The Art and Science of Gummy Smile Correction With Dr. Daniel Berant, DMD

By Genni Burkhart, Incisor Editor

A gummy smile, or excessive gingival display, refers to the exposure of more than 3 mm of gum tissue during a full smile. Research shows that nearly 29 percent of women and 10 percent of men experience this condition, which is a common concern among patients seeking aesthetic dental treatment (Chicherin et al., Journal of Clinical Aesthetic Dermatology, 2019).

Gummy smiles aren't merely cosmetic. They can impact confidence, communication, and social behavior. For dentists, knowing how to evaluate and treat a gummy smile can dramatically elevate patient satisfaction and expand the scope of services offered.

Continuing Education

In the DOCS Education Home Study course The Art and Science of Gummy Smile Correction, Dr. Daniel Berant, DMD,  Certified Specialist in Periodontics and Implant Surgery, presents an evidence-based, interdisciplinary approach to evaluating and treating patients with excessive gingival display. A diplomate of the American Board of Orthodontists and certified in periodontics and implant surgery, Dr. Berant brings a rare dual-specialist perspective to the subject. He completed his dental training with honors at the University of British Columbia and pursued advanced clinical training at the University of Pennsylvania.

This course, available for CE credit through DOCS Education, delivers a detailed framework that practitioners can apply in general and specialty practice.

What Causes a Gummy Smile?

Effective treatment of a gummy smile begins with a full-spectrum analysis of the patient’s smile. It's not just about how much gum shows but how the various facial and oral structures relate to one another. In the course, Dr. Berant walks through what he calls the essential "interfaces" that define a well-balanced smile. These include:

• Tooth position and proportion in relation to the lips.
• The way gingival contours frame and support the teeth.
• The anatomical connection between the cementoenamel junction (CEJ) and the underlying bone.
• The influence of age, gender, and ethnicity on esthetic norms.

Rather than chasing perfect numbers, clinicians are encouraged to focus on proportional harmony. A smile that appears natural, symmetrical, and balanced within the patient’s facial features is often far more impactful than one based purely on textbook ideals.

Understanding Esthetic Exposure

A key element in gummy smile diagnosis involves assessing the patient’s smile line. Tjan and Miller provide a classification system to help clinicians identify low, average, or high smile lines. A high smile line, in particular, reveals full anterior tooth exposure along with visible gingiva, indicating a true gummy smile. This classification guides treatment strategy and helps communicate esthetic expectations with the patient.

Listening to What Patients Actually Want

Instead of presenting with clinical terminology, patients often describe their concerns in relatable ways. Phrases like “My teeth look small” or “I show too much gum when I smile” are common. These remarks reflect more than surface-level dissatisfaction; they signal more profound psychosocial impacts and a desire for change.

The course emphasizes the importance of aligning diagnostic insights with patient expectations. Treatment planning is most effective when clinicians combine technical accuracy with empathetic, clear communication.

Three Treatment Options, One Unified Goal

Treatment plans must be tailored to the specific etiology of the excessive gingival display. The course covers three main treatment modalities:

• Botox Therapy: Botox targets hyperactive elevator muscles like the levator labii superioris. It reduces upper lip elevation, decreasing gingival display. Proper evaluation of smile dynamics is essential, and clinicians must work within their legal scope of practice.
• Lip Repositioning Surgery: Presented through a case study by Dr. Thomas Yoon, this approach involves repositioning the upper lip to limit upward movement. Often performed in-office, the recovery is minimal and results are immediately noticeable.
• Crown Lengthening for Altered Passive Eruption: This advanced protocol involves assessing the position of the CEJ relative to the alveolar bone using CBCT imaging. Depending on the diagnosis, treatment may include laser gingivectomy, apically positioned flaps, or full osseous recontouring. The treatment also consists of a four-type classification system to guide surgical decision-making.

Technology Improves Outcomes

Digital imaging and planning have become indispensable in gummy smile correction. Instead of relying on bone sounding alone, clinicians now use CBCT scans, intraoral scans, and digital wax-ups to plan precise surgical corrections.

This digital integration supports stronger collaboration between surgical and restorative teams. It allows for accurate planning of incisal edge positioning, protection of biologic width, and minimal preparation for final restorations. These tools enhance outcomes by streamlining the diagnostic and treatment process, making smile design more predictable and less invasive.

Long-Term Considerations for Gummy Smile Treatment

Maintaining the results of gummy smile correction depends on starting with careful planning and patient education. For example, lip repositioning can produce excellent aesthetic improvements, but minor relapses may occur within six months. Setting clear expectations and staying in close contact with the patient throughout healing makes a significant difference in satisfaction.

Furthermore, surgical tools and techniques should be matched to the clinical situation. Piezoelectric instruments and hard tissue lasers can be useful in certain cases but may not be efficient for larger procedures. For gingivectomy, preserving biologic width is essential. This step requires an accurate assessment of gingival thickness, keratinized tissue, and the CEJ-to-bone crest distance.

Visual diagnostics like CBCT, intraoral scans, and high-quality photography support precise planning and help communicate with the patient and the broader treatment team. These tools improve alignment between periodontal, orthodontic, and restorative goals and improve long-term outcomes.

Key points include:

• Discussing the potential for soft tissue rebound early on, especially in lip repositioning.
• Choosing the right instruments for each case balances efficiency and precision.
• Using digital imaging to support diagnosis, execution, and inter-specialty collaboration.

By combining detailed diagnostics with clear communication, clinicians can improve surgical predictability and patient satisfaction.

In Conclusion

Effective gummy smile correction requires a thorough understanding of the anatomical, periodontal, and orthodontic factors that influence excessive gingival display. From accurately classifying smile lines to identifying etiologies such as vertical maxillary excess, short clinical crowns, or hyperactive lip musculature, the treatment must be tailored to the patient's unique diagnosis.

The Art and Science of Gummy Smile Correction, presented by Dr. Daniel Berant, DMD, is available for CE credit through the DOCS Education membership dashboard under "Member Only Courses." This Home Study course equips dental professionals with clear diagnostic criteria, practical treatment solutions, and strategies that support long-term esthetic and functional outcomes.

Author: With over 15 years as an award-winning journalist, editor, and writer, Genni Burkhart has covered everything from politics and healthcare to finance and technology. Editor-in-chief of The Incisor newsletter and blog and features writer at DOCS Education, she brings a refreshing insight and a passion for storytelling to the world of sedation dentistry.