Etiology and diagnosis of gummy smile - Literature review




Dental aesthetics; Smile; Gingiva.


A smile represents, besides a form of communication, a means of socialization. The symmetry of a smile consists not only in the harmony between shape, position and color of teeth, but also in the balance between face, lips and gum tissue. The "gummy smile" is characterized by exaggerated gingival exposure, resulting in an un-aesthetic smile. This condition can arise as a result of one etiological factor, or by the combination of several of them, such as skeletal, dental, labial, periodontal or external alterations. It is essential that the dental surgeon knows its etiological factors in order to make a correct differential diagnosis. The objective of this study is to explore the concept, etiology, classification, and diagnosis of the gummy smile, through a literature review. Searches were performed in the Scientific Electronic Library Online (SciELO), Virtual Health Library (VHL), US National Library of Medicine National Institutes of Health (PubMed) and Google Scholar databases. According to the data available in the literature, it can be concluded that a correct diagnosis is essential to draw an individualized treatment plan, with satisfactory long-term results that meet the patient's aesthetic and functional expectations. Therefore, the dental surgeon should be able to identify the causes of gummy smile and define the predominant etiologic factor in each case.


Alpiste-Illueca F. (2011). Altered passive eruption (APE): a little-known clinical situation. Medicina oral, patologia oral y cirugia bucal, 16(1), e100–e104.

Bidra, A. S., Agar, J. R., & Parel, S. M. (2012). Management of patients with excessive gingival display for maxillary complete arch fixed implant-supported prostheses. The Journal of prosthetic dentistry, 108(5), 324–331.

Braga, M.S., Nascimento, J.M.Q., Camargo, E.B., Filho, J.M.D.C.V., Falcão, E.P., Zuza, E.P., & Pires, J.R. (2015). Cirurgia plástica periodontal para correção de erupção passiva alterada. Braz J Periodontol, 24(4), 64-68.

Cairo, F., Graziani, F., Franchi, L., Defraia, E., & Pini Prato, G. P. (2012). Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. International journal of dentistry, 2012, 837658.

Chacón Martínez, H., Castro Govea, Y., Pérez Porras, S., Vázquez Costilla, O., González Cárdenas, H.R., & Mendoza Adam, G.. (2011). Simplificando el tratamiento quirúrgico de la sonrisa gingival. Cirugía Plástica Ibero-Latinoamericana, 37(1), 43-49.

Chu, S. J., Karabin, S., & Mistry, S. (2004). Short tooth syndrome: diagnosis, etiology, and treatment management. Journal of the California Dental Association, 32(2), 143–152.

Coslet, J. G., Vanarsdall, R., & Weisgold, A. (1977). Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. The Alpha omegan, 70(3), 24–28.

Darakh, P., Khadtare, Y., Waghmare, P., Mali, A. (2017). Treatment of altered passive eruption by surgical gingivectomy: A case report. IP Int J Periodontol Implantol, ;2(2), 64-68.

Galdino, D. A., de Macedo Bernardino, Í., do Nascimento Barbosa, D., Ferreira, I. J., da Silva, F. A., da Silva, B. D., & Costa, L. G. C. (2021). Correção do sorriso gengival através do aumento de coroa clínica usando a técnica flapless: Uma revisão integrativa. Research, Society and Development, 10(5), e10210512753-e10210512753.

Garber, D. A., & Salama, M. A. (1996). The aesthetic smile: diagnosis and treatment. Periodontology 2000, 11, 18–28.

Kim, T. W., Kim, H., & Lee, S. J. (2006). Correction of deep overbite and gummy smile by using a mini-implant with a segmented wire in a growing Class II Division 2 patient. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 130(5), 676–685.

Liébart, M.F., Fouque-Deruelle, C., Santini, A., Dillier, F.L., Monnet-Corti, V., Glise, J.M., & Borghetti, A. (2004). Smile line and periodontium visibility. Periodont Pract today, 1,17-25.

Marks, S. C., Jr, & Schroeder, H. E. (1996). Tooth eruption: theories and facts. The Anatomical record, 245(2), 374–393.<374::AID-AR18>3.0.CO;2-M

Mazzuco, R., & Hexsel, D. (2010). Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. Journal of the American Academy of Dermatology, 63(6), 1042–1051.

Mishra, M. B., Khan, Z. Y., & Mishra, S. (2011). Gingival overgrowth and drug association: a review. Indian journal of medical sciences, 65(2), 73–82.

Oliveira, M. T., Molina, G. O., Furtado, A., Ghizoni, J. S., & Pereira, J. R. (2013). Gummy smile: A contemporary and multidisciplinary overview. Dental Hypotheses, 4(2), 55.

Panossian, A. J., & Block, M. S. (2010). Evaluation of the smile: facial and dental considerations. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 68(3), 547–554.

Peck, S., Peck, L., & Kataja, M. (1992). The gingival smile line. The Angle orthodontist, 62(2), 91–102.<0091:TGSL>2.0.CO;2

Pedron, I. G. (2016). Harmonização da estética dentogengivofacial. Clín. int. j. braz. dent, 150-155.

Robbins J. W. (1999). Differential diagnosis and treatment of excess gingival display. Practical periodontics and aesthetic dentistry : PPAD, 11(2), 265–273.

Rossi, R., Brunelli, G., Piras, V., & Pilloni, A. (2014). Altered passive eruption and familial trait: a preliminary investigation. International journal of dentistry, 2014, 874092.

Sabri R. (2005). The eight components of a balanced smile. Journal of clinical orthodontics : JCO, 39(3), 155–154.

Seixas, M. R., Costa-Pinto, R. A., & Araújo, T. M. D. (2011). Checklist of aesthetic features to consider in diagnosing and treating excessive gingival display (gummy smile). Dental Press Journal of Orthodontics, 16, 131-157.

Silberberg, N., Goldstein, M., & Smidt, A. (2009). Excessive gingival display--etiology, diagnosis, and treatment modalities. Quintessence international (Berlin, Germany : 1985), 40(10), 809–818.

Silva, H. F. V., Leite, R. B., de Oliveira, M. S. G., Leite, J. V. C., de Oliveira Felismino, C. M., de Araujo Cruz, M. E., Santos, A., Gusmão, G.P., & Lima, L. N. C. (2021). Avaliação de diferentes técnicas para correção do sorriso gengival: Revisão da literatura. Research, Society and Development, 10(5), e54510515092-e54510515092.

Sthapak, U., Kataria, S., Chandrashekar, K. T., Mishra, R., & Tripathi, V. D. (2015). Management of excessive gingival display: Lip repositioning technique. Journal of the International Clinical Dental Research Organization, 7(2), 151.

Tjan, A. H., Miller, G. D., & The, J. G. (1984). Some esthetic factors in a smile. The Journal of prosthetic dentistry, 51(1), 24–28.

Van der Geld, P., Oosterveld, P., Schols, J., & Kuijpers-Jagtman, A. M. (2011). Smile line assessment comparing quantitative measurement and visual estimation. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 139(2), 174–180.

Waldrop, T. C. (2008, December). Gummy smiles: the challenge of gingival excess: prevalence and guidelines for clinical management. In Seminars in orthodontics,14(4), 260-271.



How to Cite

ESPÍNDOLA, L. C. P.; FAGUNDES, D. dos S.; LIMA, V. H. S. de; MOREIRA, T. R. M. dos R. . Etiology and diagnosis of gummy smile - Literature review. Research, Society and Development, [S. l.], v. 10, n. 17, p. e223101724798, 2021. DOI: 10.33448/rsd-v10i17.24798. Disponível em: Acesso em: 24 jan. 2022.



Health Sciences