Biovolume for gummy smile: a critical analysis of what this article actually demonstrates
A case report published in 2026 presents good results in treating excessive gingival display. The technique is interesting, especially in cases of upper lip hypermobility, but some conclusions deserve careful scrutiny.
The article “Correction of the gummy smile when there is vertical growth of the maxilla and resistance to orthognathics” describes the treatment of a female patient with a gummy smile of multifactorial origin. In the case described, there were three main components: altered passive eruption, upper lip hypermobility and vertical maxillary excess.
This may be one of the paper's first merits: recognizing that a gummy smile is not, in itself, a diagnosis.
Different conditions can cause a person to show excessive gum tissue when smiling. In some patients, the problem lies predominantly in the position of the gums relative to the teeth. In others, the upper lip moves excessively. Other situations are related to vertical growth of the maxilla. And, quite often, more than one of these factors is present at the same time.
For this reason, there is no single treatment that can be applied in the same way to every patient.
What was done in the reported case?
The authors proposed a combined approach.
Clinical crown lengthening was performed to address the component related to altered passive eruption. To control excessive upper lip movement, a device called Biovolume was placed in the premaxillary region. The aesthetic treatment was subsequently complemented with ceramic veneers.
In simple terms, Biovolume works by adding volume to the concavity in the anterior region of the maxilla. This new contour acts as a mechanical barrier, making it harder for the upper lip to move excessively upward during smiling.
And here, in my opinion, lies one of the most interesting aspects of the article.
In the reported case, upper lip hypermobility was present and, after the procedure, there was a clear reduction in gingival display. The result shown after two months is aesthetically satisfactory.
The paper therefore provides clinically relevant information: in patients whose gummy smile has a substantial component of lip hypermobility, Biovolume may be an alternative capable of producing a good short-term result.
That deserves recognition.
The problem begins when we try to turn this initial result into something the study cannot yet demonstrate.
Does a good result after two months mean the treatment is definitive?
No.
And that distinction matters.
This is a report of the treatment of a single patient, followed for a relatively short period.
The article shows that the technique worked in that case and during that period. This is valid and of clinical interest. But it is not enough to determine how the result will behave after one, two or five years.
Nevertheless, the paper uses quite strong expressions when discussing the technique, suggesting predictability, a low risk of recurrence and even an absence of recurrence risk.
This is precisely where I believe greater caution is needed.
Not observing recurrence over two months is different from demonstrating that there is no risk of recurrence.
Answering this question would require studies with a larger number of patients and, above all, medium- and long-term follow-up.
Ideally, these patients would be followed at successive intervals, for example six months, one year, two years and later at even longer intervals.
Only then would it be possible to begin understanding the true stability of the technique.
What about vertical maxillary excess?
This is another point that requires an important distinction.
Biovolume does not change the position of the maxilla.
Therefore, it does not actually correct vertical maxillary excess.
What it can do is reduce one of its aesthetic manifestations by limiting upward lip movement and, consequently, reducing the amount of gum tissue exposed during smiling.
This does not make the technique any less interesting.
For a patient with several causes of gummy smile who does not wish to undergo orthognathic surgery, a compensatory approach may certainly be considered, provided its limitations are understood and discussed.
What we should not do is confuse improvement in the appearance of the smile with correction of the skeletal discrepancy that contributed to the condition.
These are different goals.
How much of the improvement actually came from Biovolume?
There is another difficulty in interpreting the result.
The patient underwent clinical crown lengthening, Biovolume placement and, subsequently, ceramic veneers.
All these procedures change the appearance of the smile.
Therefore, when we look at the final result, we cannot attribute all the aesthetic improvement exclusively to Biovolume.
It would be very useful for future studies to present objective measurements before and after each stage of treatment.
How much gum tissue was visible initially?
What was the vertical movement of the lip?
How much changed after crown lengthening?
How much changed specifically after Biovolume placement?
