A smile that shows more gum than tooth draws the eye upward and can make otherwise straight, healthy teeth look small. In clinical terms, a gummy smile is often defined as more than 3 to 4 millimeters of gingiva visible on full smile. That number is a guide, not a verdict. Some faces carry more gingival display beautifully. Others feel self-conscious with even 2 millimeters. The art lies in diagnosing the cause, then tailoring treatment to the person’s anatomy, risk tolerance, and goals.
I have treated gummy smiles in people from their late teens to their seventies. A consistent pattern emerges: success depends on a precise diagnosis and a conservative mindset. Guesswork leads to overtreatment, and once tissue or bone is removed, you do not get it back easily. The range of dentistry and adjunct procedures today is broad, from injectable neuromodulators to orthognathic surgery. A measured plan often starts small and steps up only as needed.
What creates a gummy smile
Gingival display rarely comes from a single factor. Usually, several pieces stack together. To develop a plan, I assess in repose, during a natural smile, and on a full laugh, then I measure lip length, incisor display, gingival margins, and tooth proportions. Photographs and a short lip mobility video help.
Common contributors include:
- Vertical maxillary excess: The upper jaw is positioned lower or longer in the vertical dimension, bringing gum tissue into the smile frame. You might see a long midface, increased lower scleral show, and a larger bite reveal. Hyperactive upper lip elevator muscles: The lip lifts higher than average when smiling. Lip length at rest can be normal, but the upward movement ranges from 6 to 10 millimeters or more. Short or altered passive eruption: The teeth are the correct anatomic length, but gum tissue covers part of the crown. The clinical crowns look short and square. Radiographs show the cemento-enamel junction relative to bone crest. Gingival hypertrophy or medication effects: Certain drugs, such as some calcium channel blockers or anti-seizure medications, can thicken gingival tissue. Inflammation from plaque or orthodontic appliances adds bulk. Tooth wear or compensations: Heavy wear shortens incisal edges. The body compensates by erupting teeth to maintain contact, bringing gums along for the ride. Skeletal and dental relationships: Deep bites, proclined incisors, and orthodontic relapse change lip-to-tooth balance.
Each pattern carries its own treatment logic. A hyperactive lip responds to neuromodulators or surgical lip repositioning. Altered passive eruption lends itself to crown lengthening. Vertical maxillary excess, when significant, calls for orthognathic surgery. The art is not mixing them up.
The exam that matters
Numbers and photos make decisions clearer and help set realistic expectations. Three measurements guide most of my plans:
- Incisor display at rest: In many adults, seeing 1 to 4 millimeters of upper incisor at rest looks youthful. Zero often reads aged. More than 4 millimeters at rest can foreshadow a gummy smile on animation. Gingival display on full smile: Less than 3 millimeters is considered within normal limits. Between 3 and 6 millimeters begins to look gummy on many faces. Above 6 millimeters is marked. Clinical crown length and width: A maxillary central incisor typically averages around 10 to 11 millimeters in length with a width-to-length ratio near 75 to 80 percent. A 7-by-8 millimeter central incisor usually signals covered enamel.
I also evaluate lip length from subnasale to vermillion, smile arc relative to the curvature of the incisal edges, and gingival margin harmony, especially the relationship of central incisors to canines. A periapical radiograph or CBCT helps determine bone crest levels, which dictates how much tissue can be removed safely during crown lengthening.
The conservative end: injectables for hyperactive lips
For patients whose upper lip vaults upward during a smile, small doses of botulinum toxin to the levator labii superioris complex reduce elevation and soften a gummy display. The effect is temporary. Early visits tend to last 8 to 12 weeks, then stabilize to 3 to 4 months. I prefer a light hand at first, in the neighborhood of 1 to 2 units per injection point across three to four points, then adjust. Overcorrection flattens the smile or changes speech, which nobody wants.
Advantages are obvious: quick, reversible, minimal downtime. Disadvantages include maintenance, cost over time, and variable response. This is a good trial step for people considering more permanent solutions like lip repositioning surgery. If the toxin improves the balance and the patient craves permanence, we have a strong diagnostic predictor that lip-focused procedures will help.
A semi-permanent middle ground: lip repositioning surgery
Lip repositioning narrows the vestibule by removing a band of mucosa inside the upper lip and suturing the lip closer to the teeth. The goal is to limit superior retraction of the lip when smiling. It is less invasive than jaw surgery and more durable than injectables. It does not change tooth length or jaw position. This makes it appropriate for people with normal tooth proportions and stable occlusion who simply lift too much when they smile.
Healing takes roughly 1 to 2 weeks of visible recuperation, with residual tightness for several more weeks. I caution patients about dry lip risk during healing and temporarily modifying diet. Stability is generally good for a few years, although relapse can occur, especially in hypermobile tissues or in patients with heavy facial animation. When a patient also has altered passive eruption, combining lip repositioning with crown lengthening during the same care plan can produce a natural balance.
