A gummy smile, or excessive gingival display, is a common cosmetic concern where a disproportionate amount of gum tissue shows above the upper teeth while smiling. Whether braces alone can fix this issue depends entirely on the underlying biological cause. Determining the specific origin of the excessive gum tissue is the first step in deciding the most effective treatment path.
What Defines a Gummy Smile?
A smile is classified as “gummy” when approximately two millimeters or more of gum tissue is exposed above the upper teeth during a full, natural smile. This excessive display is a symptom stemming from one or a combination of three primary categories of anatomical issues.
The first category is dental, including over-erupted teeth or altered passive eruption, where gums cover too much of the tooth crown, making teeth appear short. The second cause is skeletal, most commonly Vertical Maxillary Excess (VME), an overgrowth of the upper jawbone (maxilla) that pushes the gum line downward. The final category involves the soft tissue, specifically a short upper lip or a hyperactive lip muscle that pulls the lip too high when smiling. Accurately diagnosing which factor is at play is the basis for any successful treatment plan.
The Impact of Traditional Braces
Traditional metal braces and clear aligners are highly effective at correcting malocclusions by moving teeth horizontally to align the dental arches. When a gummy smile is caused by mild dentoalveolar issues, such as slightly over-erupted teeth or misalignment, traditional braces can provide significant improvement. Adjusting the bite and positioning the teeth into ideal alignment often naturally reduces the appearance of the gum line.
However, standard wire-and-bracket systems have limitations regarding significant vertical movement. To effectively treat a gummy smile caused by substantial dental extrusion, the teeth must be “intruded,” or pushed upwards into the bone. Traditional braces rely on adjacent teeth for anchorage; attempting to intrude one group often results in the unintended extrusion of the anchor teeth, making the overall intrusion unreliable. Therefore, braces alone are often insufficient for cases involving significant vertical discrepancy or problems arising from the jawbone or soft tissues.
Specialized Non-Surgical Orthodontic Techniques
For cases where the problem is primarily dental but requires more powerful intrusion than standard braces, orthodontists use specialized techniques. Temporary Anchorage Devices (TADs) have revolutionized the non-surgical correction of moderate to severe dental-based gummy smiles. These devices are tiny, biocompatible titanium mini-screws strategically placed into the jawbone, usually between the tooth roots or in the palate.
TADs act as stable, fixed anchor points that do not move, unlike natural teeth used for traditional anchorage. This stable anchorage allows the orthodontist to apply direct, controlled vertical force, pushing the entire upper dental arch upwards with exceptional precision. This controlled intrusion effectively reduces the amount of gum visible when smiling, often resolving the issue without the need for jaw surgery. The TADs are minimally invasive and are removed painlessly once the desired tooth movement is complete.
When Soft Tissue or Jaw Surgery is Required
When excessive gingival display is not primarily due to tooth position, non-orthodontic interventions are required, sometimes in conjunction with braces. If the problem is confined to the soft tissues, such as when gums have failed to recede properly after tooth eruption (altered passive eruption), a procedure called gingivectomy or crown lengthening is performed. This minor surgical procedure reshapes the gum line and sometimes the underlying bone to expose the full length of the tooth crowns, creating a more balanced appearance.
For cases where the upper lip is the source of the problem—either being too short or hyperactive—lip repositioning surgery may be recommended. This procedure involves removing a band of tissue from the underside of the upper lip and suturing it in a new, lower position, limiting its upward movement when smiling. In the most severe cases of Vertical Maxillary Excess (VME), where the upper jawbone is too long, the only definitive solution is orthognathic surgery. This major surgery involves surgically repositioning the maxilla upward to reduce the vertical height of the mid-face. This procedure is typically performed after a preparatory phase of orthodontic treatment.