Kiss Your Gummy Smile Good-Bye
Do you feel that your teeth are too short? That your gum line is uneven? That when you smile there is just too much gum showing? If you keep your mouth closed while smiling to keep your gummy smile from flashing out, then you’ve got nothing to worry about—change is here! Now you can have that gorgeous smile you’ve always dreamed of, without letting your excess gums ruin your look. Periodontal procedures are now available to restore and improve your smile by improving your gum line; this is called esthetic crown lengthening.
What Is Esthetic Crown Lengthening?
It is a periodontal plastic surgical procedure where gums (gingival tissue) are removed or repositioned in a more symmetrical manner to effectively reduce the appearance of a gummy smile, giving the patient the proportional smile they’ve always dreamed of. Treatment varies from one patient to another, depending on their case and the cause of the gummy smile.
The Different Causes of Gummy Smiles
Overgrown Gums (Altered Passive Eruption)
This is the case where gums have overgrown their normal tooth crowning, covering a larger part of the teeth than they should. Teeth may appear to be too short; however, they are usually of a normal size.
Post-Orthodontic Treatment
Braces may cause gum irritation, causing the gum area to erupt and overgrow. This is more likely to happen if the teeth appear too short before orthodontic treatment, causing the braces to cover the majority of the tooth and leading to gum irritation. This problem is not due to poor orthodontic care, but rather a result of the gum thickness the patient had before treatment.
Mouth Breathing
Some people may be used to breathing through their mouth rather than their nose. This may be due to a medical condition, such as a nasal or adenoid problem, or simply a matter of habit. Mouth breathing more usually occurs at night, limiting the patient’s control and awareness of the problem. Mouth breathing causes the gums to dry out, which reduces their resistance to disease. Mouth breathers may be required to wear a special mouth guard (NMA – Nocturnal Moisture Appliance) at night, post-esthetic crown lengthening surgery, to eliminate the recurrence of the same problem. The mouth guard is designed to trap moisture around the gums to reduce the problematic effects of mouth breathing.
Medication
Gum tissue growth may occur as a side effect of certain medications, namely Dilantin and Cyclosporine.
Dilantin: A medication taken to control seizures. This medication may cause gum tissue overgrowth. When combined with poor oral hygiene, the overgrowth may increase more rapidly. If the patient is still taking Dilantin post-esthetic crown lengthening surgery, gum regrowth may reoccur.
Cyclosporine: An anti-rejection medication taken by patients who have undergone organ transplants. Similar to Dilantin, Cyclosporine may also cause gum overgrowth. Post-esthetic crown lengthening surgery, the gum overgrowth may reoccur quickly and may become difficult to control.
Severely Worn Teeth – Attrition
Due to excessive wearing of the teeth, little tooth structure is left, leaving mostly gum tissue visible and causing a gummy smile. In most of these cases, an involved flap surgery is needed to expose enough tooth structure for the orthodontist to build crowns.
High Lip Line
In this case of gummy smiles, the patient’s smile shows more gum tissue than would normally be seen. A normal smile would show all of the teeth and only a small part of the gum area. High lip lines show more gum tissue than they should, sometimes even showing as high as the tip of the root of the tooth. Patients with high lip lines cannot prevent the lip from moving higher than normal, which increases the overwhelming appearance of the gums.
Treatment Plans for Gummy Smiles
Excess gum tissue is removed through surgery to help reveal more of the teeth, without reaching the bone area, resulting in a more normal smile. The amount of gum tissue removed depends on the health of the gum tissue itself. A periodontal dressing should be placed over the teeth and gums post-surgery to protect the healing tissues. The procedure is minimally invasive; patients may experience soreness and discomfort, but most often there is no pain post-surgery.
This surgery is required when there is a need to expose and remove some of the bone. This is done when the teeth are naturally too short, badly worn, or when the bone contour itself is thick and irregularly shaped. In these procedures, stitches are usually needed, in addition to a periodontal dressing for protection. Unlike gingivectomy, discomfort and pain are more likely to be experienced after this procedure due to its invasive nature.
This emerging procedure is used to reduce the negative appearance of a high lip line. Despite being introduced as early as the 1970s, this procedure is not commonly performed due to cosmetic concerns that were, and still remain, unresolved. This procedure is done under local anesthesia and involves the reattachment of the gum tissue under the lip at a level closer to the teeth and more normally positioned. This limits the excessive upward movement of the lip that bothers patients suffering from a high lip line. This procedure does not give perfect results in every case, but it has been shown to provide noticeable improvement in many cases. Patient feedback ranges from satisfactory to very good. However, in some cases, this procedure cannot be performed.
Crown Lengthening
Crown lengthening, also called gum lift or gum recontouring, is a procedure in which the periodontist shifts the gums to a position that reveals more teeth and less gum by removing gum and bone around the teeth. In cases where teeth are badly decayed or damaged, the procedure may be performed simply to expose enough tooth structure to allow for restoration.
Laser Gum Surgery
Similar to gingivectomy, excess gum tissue is removed by the orthodontist using a laser instead.
If you suffer from a gummy smile, you don’t have to suffer much longer. Contact an orthodontist for a consultation, consider the possible treatment procedures, and get your smile back on track!
Published in Identity Magazine August 2010
Written By: Nevine A. Abaza
Revised By: Dr. Ahmed Ezz El Dein, Dentist-Prosthodontist, Smile Design Cosmetic Dental Center
Fellow of the International Congress of Oral Implantologists, USA
Member of the American Academy of Cosmetic Dentistry
Member of the American Dental Association
Member of SENAME Italy
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