From etiology to intervention: 50 years of progress in gummy smile research and treatment.

Excessive gingival display, commonly referred to as a "gummy smile," is defined as more than 3 mm of gingival exposure during smiling and is often perceived as unesthetic, potentially leading to psychological and social concerns for affected individuals. Over the past five decades, significant progress has been made in understanding the etiology, diagnosis, and treatment of this condition. Initially regarded as a functional or developmental issue, the gummy smile has evolved into a major esthetic concern, reflected in the exponential growth of related scientific literature. Early treatment approaches (1975-2000) focused on surgical interventions such as orthognathic surgery, lip repositioning, and gingival reduction procedures, alongside foundational diagnostic classifications. In the last two decades (2001-2025), advancements have included refinements in surgical techniques, incorporation of digital workflows, and introduction of minimally invasive and nonsurgical options. Recent research emphasizes patient-reported outcomes, esthetic assessments, and algorithm-based treatment planning, while emerging technologies promise further improvements in diagnosis and personalized care. Continued innovation and interdisciplinary collaboration are essential to optimize treatment strategies and enhance patient satisfaction.