Efficiency of Gummy Smile Correction Using the Myotomy of the Elevator of the
Upper Lip Muscle
Luis H. Ishida, MD; Luiz C. Ishida, MD; Jorge Ishida, MD; Julio Grynglas, MD;
Nivaldo Alonso, MD; Marcus C. Ferreira, MD
Introduction: The purpose of this study is to test the efficiency of a technique
for treatment of the gummy smile. The procedure involves the myotomy of the
elevator of the upper lip muscle and soft tissue remodeling.
Method: Ten female patients with excessive gingival exposure were operated.
They were filmed performing their fullest smile using a high definition digital video
camera before and 6 months after the surgery. Images of the maximum gingival
exposures were measured and analyzed using the ImageJ® software (1).
Technique: Two 5mm incisions are made at the inner lateral aspect of the
nostrils, and one in the columella. Using a periosteum elevator, the gingival mucosa is
freed from the maxilla. Skin and subcutaneous tissue were blunted dissected from the
underlying musculature of the upper lip. A frenuloplasty is performed to lengthen the
upper lip. Both elevator of the upper lip muscles are dissected and divided.
Results: There was a reduction of the gingival exposure with an esthetic
improvement of the smile in all patients (figure 1). The mean gingival exposure before
the surgery was 5.16 ±1.67 mm, and six months after the surgery, 1.89±1.74cm (figure
2). There was a reduction of 3.27± 1.25 mm (p<0.001), ranging from 1.59 to 4.83 mm.
Discussion: The myotomies results in a similar effect caused by the Botulinum
toxin type A injection described to treat this kind of alteration (2). Subperiostal
dissection lowers the superior gingival sulcus and the frenuloplasty lengthen the upper
lip, helping to cover the exposed gum.
Treatment of excessive gingival display usually involves large procedures like Le
Fort impaction or gingivectomies. Often, the alteration is milder and does not justify
such procedures. The authors propose an alternative technique to significan