Exposing the gingiva when smiling up to some extent provides a youthful look and is cosmetically appealing. A gingival display of 1 to 2 mm when smiling is considered normal. Excessive gingival display, also known as "gummy smile," is the overexposure of the maxillary gingiva while smiling. In some severe cases, the overexposure of the gingival tissue is evident even in the resting position of the lips.
The critical element in managing a gummy smile is identifying its etiology, which determines the treatment plan and outcomes. A gummy smile may result from various disorders, including a short or hypermobile upper lip, altered passive eruption, vertical maxillary excess (VME), dentoalveolar extrusion, and gingival hyperplasia, but VME is one of its most common causes. The investigations needed to diagnose a gummy smile, and its etiology include frontal and lateral facial analysis, static and dynamic lip analysis, lip line, interlabial distance and display of incisors at rest, and complete periodontal examination. Oral radiographs and cephalometric analysis may also be needed; the latter indicated for diagnosing VME.
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