Fixing short-looking teeth: crown lengthening and tissue sculpting
When enamel is buried under gum tissue, crown lengthening reveals the true tooth proportions. There are two main flavors. Soft tissue only gingivectomy works when the bone crest is already at a biologically healthy distance from the cemento-enamel junction. If bone sits too close, removing gum alone leads to rebound or chronic inflammation. In that case, osseous crown lengthening recontours bone to maintain a stable biologic width, then positions the gingival margin higher.
A few realities guide planning:
- Smile-zone precision is unforgiving. Half a millimeter too high on one central incisor stands out across a room. I build wax-ups or digital mock-ups and transfer them with a surgical guide to control margin positions. Tissue thickness matters. Thick biotypes heal more predictably and resist recession. Thin biotypes risk papilla loss and black triangles if incisions are aggressive or bone is over-resected. Expect a settling period. Gingival margins migrate coronally during healing, often 0.5 to 1 millimeter over several months. I delay final veneers or bonding for 8 to 12 weeks in thick tissue and up to 6 months in thin tissue or after significant bone recontouring.
Proper crown lengthening can transform smiles that looked “childlike” into proportional, mature dentitions. When the underlying teeth are worn, I coordinate this procedure with additive dentistry - bonding or ceramic - to rebuild length and function.
When the jaw is the driver: orthognathic surgery
Significant vertical maxillary excess does not respond well to soft tissue tricks. If the midface is truly long and the gums dominate the smile despite good tooth proportions and a normal lip, a Le Fort I maxillary impaction remains the definitive correction. Orthognathic surgery shortens the upper jaw vertically and, when needed, advances or sets it back. The operation shifts the skeletal framework that all other tissues drape over.
I have seen life-changing results in the right cases, especially when combined with orthodontics that controls incisor inclination and bite depth. The trade-offs are major: a year or more of orthodontic planning, a hospital stay, weeks of healing, and real surgical risks. For patients with 6 to 10 millimeters of gingival display tied to skeletal excess, nothing else produces such balanced, stable outcomes. If the measured excess is mild, we often explore staged alternatives first.
Orthodontics as a quiet workhorse
Even without surgery, tooth position can nudge smile balance. Intruding maxillary incisors by 1 to 2 millimeters, leveling a deep curve of Spee, or controlling torque reduces gingival show in select cases. Orthodontic mini-implants give anchorage to move teeth without reciprocal side effects. The gains are modest, and they work best when combined with minor soft tissue procedures. Some cases of altered passive eruption also show orthodontic relapse; aligning teeth and correcting bite depth can set the stage for more predictable crown lengthening.
Orthodontics also adds risk when misapplied. Over-intruding incisors in a person with already short clinical crowns compounds the problem. The teeth look smaller, the smile flattens, and the gumline remains high. Precision in the treatment plan matters more than the appliance chosen.
Restorative strategies that respect biology
Teeth that are structurally short from wear bring a different challenge. Adding length with bonded composite or porcelain can shift the incisal edge down, increasing tooth display and decreasing perceived gumminess without cutting into bone or moving lips. In many adults, adding 1 to 2 millimeters to the incisal edge through additive dentistry brings the smile arc to life and rebalances gingival exposure.
Two cautions bear repeating. First, restorative material is not a substitute for healthy tooth proportion if significant gingiva covers enamel. Lengthening a tooth from the incisal edge alone can create an awkward, rectangular look if the gingival margin remains low. Second, occlusion must be stable. Increasing length without addressing a constricted envelope of function invites chipping, debonding, or jaw soreness. Wax-up try-ins, bite simulations, and night guards when indicated protect the investment.
Combining approaches for tailored outcomes
Real-world plans blend elements. A common sequence might be minimal crown lengthening to uncover 1 to 2 millimeters of enamel, orthodontic fine-tuning to level the bite, then two tiny aliquots of neuromodulator to relax a hyperactive lip. Another path combines lip repositioning with limited osseous recontouring where just two teeth show altered passive eruption. For a patient with vertical maxillary excess who declines surgery, a softer compromise, such as incisal edge lengthening, faint lip relaxation, and careful smile-line ceramic, can draw the eye to the teeth rather than the gums. The display may still measure on the gummy side, yet look balanced in everyday life.
The most satisfying outcomes rarely chase a number. They focus on harmony among lip position, tooth proportion, and facial features. A patient who plays a brass instrument or sings professionally might avoid lip repositioning that changes vestibular depth. Someone with periodontal vulnerability may not be a candidate for wide osseous recontouring. A patient with bruxism needs protective strategies if restorative length is added. Dentistry is full of these judgment calls.
