When most people think of a nice smile, they think of nice, white, healthy teeth. It is true that healthy teeth are essential, but those teeth are like a beautiful piece of artwork that must be appropriately “framed” to make them come to life. The frame of the teeth are the gums that surround them. Healthy and appropriately shaped gums bring harmony and visual contrast to the teeth they envelop.
A common complaint for many patients is that they feel they have a “gummy” smile. In fact, as much as 30% of women have some level of excessive gingival display (gummy smile). This condition can be associated with several different causes including tooth position, skeletal bone relationships, lip mobility, and position of gum tissues surrounding the teeth.
This month’s case highlights Caitlin, a 22 year old female patient who presented following orthodontic therapy (braces). The teeth were moved into an ideal position by the orthodontist. However, Caitlin felt that she had a gummy smile and inquired about addressing this. Caitlin’s teeth and gums were healthy. Following a thorough diagnostic workup, it was determined that Caitlin was a good candidate for a procedure known as esthetic gum recontouring (also known as esthetic crown lengthening).
The goal of gum recontouring is to create the natural flow and curvature of a pleasing gum line, while exposing the appropriate amount of tooth structure. In Caitlin’s case, she had beautiful teeth and healthy enamel. It was just covered by abundant gum tissue making the teeth appear short. Utilizing a periodontal laser, the gums are shaped to their ideal position. Following this step, the surrounding bone is gently reshaped to create the appropriate anatomy for sustaining a long-term result. Without this latter step, the tissue will regenerate once again. The final step is the securing of the tissue with small diameter, plastic-surgery style sutures. The entire surgery took less than one hour.
Following 12 weeks of healing, we can see dramatic changes in Caitlin’s gum line, and ultimately, her smile. The tissues will continue to remodel over the next 12 months to create ideal contours. In some situations, gum recontouring may be followed by restoration of the teeth with veneers.
Esthetic gum recontouring is one example of how periodontal plastic surgery may impact the smile. Most patients are focused on how their teeth appear, and may not realize that the position and harmony of the gums can have a dramatic impact on the presentation of the teeth they surround. Through addition, or in this case, subtraction procedures, a periodontist can help patients achieve their desired goals
This article first appeared in the 2010 May / June edition of the The New London Women’s Journal
I was always self-conscious about my smile, so when Dr. Toback suggested the procedure I was excited to see the difference. The procedure was unbelievably easy and quick. The results are amazing! My smile looks completely different and I couldn’t be happier with how my teeth look now! – Caitlin