Contemporary Therapeutic Strategies for Gummy Smile Correction: A Narrative Review of Botulinum Toxin, Combined Techniques, and Functional Preservation in Sports Dentistry
DOI:
https://doi.org/10.12775/QS.2026.66.74131Keywords
gummy smile, botulinum toxin, hyaluronic acid, myomodulation, lip repositioning, gingivectomy, orthodonticsAbstract
Background
Gummy smile (GS), or excessive gingival display (EGD), is defined as >2–3 mm of visible gingiva during smiling. It affects 10.5–29% of the population, with a higher prevalence in women, and may significantly impair self-esteem and quality of life. Its etiology is multifactorial, involving skeletal, dental, muscular, and soft tissue factors.
Aim
To evaluate the effectiveness of contemporary treatment methods for gummy smile and provide an etiology-based framework for selecting the most appropriate therapeutic approach.
Materials and Methods
A literature review was performed focusing on classification systems (Mazzuco and Hexsel, Mercado-Rosso), severity scales (Chu and Garber-Salama), and diagnostic techniques, including clinical examination, CBCT, electromyography (EMG), and digital smile analysis.
Results
BTX-A effectively reduces gingival display by relaxing the LLSAN, LLS, and ZMi muscles, with maximal improvement after 14 days and a duration of 3–6 months. HA fillers used for myomodulation provide longer-lasting correction (6–18 months) and greater patient satisfaction. Surgical lip repositioning improves smile aesthetics but is associated with recurrence, which may be reduced by adjunctive BTX-A. Laser gingivectomy provides predictable results in altered passive eruption, whereas orthodontic intrusion using TADs offers a less invasive alternative to orthognathic surgery. MAFT produces a stable spacer effect lasting up to 24 months.
Conclusions
Successful management of gummy smile requires accurate diagnosis and etiology-driven treatment selection. Combined protocols integrating surgical or orthodontic procedures with pharmacological modulation, particularly BTX-A, provide the most predictable and durable outcomes. Minimally invasive methods are especially advantageous for athletes because of shorter recovery. Further standardized protocols and long-term prospective studies are needed.
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Copyright (c) 2026 Julia Kalsztein, Weronika Kubiak, Olgierd Czapiński, Zuzanna Małek, Aleksandra Wyciślok, Katarzyna Waśkowska, Kacper Wiertelak-Makała, Marta Kwiatkowska
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