Correcting a Gummy Smile
A gummy smile makes the teeth look short and not in proportion with the patient’s face. The smile can be greatly enhanced by sculpting the gum to make the teeth appear more natural.
Gum recession often shows the unsightly root of the tooth. Following gum grafting, root coverage may be desired by patients to improve appearance. A connective tissue graft provides new attached gingiva while at the same time covering the root surface.
Irregular Gum Levels
Very simply, irregular gum levels detract from an attractive smile. Unless the gum has a natural contour, the results with new crowns can never be satisfactory. We may choose to change a single tooth or work on all the upper front teeth to provide the optimal appearance.
Periodontists sometimes see an association between a lack of attached gingiva with a high frenum attachment, which exaggerates the pull on the gum margin. The frenum is a naturally occurring muscle attachment, typically seen between the front teeth. If pulling is seen on the gum margin or recession, the frenum is surgically released from the gum with a frenectomy. A new band of hard gum is also added to re-establish an adequate amount of attached gingiva.
Even normal attached gum can be worn away over time, most commonly from vigorous brushing. We often see this in those with naturally thin tissues or when the tissues have been stretched during orthodontic care. If there is still adequate attached gum to act as a muscle barrier, the treatment for recession is to prevent any future damage while brushing. An attached gum that’s worn to the point where it can’t resist the constant pull of the mucosa will continue to recede unless a new hard band of gum is placed. Recession can eventually cause tooth loss if unchecked by a professional.
Gingival grafting is the treatment of missing attached gum. The muscle pulling down is surgically resected and repositioned away from the gum margin. A small piece of attached gingiva is then taken from the roof of the mouth and transplanted to the necessary area. A new layer of attached gum is formed and the quick healing process of the roof of the mouth begins to take place. Patients can enjoy the benefits of this procedure with no fear of postoperative pain, which can be managed effectively with over-the-counter pain medication. Patients find the most difficult part not chewing on the area for two weeks.
If you desire to cover up the exposed root surface, a different surgical technique will be used. Keep in mind, however, that root coverage procedures are primarily done for cosmetic reasons or when there is exceptional root sensitivity after recession.
Once teeth are extracted, the bone often resorbs during healing and leaves a gum indentation. The bridge placed prevents the artificial tooth from looking real. Consequently, the artificial tooth appears to be growing out of the gum and can’t be distinguished from the natural teeth.
The ideal way to treat a ridge deficiency is to prevent it from occurring altogether. Performing a ridge augmentation at the time of extraction can manage the amount of bone loss.
Treating Extraction Sites
A resorbed ridge forms once the gum heals down in the socket before the bone has time to completely reform. After extraction in order to prevent bone resorption, we advise the socket be filled with a material that reduces gum shrinkage and prevents gum down growth. It’s ideal to treat the problem before it occurs.