Gummy Smile Treatment UK

What is a gummy smile?

A gummy smile is defined clinically as excessive gingival display — more than 3 to 4 mm of gum tissue visible above the upper front teeth when a patient smiles fully. While the exact threshold considered aesthetically acceptable varies between individuals and cultures, most clinicians use 3 mm as the clinical boundary, with displays of 4 mm or more considered a cosmetic or clinical concern. It is important to understand that a gummy smile is a description of an aesthetic finding, not a single diagnosis. The same appearance can be produced by four fundamentally different anatomical causes, and treating the wrong cause produces either no improvement or can make the situation worse.

Causes: why diagnosis matters

There are four principal causes of excessive gingival display, and they can occur in isolation or in combination. Vertical maxillary excess is a skeletal cause — the upper jaw (maxilla) has grown too far downwards relative to the rest of the face, dropping the teeth and gums lower than normal. This gives the face a longer lower third and frequently causes an anterior open bite or a long face appearance. This is the most severe cause and in adults who have finished growing, orthodontic treatment alone cannot fully correct it. Altered passive eruption is a dental and periodontal cause — the teeth have erupted normally but the gum margin has not receded to the correct level, leaving the teeth looking short and covered with excess gum. The teeth may be entirely normal in length; they are simply obscured by gum tissue. This is one of the most common causes and is highly amenable to treatment. Short upper lip means the lip does not adequately cover the gum margin at rest or on smiling. The teeth and jaw position may be entirely normal. This is a soft tissue cause. Lip hypermobility — excessive elevation of the upper lip on smiling due to overactive lip elevator muscles — exposes normal amounts of gum tissue but does so more dramatically than usual during animation. Diagnosis involves clinical examination, cephalometric radiographic analysis to assess jaw relationships, and often input from a multidisciplinary team including an orthodontist and periodontist.

Orthodontic treatment: maxillary incisor intrusion

For patients whose gummy smile is primarily dental in origin — where the upper front teeth have over-erupted or erupted too far downwards — orthodontic intrusion of the upper incisors can reduce gingival display. Intrusion means applying forces that push the teeth upward into the bone, reducing how far they descend below the gum margin. This is technically challenging with conventional fixed braces because intrusive forces can inadvertently cause the roots to tip. The most effective orthodontic intrusion of multiple upper incisors is achieved using temporary anchorage devices (TADs) — miniscrews placed in the bone between the roots that provide a stable anchor point for intrusive mechanics. TAD-assisted intrusion can reduce gingival display by 2 to 4 mm in appropriate cases. This approach is suitable for a dental gummy smile (over-erupted teeth, normal jaw position) and is not appropriate for a skeletal cause. Clear aligners can produce modest incisor intrusion in select cases, but for significant intrusion requirements, fixed appliances with TAD anchorage are more reliable.

Crown lengthening by a periodontist

For altered passive eruption — where the gum sits too low on the teeth and makes them appear short and gummy — the treatment of choice is surgical crown lengthening. This is performed by a periodontist (a gum specialist) and involves a minor surgical procedure under local anaesthetic to reposition the gum margin upward and reshape the underlying bone to the correct level. The procedure typically takes 45 to 90 minutes and results in teeth that appear longer and normal in proportion. Recovery takes two to four weeks for the gums to settle; final aesthetic assessment is made at six months when healing is complete. Crown lengthening for altered passive eruption is one of the most predictable and effective treatments available for a gummy smile of this cause. It does not move any teeth and is therefore a standalone procedure — orthodontic treatment is not required unless there is also a bite problem. Results are permanent and do not relapse.

Botox (botulinum toxin) for lip hypermobility

For a gummy smile caused by hypermobile lip elevator muscles — where the lip rises excessively on smiling — botulinum toxin (commonly known as botox) injected into the levator labii superioris or levator labii superioris alaeque nasi muscles can reduce the height the lip achieves on smiling, reducing gingival display. This is a temporary treatment — effects last three to six months before the injections need to be repeated. It does not address any underlying skeletal or dental cause. Botox for gummy smile must be administered by a licensed medical professional or GDC-registered dentist with appropriate training. From 2022, UK regulations require a prescription from a prescribing clinician for botulinum toxin treatments. Results, while temporary, can be very satisfying for correctly selected patients and allow patients to trial the result before committing to surgical options. Cost per treatment session in the UK is typically £150 to £300.

Orthognathic surgery for skeletal gummy smile

When a gummy smile is caused by vertical maxillary excess — the upper jaw being positioned too far downward — the definitive treatment is Le Fort I osteotomy with maxillary impaction, a form of orthognathic (jaw) surgery. The operation involves a cut across the upper jaw just above the tooth roots (the Le Fort I level), allowing the maxilla to be repositioned upward — impacted — by the required amount to reduce gingival display. Impaction of just 4 mm can produce a dramatic change in facial appearance and gingival display. This surgery is performed under general anaesthetic, usually with an in-patient stay of one to two nights, and is carried out by an oral and maxillofacial surgeon. It is almost always combined with fixed orthodontic treatment before surgery to decompensate the teeth (remove the natural tooth adaptations that have occurred in response to the jaw discrepancy) and after surgery to fine-tune the bite. Total treatment time including orthodontics and surgery is typically 18 to 36 months. For NHS eligibility, a severe skeletal gummy smile causing functional problems may qualify for NHS orthognathic surgery under specific commissioning criteria, but purely cosmetic cases are not funded. Private orthognathic surgery in the UK costs £15,000 to £30,000 or more depending on complexity.

Finding the right specialist and realistic expectations

Because a gummy smile can have multiple causes — and sometimes a combination — it is essential to be assessed by an orthodontist with experience in multidisciplinary cases. A specialist orthodontist will take a comprehensive history, clinical photographs, and radiographs, and will identify the primary cause before recommending treatment. For complex cases, referral to a periodontist (for altered passive eruption or crown lengthening), a maxillofacial surgeon (for orthognathic cases), or a specialist restorative dentist (for combined smile design) may be appropriate. Patients should be cautious of practices offering a single treatment solution — such as veneers or botox — without a diagnostic work-up, as misidentified causes produce poor outcomes. Realistic expectations are important: orthodontic intrusion typically reduces gingival display by 2 to 4 mm; crown lengthening can produce a near-complete resolution of altered passive eruption cases; jaw surgery produces the most significant change but carries the longest treatment duration, highest cost, and most significant surgical risks.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.