may be insufficient. The physician performs a comprehensive analysis to determine which treatment (or combination) will give the best result. Sometimes in advanced cases with a skeletal component, if the patient does not want to undergo orthognathic surgery, reduction can be preferred with more limited conservative methods (gingivectomy plus Botox); in this case, it is important for the patient to keep expectations at a realistic level.
Will my smile look natural after treatment?
With the correct indication and correct application, yes, the result looks very natural. Modern gummy smile treatments are not so aggressive as to create an "artificial" appearance; the goal is to bring the gum, lip, and tooth relationship into natural aesthetic ranges. After gingivectomy, your gumline forms a smooth contour, teeth reach their true anatomical dimensions, and your smile appears more "correctly proportioned." You usually do not get questions like "did you have dental treatment" from those around you; people generally respond with "you look better" or "there's a change but I can't quite tell what it is." When Botox is applied at the correct dose, your upper lip still moves naturally, only the excessive upward pull is prevented. Your face does not become expressionless, your smile does not disappear; you just get a more balanced smile with reduced gum display. Incorrectly applied Botox (excessive dose or wrong muscle selection) can create asymmetry or a frozen smile; this is why practitioner selection is critical. Orthognathic surgery (skeletal correction) gives the most dramatic result because it changes all facial proportions; long face appearance shortens, lip closure improves, smile aesthetics improve markedly. In these cases, the patient achieves the smile they have dreamed of for years. For the result to look natural, a few basic rules apply: physician selection (experience and aesthetic understanding), correct indication (appropriate treatment type), staged approach (coordinated use of more than one treatment if necessary), and realistic patient expectations. Post-treatment "fake" appearance usually stems from either wrong indication (aggressive gingivectomy on a Type III patient, for example) or exaggerated intervention to meet the patient's overly exaggerated expectations. With proper planning, the result is both permanent and natural, and the patient remains satisfied for years.
When the Botox effect wears off, does gummy smile come back?
Yes, when the Botox effect wears off, the upper lip muscle returns to its normal activity and gummy smile largely returns. This is why periodic reapplication is needed for permanent results in Type IV patients; typically every 3 to 4 months. However, there are two positive points. First, regular Botox application can create a "retraining" effect on the muscle over time; as the muscle becomes accustomed to constant suppression, its resting activity also decreases, and some patients notice that the effect duration extends or the condition improves slightly after 2 to 3 years of regular application. Second, the Botox effect does not wear off suddenly but gradually; gummy smile does not return overnight, it increases slowly over weeks. If you are looking for a permanent solution, there are two surgical options for Type IV cases. Lip repositioning surgery: a small strip of mucosa is removed from the inside of the upper lip to permanently limit lip movement. It is a surgical procedure, takes 30 to 45 minutes under local anesthesia, recovery is 1 to 2 weeks. Results are maintained for many years in a significant portion of patients, but in some cases the muscle adapts over time and gummy smile may return to some extent. In more advanced cases, myectomy (surgical removal of part of the muscle) may be an option; it is rarely preferred. When deciding between Botox and surgery, several factors are evaluated: your age (in younger patients, the muscle may adapt over the years), your desire for a permanent solution to the condition, your capacity to allocate time and cost for periodic repetitions, whether you want to undergo surgery. As a practical approach: after testing the treatment effect with Botox for the first 6 to 12 months and confirming you are satisfied, you can switch to lip repositioning if you want a permanent result. This approach provides both a trial opportunity and helps you make the right decision. Some patients prefer the practicality and reversibility of Botox and do not consider permanent surgery; this is also a completely valid choice.
Can braces correct gummy smile?
Yes, but only in certain types and to a limited extent. Orthodontic treatment (fixed braces or clear aligners) is markedly effective in two types of gummy smile. First, in Type II (dental) cases; if the upper front teeth have over-erupted (for example, due to missing teeth in the lower arch or as a result of deep bite), teeth are moved upward with orthodontic intrusion. This movement pulls the gum upward as well, correcting gummy smile. Effective results are obtained with mini-screw (TAD) supported intrusion techniques. Treatment duration is 6 to 12 months, depending on the case. Second, in mixed-type cases, orthodontics is used as preliminary preparation for other treatments. For example, if orthognathic surgery is planned for skeletal gummy smile (Type III), teeth are brought to the correct position with 6 to 12 months of orthodontic treatment before surgery; after surgery, 6 to 12 more months of orthodontics stabilize the result. However, orthodontics alone does not solve some types. In Type I (gum) cases, because the gum level is the problem, orthodontic movement does not correct gummy smile; gingivectomy is needed. In Type IV (hyperactive lip) cases, tooth position is already normal; orthodontics does not contribute to the condition, Botox or lip repositioning is needed. In some cases, gummy smile findings are seen to become more pronounced during or after orthodontic treatment; especially incorrect mechanical use (excessive extrusion of upper teeth) can produce this result. This is why gum smile analysis must be performed when planning orthodontic treatment, and the presence of gummy smile or possible risk should be evaluated beforehand. Modern orthodontic approaches (digital planning with clear aligner systems like Invisalign) offer more controlled treatment opportunities in this regard. At Doredent, for orthodontic evaluation you can refer to braces treatment and clear aligner treatment pages; comprehensive analysis is performed by Uzm. Dt. Merve Özkan Akagündüz.
Will people around me notice that I had treatment for gummy smile?
With the right treatment choice and correct application, those around you generally do not notice that you had treatment. In fact, for most patients, the most common response is "there's a change but I can't quite tell what you did." Modern gummy smile treatments do not create an "artificial" result; the goal is to achieve natural aesthetic proportions. After gingivectomy, your gumline improves, your teeth reach their true dimensions, and your smile appears more balanced. There may be slight swelling for the first few days, but this passes quickly; it mostly does not disrupt your social life. Within a week you return with an appearance that no one notices, and the full aesthetic result becomes apparent after a few months. Botox application remains even more hidden; neither injection marks are visible nor is there a noticeable change in the face. They may only notice that gum display decreases during smiling, but they cannot figure out the reason. One of Botox's biggest advantages is that it provides aesthetic correction "without being noticed." After surgical procedures like lip repositioning, there is slight swelling and limited lip movement for the first 1 to 2 weeks; during this period you may want to stay away from social activities, afterward you return to normal appearance. Orthognathic surgery (skeletal correction) creates the most dramatic change; after this treatment your face changes noticeably and those around you definitely notice. But even here the change is in a "natural," not "artificial," direction; your long face appearance shortens, your lips close comfortably, your smile becomes balanced. Those around you see the difference, but perceive it as a positive change, not a negative one. Practical recommendations for patients who value privacy include: planning the treatment during vacation periods, staying away from work or social activities for the first few days, avoiding photos briefly. In conclusion: there is no appearance that "gives away" that you had treatment; on the contrary, an unnatural smile pattern becomes natural, those around you perceive a positive general improvement but the reason does not become clear. This is a feature that shows gummy smile treatments are successful; the more noticeable the result, the more hidden the treatment itself remains.
Content Information
This page was prepared by the Dore Medical Editorial Board and medically reviewed by Dr. Merve Özkan Akagündüz.
Published
May 12, 2026
Updated
May 13, 2026
