Periodontal plastic surgery

Gum reshaping (gum recontouring)

Gummy smile (excessive gingival display) is a condition in which a high lip-line exposes an excessive amount of gum tissue, having a negative effect on the esthetics of a smile. If the gums cover too much of the teeth (usually the front teeth), the length of the teeth looks too short, affecting a person’s general desire to smile. This condition is commonly caused by genetic factors or certain medications. The soft tissue diode laser is commonly used by cosmetic dentists to trim away any excessive gum tissue overlying the teeth. This is a quick and painless treatment, eliminating the need for stitches, and having an ability to seal blood vessels during the procedure. On occasion, removing the gum tissue isn’t enough to achieve desired results. In this situation, a simple surgical procedure with recontouring of the underlying bone would be recommended. The gum contouring can be also combined with the placement of crowns or veneers to esthetically improve the smile when desired by the patient. This is usually performed 3-6 months after the gum treatment is complete to ensure stability of the gum contour.

Crown lengthening

The creation of an esthetic dental restoration with gingival harmony can be challenging. Crown lengthening is a surgical procedure where the gum tissue and/or bone are removed to expose more of a tooth structure necessary to support a filling or a crown. It may be required to properly restore the tooth that fractured off or is decayed at/below the gum line, or when the margin of the existing restoration is placed deeply into soft tissues causing chronic inflammation. There are times when crown lengthening is the only practical alternative to extracting a tooth. Crown lengthening may also be performed for esthetic reasons e.g. for “gummy smile” correction.

Treatment for gum recessions

Gum recession refers to the exposure of a root surface as a result of destruction of the gum tissue of the affected area. The main factors associated with gum recessions are improper tooth position, hereditary thin fragile and inadequate gum tissue or underlying bony defect. Other predisposing factors include poor oral hygiene, traumatic toothbrushing, self-induced injuries, teeth grinding, oral piercing and certain dental procedures or appliances. Gum recessions are also among the most frequent problems presented by periodontal patients. In some cases, removing the cause and monitoring is sufficient. Other clinical situations may require orthodontic treatment to correct the position of the tooth/teeth, microsurgical intervention covering the exposed root with a soft tissue (soft tissue grafts, flap surgery with or without regenerative materials) or gingival veneers. Treatment may be directed by the patient’s concerns about esthetics, longer teeth, exposed roots or, occasionally, root sensitivity. If untreated, recession may progress to the point where the tooth prognosis becomes questionable. Additionally, root surface exposure may result in decay or abrasion, with possible pulpal involvement. In addition, the gum recession treatment may also be recommended to aid esthetic restorative results creating a crown, bridge or an implant that is in harmony with surrounding soft tissues. The use of periodontal plastic surgical procedures to aid in evening-out the gingival margins or to creating ovate pontics can set the stage for a truly esthetic restoration.