When someone smiles and then shows more gums than teeth, we essentially refer to this as a gummy smile. Although it could be aesthetically pleasing to show a little bit of gums, the ideal would be to reveal no more than 1mm of your pinks when you smile.
Since the inception of aesthetic dentistry we now have different options on how to treat the gummy smile. Before we make a diagnosis, we would first have to establish whether it is a gummy smile that originates from skeletal reasons (the upper jaw being too forward or the lip being too short); whether it is a hyperactive muscle that pulls the lip upwards when you smile or whether the gums are hyperplastic (abnormal overgrowth of the gums)
The muscle responsible for this action of lifting the lip upwards is called the levator labii superioris alaeque nasi (I know, a mouth full right) Translated from Latin, the “lifter of both the upper lip and of the wing of the nose”. It has the longest name of any muscle in an animal. The muscle is attached to the upper frontal process of the maxilla and inserts into the skin of the lateral part of the nostril and upper lip… If you add pressure on to this muscle by putting your fingers on it, it should inhibit the gummy smile when you try and smile again. This would mean that your gummy smile may be as a result of this muscle working harder than it should. In modern times we use a very simple procedure where we would inject neuromodulators (botulinum toxin) into the muscle to help it to relax.
The Diamineer Procedure
The procedure would need to be repeated almost every 3 months and the procedure itself is relatively painless. The general cost involved is R900 – R1500 per session. It is non-invasive and safe, as long as the patient adheres to the post-operative instructions, to not exercise for a day and also not to cause any form of pressure onto the injected site. By adding pressure after injections, this may force the neuromodulators to different muscles which may inhibit facial expression or smiling for the next 3 months. This and other side-effects are really not common.
Say the muscle is not the culprit and the reason is related to the hard tissue, we as dental professionals will be able to guide you as to which options would be best for you as a patient. One of them includes manipulating the positioning of the maxilla and bringing it backwards. This, in essence, may be hampering the profile of your face and it can also decrease the bony support which we need to age gracefully. It might be suggested (but only confirmed after proper diagnosing) that the gums can be contoured using a laser to lengthen the teeth. With the laser we can now successfully do a crown-lengthening procedure where we either remove only soft tissue, but in more severe cases bone will also need to be removed. The amazing thing about the era that we live in is that the down-time is reduced to a minimal – which means that we do not have to wait 6 weeks like before in order to perform a smile makeover.
If a patient wants the smile to be veneered this procedure can literally be performed on the same day of the gum contouring appointment. The cost of laser treatment will depend on the severity and bony involvement. Anything from R5000 to R18 000 is generally the going rate.
In facial aesthetics, we as aesthetic practitioners always try to adhere to the golden ratio of facial aesthetics. This means in the mouth that the first upper incisor would be more or less on the same gum height than the canine, with the second incisor slightly lower, but symmetrical to both sides of the mouth. Ideally, the midline will run through the two front teeth which will then intercept the frenum, filtrum and dividing the cupid’s bow into symmetrical halves. Add the correct lip volume and upper and lower lip ratio and profile to the equation and we end up with the most beautiful people of the world. The advantage of the laser is that we can utilise it in the treatment of these asymmetries and eventually patient satisfaction is much higher. The industry has become more interested in optimal results from both patient and aesthetic dentists.
Now, say the gums are hyperplastic (overgrown), it should first be investigated whether the condition is genetic or whether it may be as a result of having underlying gingivitis or periodontitis. These infections can cause the gums to be swollen due to the inflammatory response. This could be treated by visiting the oral hygienist to remove calculus and with a proper oral hygiene programme. It is advisable to have your teeth cleaned at least every 6 months as part of an investment in a healthier you. Should the gums be overgrown by hereditary reasons, if you suffer from gum hyperpigmentation, or should you have an overactive frenum, this could all easily and effectively be treater by laser. The advantages of the laser is numerous and the procedure is absolutely pain-free. Patients also should have no fear as no scalpel will be involved.
Should the lip be too short, the easiest way of treatment would be to use Hyaluronic acid fillers which will add volume to the lip and this should add to a more pleasant smile. The cost for this procedure is between R3 500 and R6 000 depending on the filler and amount that is used and can last anything from 8 to 18 months. Patients should be fair to society and not go overboard with the amount of filler that gets injected. Results should be natural and soft. Few things are as scary as some “creatures” with the most over-volumized results. Not only are you the only person that thinks you look pretty… you are also upsetting the general public and you are giving the whole industry a bad reputation.
Veneer Technology in South Africa
Now, probably the best news of this article… The latest in Veneer technology has just been launched in South Africa with the latest new Diamineers. These veneers are so highly aesthetic that even I am getting mine done as a Christmas gift to myself. They come in three shades and due to their exceptional thin 0.2mm thickness, they are highly translucent, opalescent and natural. The preparation for them is also minimally invasive because of their tensile strength which means less of your natural tooth structure needs to be removed in order for the veneers to be placed over your natural teeth.
The 3 shades are Pearly Sands, which is the most natural… Then there is Champagne White (my favourite colour) which is the second whitest colour. And then for the very daring patients out there, there is the UltraluX Opalescence. Although this is the whitest shade, it still resembles a very natural look and feel. The nice thing about these Veneers is that the Diamineer Lab guarantees them
For 5 years. This shows a lot of confidence in their product. The other benefit is that the lab also advises us as aesthetic dentists on which cement to use. Patients receive a letter of authenticity from the lab, which means that you would be able to rest assured that you are indeed receiving the real McCoy.
Diamineers, luxury handcrafted veneers, have a 520MPa tensile strength on a mere 0.2mm thickness, which is wonderful news to people thank believe in minimal invasive dentistry. Diamineers, because they are so thin, would not work well on dark or discoloured teeth, due to the extreme translucency. Teeth whitening is advised before treating these cases. The more colour particles used in lithium disilicate (the material that the veneers are made of) the weaker the material. For this reason, and the addition of more opalescence to the formula, the teeth under a diamineer would need to be of a whiter shade already. The flexibility of the Diamineers is astonishing.
They look very natural, and in my opinion a huge breakthrough in the world of dental aesthetics. I was honoured to perform the first Diamineer Smile Makeover in Africa. Now, many aesthetic dentists are offering this service. To locate a provider visit www.diamineers.com and the lab will appoint a suitable aesthetic practitioner in your area or hopefully close by. Diamineers typically retail for R9500 – R25 000 per tooth…