And, most importantly, how much of that change persisted over the years?
Photographs and videos are essential in smile analysis, but standardized measurements would make the evaluation of the technique much more objective.
An important question about the material used
Another aspect of the article deserves attention.
The paper describes the digital fabrication of Biovolume using CAD/CAM and a prototype made of synthetic resin. This piece was sterilized, positioned in the premaxillary region and fixed with screws.
However, the instructions provided by the company responsible for manufacturing Biovolume state that the prototype is not the definitive piece.
The company's recommended protocol calls for duplicating this prototype using addition silicone and manufacturing the piece intended for implantation from surgical cement.
There is therefore an important difference between the protocol described in the article and the one recommended by the company responsible for manufacturing the device.
This should have been explained in the paper.
If directly using the resin prototype represents a modification of the technique, it would be important to clearly explain why this change was made and what evidence supports leaving this material in the body.
Sterilizing a material does not necessarily mean it can remain implanted
This distinction also matters.
The fact that a material can be sterilized and has biocompatibility characteristics does not automatically mean that it is indicated to remain permanently in contact with bone tissue.
These are different issues.
When we use a material as a permanent implant, especially in an elective procedure for aesthetic purposes, we need to understand not only whether it can be sterilized, but also its long-term behavior in that specific situation.
It would be important to assess, for example, tissue response, fixation stability, possible bone changes, infection, device exposure, displacement or a possible need for removal.
Once again, two months are insufficient to answer these questions.
A point that calls for transparency
The article declares no conflicts of interest. However, one of the authors owns the company responsible for manufacturing the Biovolume presented in the paper.
This does not mean that the clinical result is wrong, nor does it allow us to conclude that there was any influence on the results.
But it is a relationship directly linked to the product discussed in the article and, for that reason, it should be clearly disclosed to the reader.
That is precisely the purpose of a conflict-of-interest statement: to allow readers to know about professional, commercial or financial relationships related to the subject being studied and to interpret the paper with all available information.
Having a conflict of interest does not invalidate research.
Failing to disclose a relevant relationship, however, reduces the transparency needed for critical evaluation of the paper.
So, does Biovolume work?
This may be the most interesting question.
The reported case indicates that yes, Biovolume can produce a satisfactory short-term result, especially when there is a substantial component of upper lip hypermobility.
And I consider this an interesting clinical finding.
The idea of modifying the anatomy of the premaxillary region to mechanically limit excessive upward lip movement during smiling makes clinical sense, and the result presented in the article deserves attention.
What we do not yet know is whether this result remains stable over the years.
We also need a better understanding of which patients truly benefit from the technique, what its possible complications are and what the ideal material should be for manufacturing the definitive device.
For this reason, I would not dismiss Biovolume.
But with the evidence available today, I would not present it as a proven definitive solution or one free from recurrence.
What can we conclude?
The article deserves credit for addressing gummy smile as a multifactorial condition and presents an interesting clinical result.
Particularly for the component of upper lip hypermobility, Biovolume showed a satisfactory short-term reduction in gingival display.
This result justifies further research.
However, a case report involving a single patient and two months of follow-up cannot demonstrate long-term safety and stability, much less an absence of recurrence.
Questions also remain about the material used, the difference between the protocol described in the article and the one recommended by the company responsible for manufacturing the device, as well as the need for greater transparency in the conflict-of-interest statement.
In clinical practice, this may be the most important message: a good initial result is an important finding, but it is not the same as evidence of long-term stability.
Biovolume emerges as an interesting alternative for selected cases, especially when lip hypermobility makes a substantial contribution to the gummy smile. We now need larger studies and longer follow-up to find out how far this promise holds true.
Reference analyzed
SILVA et al. Correction of the gummy smile when there is vertical growth of the maxilla and resistance to orthognathics. RGO – Revista Gaúcha de Odontologia, 2026. DOI: 10.1590/1981-86372026000820230090.