Healing timelines and what to expect
People plan around weddings, graduations, and new jobs. Setting expectations prevents disappointment. Injectable relaxation settles within a week and lasts a few months. Lip repositioning needs a quiet two-week window, with most normal activity resuming within days, but with caution against wide yawns, spicy foods, and vigorous laughing while sutures sit. Gingivectomy sites look presentable in a week, though final margin position stabilizes over months. Osseous crown lengthening demands more patience. I schedule final aesthetic restorations at 12 weeks to 6 months depending on tissue type and the amount of bone work.
Orthognathic surgery requires the longest runway. Orthodontics before and after can run 12 to 24 months, with the operation in the middle. Swelling subsides enough for public life in a couple of weeks, yet full remodeling continues for months. Patients who embrace the process and visualize the endpoint do best.
Risks that deserve airtime
No procedure is risk-free, and most regrets I see stem from underestimating downsides. Excessive gum removal can expose roots, increase sensitivity, and unmask triangular black spaces between teeth. Over-relaxing the upper lip changes phonetics and makes smiling feel awkward. Lip repositioning can relapse or create tightness that some patients dislike. Orthognathic surgery entails nerve sensation changes, infection risk, and bite adjustments that require diligence.
There is also the risk of chasing perfection. If a patient brings a photo of a celebrity smile filtered and shot from a specific angle, we talk about face shape, philtrum length, and tooth-to-lip relationships that make that smile unique. The goal is a balanced grin that belongs to the patient’s face, not a template.
Cost, maintenance, and long-term thinking
Financial planning shapes decisions. Neuromodulators look affordable at first, but over three to five years the cumulative cost can exceed a one-time surgical option. Crown lengthening is a single purchase with occasional refinement. Orthognathic surgery is expensive and requires insurance navigation, though functional indications such as airway, chewing efficiency, or bite correction sometimes help coverage.
Maintenance matters. New tooth length needs night guards in bruxers. Enhanced hygiene prevents rebound of inflamed tissues. Orthodontic outcomes require retainers. Lip-based procedures may need touch-ups. I find that a six-month periodontal maintenance schedule after soft tissue work keeps results stable, and that photography at baseline, 6 weeks, and 6 months anchors both clinician and patient on the same page.
Case patterns from the chair
A 28-year-old graphic designer came in with short-looking front teeth and 4 to 5 millimeters of gum showing on a big smile. Radiographs revealed the bone crest sitting close to the enamel junction across the anterior sextant. We performed osseous crown lengthening from second premolar to second premolar with a digital guide, revealing roughly 1.5 millimeters of additional enamel. Twelve weeks later, we placed additive ceramic veneers that extended the incisal edges by another millimeter. The gingival show dropped to about 2 millimeters. She skipped injectables. The result looked natural, and maintenance has been uneventful at two-year follow-up.
A 34-year-old teacher with normal tooth proportions had a lip that vaulted dramatically on laughter, showing nearly 7 millimeters of gingiva. We trialed neuromodulator injections at low dose. Her smile softened to about 3 millimeters of display and looked relaxed. After four cycles, she opted for lip repositioning surgery for longevity. Three years out, she needs only occasional micro-doses before holidays with lots of photos.
A 21-year-old with a long midface and Class II skeletal pattern showed 8 to 9 millimeters of gingiva on full smile. After joint orthodontic and surgical consultations, he underwent Le Fort I impaction with mandibular advancement. The change altered not just his smile, but his facial balance and airway. Recovery took dedication. He still calls it the best decision he made in college.
Choosing the right path
A balanced grin is less about Farnham Dentistry Jacksonville banishing gums and more about restoring proportion. Start with clear photographs, accurate measurements, and a candid conversation about priorities. If the gums are the main culprit and the teeth are properly proportioned, think lip strategies. If the teeth are short, think crown lengthening and restorative harmony. If the jaw is too long, consider whether orthognathic surgery fits your goals and timeline. Try reversible steps when uncertainty exists.
The best dentistry respects biology. It preserves structure whenever possible and adds or removes tissue only to the degree required. It integrates periodontics, orthodontics, restorative care, and sometimes oral and maxillofacial surgery into a coherent sequence. It listens to the patient who just wants to stop feeling self-conscious in photos, and it meets that goal with the least intervention that will hold.
A simple decision framework
- Identify the dominant cause: lip, tooth, bone, or a mix. Photograph at rest, natural smile, full smile, and measure. Consider a reversible trial if the lip is involved: low-dose neuromodulator for 2 to 3 cycles to gauge satisfaction. Address tooth proportion if needed: crown lengthening when biologically indicated, then additive dentistry once tissues stabilize. Use orthodontics to fine-tune incisor position and bite depth when it supports the primary plan. Reserve orthognathic surgery for marked vertical maxillary excess or when combined functional goals make it prudent.
The most rewarding moment in gummy smile correction is not the spec sheet of millimeters, it is when the patient forgets the conversation about gums entirely because the smile finally fits the face. In dentistry, that is balance, which is what we are after.