Gum Aesthetics

When more than a few millimetres of gum shows above the teeth when you smile, this is referred to as a gummy smile. There's more than one possible cause. The gum may simply cover more of the tooth than it should, the upper lip muscle may pull up further than expected, the upper jaw may have grown excessively in the vertical direction, or the teeth themselves may be short. At examination, your dentist assesses lip movement, tooth length and bone level together. The cause behind what looks like the same picture completely changes which method gets chosen.

Simply raising the gum margin by a few millimetres isn't enough in every case. There's a distance between the visible part of the tooth and the bone that the tissue needs to stay healthy; push past that distance and the gum either grows back to its original position or settles into chronic inflammation. With crown lengthening, your dentist reshapes the bone level as well as the soft tissue where needed. In teeth where a fracture extends below the gum line, this procedure is also needed so a restoration has something to grip onto. Gingivectomy, which doesn't touch the bone, has a narrower range of indications by comparison.

A limited margin adjustment around a single tooth is usually finished in one session of twenty to thirty minutes. In plans that cover the whole of the front teeth and include bone recontouring, the session can run over an hour. Where stitches are placed, your dentist books a suture-removal appointment a week later; in cases where the bone has been reshaped, an extra review appointment is added on top.

Gingivectomy refers to removing excess tissue, while gingivoplasty refers to reshaping the contour; the two are often carried out in the same session. The instrument used varies too: the scalpel is the classic method, while electrosurgery and diode lasers limit bleeding and can be preferred in some cases. Areas treated with a laser may not need stitches, though heat control needs its own separate care. No one method is superior across the board — the choice depends on the thickness of the tissue and whether bone needs treating too.

With active gum inflammation, untreated periodontal pockets and widespread plaque present, your dentist postpones the procedure and brings the inflammation under control first. Areas where the root is already exposed are kept out of the incision, because removing tissue there would make things worse. Uncontrolled diabetes, bleeding disorders and blood-thinning medication all have a direct effect on the surgical plan. A history of head and neck radiotherapy and bisphosphonate treatment both call for separate assessment. In young patients who haven't finished growing, the relationship between lip and jaw keeps changing, so treatment is usually held off. In gummy smile cases with a significant skeletal cause, gum trimming alone isn't enough — orthodontic and jaw surgery options are considered instead. If the picture owes more to the upper lip pulling up excessively than to the tissue itself, margin recontouring may again not be enough on its own; in this scenario, your dentist may bring up surgical approaches addressing lip position, or treatments that reduce muscle activity.

Whether the margin line stays in place is largely down to keeping up your gum health. Without regular brushing, interdental cleaning and six-monthly check-ups, accumulating plaque will make the gum swell again. Because mechanical factors such as mouth breathing and night-time clenching can put strain on the tissue, your dentist recommends a night guard where needed. Since hormonal changes and some blood pressure and epilepsy medications can increase gum volume, the recall interval is shortened in these cases.