The first step in treating a gummy smile is to find out why too much gum shows. If the upper front teeth and the bone carrying them have come down further than normal, orthodontic treatment can reduce the gum display by moving these teeth upward into the bone (intrusion). However, not every gummy smile is caused by the position of the teeth. The gum may be covering too much of the tooth, the upper lip may rise too much when smiling, or the upper jaw may have grown too much vertically. These causes occur alone or together, and each requires a different treatment. For a general definition of a gummy smile and its causes, see our article what is a gummy smile; this page focuses on choosing the treatment.
How is the cause of a gummy smile identified?
In a broad smile, it is natural for up to a few millimeters of gum to show above the upper front teeth. If noticeably more than this shows and it bothers the person, an assessment is done. The examination looks at:
- How much of the upper front teeth shows with the lips at rest: If the teeth show a lot with the lips closed, the teeth or the jaw may have come down too far.
- The length and proportions of the tooth crowns: If the teeth look short and square, the gum has probably remained too far over the tooth (the gum not receding in its normal course).
- The length and movement of the upper lip: A lip that is short or rises too much when smiling exposes the gum even when the teeth are in a normal position.
- The bite: In a deep bite, the upper front teeth have often come down too far, and this accompanies a gummy smile.
- The vertical proportions of the face: If the lower third of the face is noticeably long and gum shows excessively along all the upper teeth, a vertical excess of the upper jaw may be the cause.
In this assessment, the position of the gum relative to the bone is measured with smile photographs, a lateral X-ray and, if needed, gum probing. For gum-related causes, the opinion of a periodontist (gum specialist) is also sought.
How does orthodontics reduce a gummy smile?
Orthodontics plays a role when the problem comes from the vertical position of the teeth. The aim here is to move the upper front teeth slightly up into the bone and thereby reduce the amount of gum visible when smiling. As the tooth is intruded, the gum moves up with it.
Mini-screw-assisted intrusion
Intrusion is one of the hardest movements to control in orthodontics, because the force applied to the tooth being intruded tends to affect the neighboring teeth in the opposite direction. For this reason, support is often taken from small titanium mini-screws placed between the tooth roots in the upper jaw. Mini-screws are placed in a few minutes under local anesthesia, removed when treatment ends and can be used together with fixed braces or clear aligners. In mild to moderate cases where the back teeth have also come down too far and the face is long vertically, lifting the entire upper dental arch with mini-screws placed in the back region can provide an improvement as an alternative to surgery; however, the effect of this approach is limited and it is not suitable for every patient.
Is treatment with clear aligners possible?
If the gummy smile is accompanied by a deep bite and the problem mainly comes from the front teeth having come down too far, intrusion of the front teeth can be planned with the Invisalign system in suitable cases. In aligner treatment, the movement is seen in advance in ClinCheck; mini-screw support is added when needed. If a large amount of intrusion is needed, fixed braces may be more predictable. How this movement is done with aligners is explained on our clear aligners for deep bite page; for the fixed braces option, see our braces treatment page.
Which treatments other than orthodontics may be needed?
If the cause is not the position of the teeth, or if several causes are present together, other treatments come into play:
- Gum contouring and crown lengthening: If the gum covers too much of the tooth, it is surgically reshaped; if necessary, the underlying bone is also adjusted. This procedure is performed by a periodontist.
- For lip-related causes: Botulinum toxin injections to relax the muscles that lift the upper lip when smiling have a temporary effect and need to be repeated every few months. For general information on this, see our article botulinum toxin in dentistry. Surgical procedures that change the position of the lip are also among the options.
- Orthognathic surgery: If the vertical excess of the upper jaw is pronounced, the lasting solution is jaw surgery in which the upper jaw is moved up, combined with orthodontics.
How is the order of treatments planned?
If several causes are present together, the order of treatments affects the result. The general approach is as follows:
- Diagnosis and joint planning: The orthodontist, together with a periodontist and jaw surgeon when needed, sets out the causes.
- Orthodontic phase: The teeth and bite are corrected first, because intruding the teeth also changes the gum level.
- Gum adjustment: After orthodontics is completed, any remaining irregularities in the gum line are reshaped.
- Final esthetic touches: If needed, procedures related to tooth shape or color are done last.
If gum contouring is done before orthodontics, the gum line may change again as the teeth move later, and the procedure may need to be repeated. That is why the order is discussed from the start.
Which option suits whom?
- Those with a deep bite and upper front teeth that have come down too far: Orthodontic intrusion, often with mini-screw support.
- People whose teeth look short and whose gums cover too much of the teeth: Gum contouring or crown lengthening.
- Those whose teeth and gums are normal but whose lip rises too much when smiling: Lip-related treatments; in these people orthodontics alone will not give the expected result.
- Those with a vertically long face and gum showing prominently across the whole smile: Mini-screw-assisted full-arch intrusion in mild to moderate cases; orthodontics and jaw surgery in pronounced cases.
When is a gummy smile treated in children and teenagers?
In children and early adolescence, a gummy smile may be partly temporary. The gum over newly erupted permanent teeth recedes over time and the upper lip lengthens with growth; for this reason, excess gum display seen at these ages may decrease on its own over the years. Gum surgery is generally not done at this stage. However, if there is an accompanying deep bite, protruding upper teeth or a vertical growth problem, an orthodontic assessment is done; treatments that guide growth offer more options in this age group.
What happens during the treatment process?
- Records: Smiling and resting photographs, an intraoral digital scan and X-rays are taken. These records are used for comparison throughout treatment.
- Mini-screw placement: If needed, it is done under local anesthesia; there may be mild tenderness for the first few days. The area around the screws should be kept clean with a toothbrush and mouthwash.
- Check-ups: Usually every 4–8 weeks with fixed braces and every 6–10 weeks with aligner treatment. Intrusion progresses slowly; the change usually becomes visible in photographs over a period of months.
- Evaluation: At the end of the orthodontic phase, the gum line is reassessed and a decision is made on whether any additional procedure is needed.
Is the result permanent?
Intruded teeth may tend to come down somewhat over time. That is why retainer use and regular check-ups at the end of treatment are important; in patients treated together with a deep bite, maintaining the bite also helps maintain the gum display. The effect of temporary methods such as botulinum toxin decreases over time. For retainer use, see our retainer after treatment page, and for other types of treatment, our orthodontic treatments page.