An excessive gingival display while smiling, also known as gummy smile, can have a negative impact on general appealing, and with that, self-esteem of patients. Its multifactorial etiology requires a correct diagnosis. The aim of this review is to establish a protocol that helps to identify in every case the etiology of a gummy smile, in order to guide a better treatment plan. A search of the terms “gummy smile” OR “excess gingival display” was carried out in the following databases: PubMed, Scopus and Cochrane Library. After applying the inclusion and exclusion criteria, a total of 26 articles were included to full read. The etiologies are presented separately, being altered passive eruption and hypermobility of the upper lip the focus. A protocol with a simple and organized sequence is presented. From an extraoral to an intraoral view, the full scope of the different etiologies, are taking into account considering the contemporary orthodontics era: harmonize the patients smile without altering them individual beauty, introducing the dynamic analysis in the diagnosis process, considering sexual dimorphism and passage of time. Only through a complete diagnosis we will perform a successful treatment plan, often multidisciplinary, that will satisfy the needs of the patient.
(Rev Esp Ortod. 2017;47(3):136-145)