Oftentimes a “gummy smile” can be corrected. Typically, teeth that appear short, or square, may actually be the proper length but are covered up by too much gum tissue. If this is the case, excess gum tissue is removed and the bone is reshaped to expose more of your natural tooth structure, improving the appearance of your smile!
Many patients exhibit excessive gingival display resulting in the appearance of a gummy smile. Recontouring the gum tissue to expose hidden natural tooth structure allows your periodontist to achieve appropriate tooth length and provide a more aesthetic smile.
Case Study 1
Meet Patty. Patty was on of my dental assistants in Chicago and always disliked her smile. One day she asked me, “why are my teeth so square? My mom told me it’s just the way they are but can I do anything about it. And I always show so much gums… that’s all I see in photos of myself, more teeth than gums. When I smile I feel like my upper lip gets stuck on above my teeth and I have to make an effort to pull it down.” I discussed with patty that her smile “gummy smile” is due to a combination of things, including vertical maxillary excess (VME; her upper jaw grew down too far) and excessive gum and bone tissue. I explained to Patty that aesthetic crown lengthening would help restore a more normal shape to her teeth and reduce the “gumminess” of her smile but that she will always show some gum while smiling due to VME. Additionally, by thinning out her excessive bone our goal was to allow Patty to smile without getting her upper lip caught up on a heavy ledge of bone above her upper teeth. Patty understood and was eager to start with therapy.
Note Patty’s “gummy smile” while smiling and while her lips are at rest
Note below submarginal incisions at the level of the CEJ to expose the hidden tooth structure
After tissue was removed and flap was raised, the thick abundance of excessive bone was clearly evident and was thinned and reshaped.
Immediately following surgery notice the significant difference in the Patty’s smile, she was thrilled and surprised at how quick and easy the whole process was. Her lip no longer caught on her excessive thickness of bone and she no longer showed “gumminess” at rest.
PRIOR TO SURGERY – AT REST AND SMILING
AFTER SURGERY – AT REST AND FULL SMILE
Functional crown lengthening is a surgical procedure that is required when your tooth needs a new crown and the decay extends deep below the gum line and thus is inaccessible for your dentist. The procedure involves adjusting the levels of the gums and underlying bone surrounding the affected tooth to expose more of the tooth surface. Most crown lengthening procedures are straightforward and there is minimal or no post-operative discomfort. This procedure allows your dentist to remove all the decay that was hiding underneath your gums and ensure a proper fit of your new crown. Typically, your dentist should wait 4-6 weeks for your gums to fully settle into their new position before finalizing your new crown. If the crown is to be placed in an aesthetic area, your dentist should wait 8-12 weeks before taking final impressions, as the gums may continue to shrink slightly during this healing period. It is important to ensure that your gums are in their final position before your new crown is made. Additionally, this procedure allows you to have better access to clean the edges of your new crown when brushing and flossing helping to prevent future decay and gum disease.
When a tooth is decayed or fractured to the extent that no restoration is possible, a surgical procedure called crown lengthening can be performed. Crown lengthening involves the recontouring of bone and gum tissue in order to expose enough tooth structure to allow a crown to be placed.
Case Study 1
This case required a combination aesthetic and functional crown lengthening to allow for crown placement on multiple severely decayed and broken down teeth.
Temporary restorations were placed prior to crown lengthening surgery. Notice how the gums are inflamed as the temporary crowns were placed too close to the bone. Also, note how the teeth look too short and square and asymmetry exists at the level of the gingival margin.
Final restorations were placed 3 months following crown lengthening surgery. Note the proper height and width of the crowns and the significantly improved gum health.