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Pocketmags Digital Magazines
Pocketmags Digital Magazines

The gummy smile dilemma

Dr Stuart Frost illustrates an innovative treatment for an often-untreated condition

Gummy smile patients have always presented orthodontists with a huge dilemma. For many years, I would feel that churn in my stomach when a gummy patient would show up to my practice for a consultation because the only clear path to truly correct the gumminess was braces and surgery. My choices were to mention it to the patient or choose to just ignore the gumminess and present a treatment plan that just lines the teeth up.

The majority of gummy smile patients that came for consultations didn’t really list their gummy smile as a chief complaint because most didn’t know there was something that could be done about it. Until the last decade, correction of the gummy smile has been under-researched and lacking in innovation.

Often these patients are treated by lining up the teeth and creating a beautiful straight smile, leaving the gumminess and feeling happy when the patient really smiles and shows an acre of gums. Just a few millimetres of gum-show can distract even the most beautifully treated orthodontic case. Herein lies the dilemma; treat it or ignore it!

For orthodontists, do we offer an invasive treatment plan because we know how it can positively affect the patient’s life but run the risk of them declining treatment? Or do we settle with routine care, doing the best we can without addressing the elephant in the room?

These cases have always been extremely difficult to treat, and even when we attempt to treat them, the path of treatment can seem unclear on how to achieve a desirable finish without compromising the smile for less gum-show. Historically, the only effective option for correcting gummy smile cases has been jaw surgery, specifically taking a wedge out of the maxilla in order to impact via LeFort surgery, thus eliminating excess gum-show. When most patients are presented with this type of treatment plan, most decline after hearing the word ‘surgery’. This may be due to high risks associated with surgical intervention, high cost, or a combination of these objectives. So, from the patients’ standpoint, correcting their gummy smiles feels hopeless. An alternative method of treatment should be considered to obtain impaction and correct the gummy smile with less cost, less risk and stunning results.

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Sept / Oct Orthodontic Practice 2019