Gummy Smile, Gingival Smile, Extraction, Protrusive Mouth, Deep Bite Orthodontic Review

Hello.

Today, let’s talk about orthodontic treatment for a gummy smile.

If the cause of the gummy smile is that the teeth have come down along with the gums, then orthodontic treatment can be used to move the teeth and gums upward.

If the cause is that the gums are covering the teeth excessively, then gingivoplasty can be performed to remove the excessive gum tissue.

Today’s case is about when both causes are present.

23.07

This is a foreign patient who came to continue orthodontic treatment that had started two years earlier.

While undergoing extraction-based orthodontic treatment overseas, the patient came midway with the brackets still attached, and since they were staying in Korea, they came to finish treatment here.

The photo is after the brackets were removed, and a deep bite is visible, with the upper front teeth covering the lower front teeth significantly.

It is a severe deep bite to the point that the lower teeth are not visible.

More than half of the extraction spaces in the upper and lower arches are still remaining.

Rather than focusing only on closing the extraction spaces, we decided to move the front teeth upward to also address the gummy smile.

The Clippy-C brackets were attached and treatment began.

23.11

This is four months after the start of treatment.

When the front teeth are moved upward and intrusion, which is movement in the direction of the bone, is induced, the gums also move upward with the teeth, reducing the amount of gum shown when smiling.

For this, orthodontic mini-screws are needed.

24.06

One year after treatment began, the deep bite had been corrected.

And in May 2025, treatment was completed 1 year and 10 months after continuing orthodontic treatment at our clinic.

25.05

This is a photo immediately after gingivoplasty, after removing the Clippy-C brackets.

25.05

The angle of the front teeth and the molar occlusion are good, showing a Class I occlusal relationship.

25.05

One week after gingivoplasty, the gums had healed well.

Left - before treatment / Right - after treatment

23.07~25.05

23.07~25.05

Now, let’s look at the before-and-after comparison.

23.07~25.05

The midline is well aligned, and the deep bite has improved.

23.07~25.05

In the facial view, the improvement in the gummy smile is clearly noticeable.

23.07~25.05

Even though the front teeth were moved back quite a bit, the change in lip appearance before and after treatment is not very large.

Only a reduction in fullness around the philtrum area and a slight retraction of the lower lip are noticeable.

Based on the upper front teeth, they were moved back by 4–5 mm and intruded upward by 2–3 mm.

In cases like this, when the lips and philtrum area are thick, there are times when even a substantial amount of backward movement of the front teeth does not lead to a major change in lip appearance.

Conversely, when the lips and philtrum area are thin, the change in lip appearance can be large even if the front teeth are not moved back very much.

It varies from person to person, and there are differences depending on soft tissue thickness, elasticity, and even gender.

For how lip appearance changes in protrusive mouth correction depending on gender, please refer to the paper by Dr. Baek Euisun, director of Apgujeong Yonsei Baro Dental Clinic.

23.07~25.05

Compared with the initial examination, there was no root resorption, and root parallelism was good.

I hope this is helpful for those preparing for orthodontic treatment and worrying about a gummy smile.