How Do You Fix Gummy Smile With Braces? Intrusion Explained
Gummy smile can be fixed in a variety of ways, and one of them includes braces. With all the information out there, it’s easy to get confused. Dentists will claim to fix your gummy smile with gum surgery, veneers, botox, or all of the above. So where do braces come in?
When gummy smile has a skeletal cause (vertical maxillary excess) or is caused by overerupted front teeth, braces are the best way to correct it. Your orthodontist will use braces and accessories like miniscrews and special archwires to lift your top teeth toward the lip.
Read on if you’re curious about the nitty gritty details of gummy smile correction. We’ll cover intrusion, what miniscrews are, how long everything takes, and lastly, gum surgery.
What is gummy smile and what causes it?
Gummy smile, also known as ‘excessive gingival display’ in medical terms, simply means showing an increased amount of gum above your top teeth when you smile.
Showing some gum when smiling is perfectly normal, and a youthful part of any smile. A true ‘gummy smile’ is considered to be anything from 3 to 4 mm of gum display, or more.
Not all people are bothered by their gummy smile, which is perfectly fine. But for some, it impacts their self-esteem and they’re avoiding a full smile because of it.
Here are some of the factors that can contribute to gummy smile:
- Skeletal issues (maxillary bone that grows too far down)
- Deep bite with overerupted top incisors
- Small teeth
- Worn teeth due to bruxism
- Short upper lip
- Overactive upper lip
What type of gummy smile can be treated With braces?
You’re a great candidate for braces if your gummy smile is caused by your maxillary bone growing too far down (vertical maxillary excess), or if you have a deep bite caused by overerupted top and bottom incisors.
Your skeletal structure and lip position influence where your teeth go and how you smile, and it’s often a difficult thing to correct. Vertical maxillary excess used to be corrected with a complex jaw surgery called Lefort maxillary impaction.
Nowadays, with the invention of bone screws, it’s much easier to achieve gummy smile correction in the orthodontic office, without any painful or complicated procedures, avoiding jaw surgery altogether.
Deep bite, which has both an underlying skeletal cause and a dental cause, is best corrected with braces anyway. As a bonus, you’ll have your gummy smile corrected too.
How do we fix gummy smile with braces?
Gummy smile is corrected with braces through a process called intrusion. Intrusion is an orthodontic movement in which teeth are pressed partially into the bone, towards the lip. This causes the top teeth to lift up, or the bottom teeth to go down.
Intrusion is one of the most difficult orthodontic movements to achieve. This is because the bone underneath the teeth opposes great force and is difficult to remodel. But, thanks to miniscrews, true intrusion has become possible.
While other methods of gummy smile correction in the dentist’s office only camouflage teeth by making them bigger (through veneers and crown lengthening), or use botox to relax your upper lip, braces are the only method that actually lifts your teeth and reduces gingival display.
Here are some of the tools we use in orthodontics to correct gummy smile:
- Bonding brackets strategically lower on some teeth
- Using reverse curve archwires to level teeth that are too far down
- Using miniscrews (also called TADs) to help pull teeth up toward the lip
- Gum surgery and enamel reshaping as the final step
This awesome video of Dr. Frost & Dr. Nichols’ work best demonstrates how we can use miniscrew-supported intrusion and gum laser surgery to correct gummy smile and achieve incredible results:
How TAD-supported intrusion works
Miniscrews, also called temporary anchorage devices (or TADs), are small screws that are temporarily inserted into the maxillary bone. They are usually about 8 mm long, and only 4 mm actually go inside the bone.
Inserting miniscrews is a simple chairside procedure that’s done under local anesthesia; nothing to be scared or worried about. We use a special screwdriver to manually drive these TADs directly through the gum and into the bone. When the treatment is over, we simply unscrew them, and what’s left is a little hole in the gum that will heal within days.
For gummy smile correction, we need to insert these miniscrews as high as possible above the top teeth. This sometimes means your miniscrews can irritate your upper lip when you talk or eat, but it’s nothing a little orthodontic wax can’t fix.
Miniscrews are just passive components that we use as bone anchorage to pull the teeth up. We do this by securing an elastic chain from the archwire to the TADs. This elastic chain applies constant tension to the archwire and causes your front teeth to lift up.
Complex cases of gummy smile may need 4 to 6 miniscrews placed all around the top teeth to lift the entire arch, while simple cases may only need 2 miniscrews.
Some gummy smiles may be asymmetrical, in which case miniscrews are great for correcting one side more than the other by simply adjusting the amount of force, or pulling to only one miniscrew.
How long does gummy smile correction take With Braces?
A bonus of getting braces for gummy smile is that you’ll also fix any misaligned teeth you might have, or fix a bite that’s not quite balanced. But this means you’ll need to go through a full orthodontic treatment to reap the benefits.
Treatment with braces always starts out the same. You have the aligning and leveling phase where we use light forces, then the working phase, and lastly, the finishing phase.
Gummy smile correction with miniscrews takes place during the working phase of braces. We need about 10 to 12 months of intrusion to achieve notable results. This amounts to a total treatment time of 18 to 24 months of braces, depending, of course, on the difficulty of your case.
The average length of orthodontic treatment is 18 to 24 months anyway, so gummy smile correction isn’t adding too much to that time.
Will you still need gummy smile surgery?
At the end of orthodontic treatment, your gums may partially cover your teeth. This is because during intrusion, the periodontal tissue didn’t get a chance to remodel. Another reason why your gums may seem red and puffy is poor oral hygiene, but let’s hope that’s not the case.
Dentists often remodel gums when lengthening crowns, a one-visit procedure improperly called gum surgery. It’s not actual surgery, especially when using tools that keep bleeding to a minimum.
During your debonding session, your orthodontist should do a few things:
- remove all the glue;
- reshape your teeth where needed;
- contour your gums using a laser diode.
Laser gum surgery is painless, precise and very predictable. Your gums will look brown and a little burnt for a few days, but you’ll heal in as little as a week. Gum contouring is very important for the overall look of your smile, as uneven gums can cause your smile to look asymmetrical.
So look at gum surgery as a good thing – that last step toward a Hollywood smile.
Conclusion
If you’re looking to correct your gummy smile with braces, don’t be put off by all the treatments you have to go through: braces, miniscrews, gum surgery, etc. You can even go the extra mile and ask for your teeth to be whitened – your old friends may not recognize you when you’re done!
