Abstract
Background
Excessive gingival display is an aesthetic concern for patients and a challenge for clinicians. An accurate diagnosis is essential in order to provide effective treatment.
Aim
The aim of the present article is to fill a gap in the current literature by providing clinicians with an overview and a stepwise approach to assessing gingival excess, as well as reviewing possible treatment.
Method
Published articles related to smile aesthetics and excessive gingival display over the last 40 years were identified and analysed through an electronic search.
Results
An examination should be initiated extra-orally to distinguish contributing skeletal factors. The relationships of four aesthetic parameters (LIPG): lip length (L), incisal lines (I), tooth proportions (P), and gingival lines (G), should be examined individually to determine other possible causes of gingival excess. Contributing factors may include a short or hypermobile upper lip, dentoalveolar extrusion, or altered passive eruption. Further investigation to identify patients who might benefit from orthognathic surgery, orthodontic treatment alone, lip repositioning or botulinum injection, or aesthetic crown lengthening procedures, should be conducted to reconfirm a diagnosis and provide the optimal treatment.
Conclusion
Clinicians can have a dental blueprint for anterior tooth reconstruction and are able to provide comprehensive treatment in co-operation with other disciplines. By understanding the principles of an aesthetic smile line, the aetiology of an excessive gingival display and treatment concepts, clinicians may provide alternative treatments to avoid extensive surgical procedures while achieving acceptable outcomes.