Aesthetic crown lengthening can be a treatment option for patients with a ‘gummy’ smile. The best way of approaching the treatment depends on what is actually causing the excess display of gum. In its simplest form, it may simply be extra gum that can be cut away to expose the tooth underneath. At the other end of the spectrum is too much gum showing as a result of an underlying skeletal discrepancy, whereby only major surgery can completely address the problem. Proper assessment is required to determine the underlying cause and to decide what end result can be gained and by what method this can be achieved.
Often, to gain a predictable and stable long term result, some degree of adjustment of the underlying bone levels is required. To achieve this, the gum must be raised and adjusted to the desired level, and the underlying bone adjusted to re-establish the proper anatomical relationship (‘Biological width’).
Relatively small amount of crown lengthening required to expose clinical crown that was hidden by excess gum.
Gum recession localised to the cheek surfaces of the patient's teeth. The yellower colour of the tooth root is visible.
There are a number of factors that cause gum recession, and they do result in different patterns of recession. Chronic periodontitis does cause recession, but this tends to occur on all aspects of the tooth and reparative treatment is difficult or impossible.
Localised gum recession can occur as a result of trauma or gingivitis in patients who have thin gums. This is often self limiting, but on occasion can be progressive and compromise the tooth. Treatment of recession is indicated when there is a risk of such progression, or when the recession has lead to an aesthetic concern. This is most common in patients who have a high smile line and show gum when they smile.
Coverage of gum recession involves a minor surgical procedure that moves the adjacent gum over the recession. Often a small piece of gum is also taken from the palate to add to the missing gum over the recession.
Surgical correction of gum recession - before, shortly after and two years post correction.
Aesthetics Following Gum Disease and Periodontal Treatment
Chronic Periodontal Disease (‘Gum disease’) results in the loss of the bone and supporting tissues that hold the teeth in. In many cases this leads to the formation of deep gum however in patients with this tissues this can lead to gingival/ gum recession, the patients becoming ‘long in the tooth’. Unfortunately the successful treatment of chronic periodontitis will often lead to gum recession. The extent of the recession is directly related to the extent of the disease and amount of underlying bone loss that has resulted.
Unfortunately the recession can lead to an unaesthetic end result. The image on the right does show a patient who has suffered localised gum disease that has resulted in gum recession. This form of recession is untreatable by gum surgery. The only way to improve the aesthetics is to try and mask the tissue loss. Occasionally this can be done by clever use of white fillings to close the gaps between the tooth.
Where the loss of gum tissue is extensive, treatment options are limited. Patients may have to accept the aesthetic result. One option is the construction of a ‘gingival veneer’- a thin acrylic or silicon mask that is worn to cover the exposed root surface and mimic the missing gum. An example is the case below.
Treatment of advanced chronic periodontitis has resulted in a significant loss of gum tissue resulting in an unaesthetic result
Gingival veneer in place and polishing of white fillings improves the aesthetics
The Gingival veneer is a thin, lightweight design, held in by extending it between the teeth