Treatment of Excessive Gingival Display Using a Lip Repositioning Technique: A Case Report

Case Report

J Dent App. 2014;1(1): 13-15.

Treatment of Excessive Gingival Display Using a Lip Repositioning Technique: A Case Report

Tasdemir Z1*, Alkan BA1 and Alkan A2

1Department of Periodontology, School of Dentistry, University of Erciyes , Turkey

2Department of Oral MaxilloFacial Surgery, School of Dentistry, University, University of Erciyes, Turkey

*Corresponding author: Tasdemir Z, Department of Periodontology, University of Erciyes, T.C. ErciyesÜniversitesi Dis Hekimligi Fakültesi ve Hastaneleri 38039, Melikgazi, Kayseri

Received: June 10, 2014; Accepted: June 18, 2014; Published: June 20, 2014


Objective: One of the most important goals of dental clinicians is to meet the esthetic expectations of the patients. Excessive gingival display upon smiling is defined as “gummy smiling” and this situation may be a problem for the patients. Orthognathic surgery performed in gummy smile cases resulting from jaw deformites eliminates this problem. However, these procedures are quite invasive and requires hospitalization of the patients. For these reasons, “lip repositioning procedure”, which involves retraction of smile elevator muscles, may be an alternative in the treatment of some gummy smile cases.

Materials and Methods: Gummy smile resulting from delayed tooth eruption and lip hyperactivity was diagnosed in a 22-year old female who applied to the ERU University, Dental Faculty, Periodontology Department with the complaint of excessive gingival display upon smiling. Lip repositioning procedure depending on the removal of a strip of mucosa from the maxillary buccal vestibule and suturing the lip mucosa to the mucogingival line was performed.

Results: Clinical success was achieved. The patient complained about tension while talking or smiling, which lasted for one week. At the 1-year follow-up, it was observed that the results were maintained and patient was statisfied with her clinical appearance.

Conclusions: Lip repositioning procedure performed in the true indication may be an alternative in the treatment of gummy smile.

Keywords: Gummy smile; Excessive gingival display; Lip repositioning; Periodontal plastic surgery


One objective of the dental clinician is to meet patient expectations [1]. A person’s smile is one of the most important factor for the first impression [2]. Patients with excessive gingival display, also known as “gummy smile,” usually experience dissatisfaction with their clinical appearance [3].

A gummy smile has four different etiologies. The first is passive eruption where gingiva does not complete its apical migration [4]. In these patients, the problem can be solved through crown lengthening, which is a very simple and effective procedure involving hard and soft tissue resection. The second etiology is a dentoalveolar extrusion [4]. Patients with a dentoalveolar extrusion must be treated by an orthodontist or through orthognathic surgery. The third etiology is a vertical maxillary excess; for these patients [4], orthognathic surgery is the inevitable treatment choice. The fourth etiology is a hyperactive upper lip [4]; these patients have different treatment choices available with variable outcomes reported for each, including a myectomy, botulinum toxin injection, lip elongation (associated with rhinoplasty), detachment of lip muscles, and lip repositioning [5]. Lip repositioning was first defined in plastic surgery literature in 1973 [6]; the topic was recently explored again in periodontology literature [4,5]. The objective of lip repositioning is to partially inhibit gingival display by limiting the retraction of elevator smile muscles (i.e. zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). This technique involves removing a strip of maxillary vestibule mucosa and suturing the mucosa to the mucogingival line [6]. Other procedures are invasive, require patient hospitalization, or involve a long treatment period. For these reasons, lip repositioning may be an effective and alternative treatment in particular cases of gummy smile.

The aim of this case report is to present the one-year outcome of gummy smile treatment using lip repositioning.

Case Reports

A 22-year-old woman visited the Periodontology Clinic at Erciyes University in Kayseri, Turkey. Her chief complaint was excessive gingival display upon smiling (Figure 1). She desired to minimize the gingival display of while smiling. Her medical history was unremarkable. On clinical examination, it was determined that the etiology of gummy smile was delayed tooth eruption and lip hyperactivity. Treatment options mentioned above were then explained to the patient. In accordance with the patient choice of therapy, a lip repositioning surgery was scheduled. Before surgery, the patient signed the informed consent.