Dual Approach for Gummy Smile Management: Combining Gingivectomy and Botulinum Toxin for Aesthetic and Functional Enhancement

Background: A gummy smile (excessive gingival display) is a common aesthetic concern that disrupts the visual harmony between teeth, gingiva, and lips. Its etiology may be gingival, muscular, or skeletal. While multiple treatment modalities exist, selecting the optimal plan depends on accurate diagnosis of the underlying cause. Objective: To evaluate the effectiveness of combining gingivectomy and botulinum toxin injections in managing gummy smiles caused by altered passive eruption and hyperactivity of the upper lip elevator muscles, and to compare the outcomes with those reported in the literature. Materials and Methods: Diagnosis was established through clinical examination, panoramic radiography, and gingival measurements. An external bevel gingivectomy was performed without osseous recontouring, followed by botulinum toxin injections (2 units per side) at the Y-point. Outcomes were assessed in terms of aesthetic improvement, stability, and patient satisfaction. Results: The combined approach reduced gingival exposure and improved the crown-to-gingiva ratio, achieving high patient satisfaction. Findings were consistent with studies supporting the integration of surgery and botulinum toxin in multi-factorial cases. Botulinum toxin provided rapid but temporary improvement (4–6 months), while gingivectomy offered longer-lasting results in gingival-related cases. Conclusion: The combination of gingivectomy and botulinum toxin injections is an effective treatment option for gummy smiles of mixed etiology, provided that precise diagnosis and clear indications for each procedure are established. A multidisciplinary approach and well-defined diagnostic algorithms are recommended to ensure optimal aesthetic and functional outcomes.