Are you self-conscious about showing too much gum when you smile? Do you feel like your teeth appear small due to being largely covered by gum? Or have you undergone gum surgery in the past only to find that it has returned to its original state? Do you know what gingivectomy means?
These are common questions our patients ask and I want to provide a clear explanation of what you may not have been informed about gingivectomy so that your next smile design treatment is a success.
It’s important to understand that as gingivectomy has become more popular, many patients believe that the same procedure works for everyone and that the cost will also be similar. This is not the case. That’s why I will break down each case so that you can determine which one applies to you and know what treatment will have the biggest impact on your smile both in the short and long term.
Case 1
The size of your teeth is limited, and they appear broader than they are tall. It’s possible that you experienced dental inflammation, which caused your teeth to appear smaller:
Solution:
When teeth are wider than they are tall, it is often due to a condition known as “passive eruption.” This occurs when the tooth emerges completely from the gum line but the gum tissue does not return to its normal position. It is similar to when the cuticle layer covers our nails and needs to be trimmed to make the nail look neat. It also happens when the gum tissue becomes inflamed and refuses to heal, causing the problem to escalate over time and making it harder to clean.
The solution for this issue is gingivectomy, which involves a simple removal of the gum tissue. This can be done with a scalpel or an electrocautery, which is a preferred method as it minimizes bleeding. The procedure is performed under local anesthesia, with the areas to be treated marked and then trimmed.
Contrary to popular belief, the procedure is not as complicated or painful as it sounds. The patient may feel anxious about the procedure, but the specialist will finish quickly. When the electrocautery is used, there may be a faint smell of cooked meat, which some patients find curious, but this is simply the result of trimming and cauterizing the gum tissue.
The recovery is quick, usually taking between 1 to 2 weeks, and it is important not to eat anything after the procedure until the effects of the local anesthesia wear off to prevent accidental injury.
Case 2
Your teeth are small and when you smile, you can see around 3 to 5 cm of gum tissue:
Solution:
When this occurs, it indicates that you are not experiencing a passive eruption or any similar issue, as was the case previously. Instead, to achieve improved aesthetics and a more harmonious smile, it is ideal to undergo a gingivectomy with bone cutting or gingivoplasty, as it is sometimes referred to.
What’s crucial is not the name, but rather understanding that the procedure you will undergo involves cutting and reshaping not only the gum but also the bone, so it doesn’t regrow after healing. This procedure can be highly beneficial in these cases, as lengthening the teeth isn’t always achievable through resin or ceramic veneers. Often, attaining the desired divine proportions sought after by aesthetic dentists can be accomplished simply by adjusting the gum to prevent it from being visible when you smile, resulting in a complete transformation of your smile.
It usually takes 1 to 3 months to fully recover from this procedure, as the bone takes longer to heal than just the gum. If you plan to undergo this procedure and then have a smile design or crowns, you should wait at least a month, ideally three months, for full healing, so that the dental restorations can adapt and have long-term success.
Case 3
Although your teeth are of normal size, when you smile, 3 to 8 millimeters of gum can be visible.
Solution
When teeth are of normal size, it is not advisable to make excessive gum cuts that would negatively impact the dental proportions, making the teeth appear unnaturally long. The ideal solution in such cases, which is not well-known, is to use BOTULINUM TOXIN in specific areas of the face to relax the pressure that the upper lip exerts and prevent it from rising too high. This procedure results in a beautiful smile quickly, as it only takes about 15 minutes to perform and the effects are fully visible after 15 days. The botulinum toxin has a desired effect on the muscles and the results can last anywhere from 4 to 8 months.
Case 4
While your teeth are of normal size, when you smile, more than 8 millimeters of gum are visible.
Solution
When there is an excessive amount of gum showing when smiling, the treatment options are slightly different as we are seeking to achieve a more harmonious smile and significant changes are necessary.
One option is called UPPER LIP REPOSITIONING, which aims to change the position of the lip, resulting in a radical transformation. This treatment is less well-known, but it provides excellent aesthetic results for the smile and is performed with local anesthesia. In some cases, it can also be combined with the application of hyaluronic acid on the lips when necessary.
In other instances, maxillofacial surgery may be required to reposition not only the lip but also the entire upper jaw. This will change the amount of gum visible when smiling and enhance the facial features according to the individual needs of the patient. Maxillofacial surgery in these cases is performed under general anesthesia, and it is crucial to follow the aftercare instructions provided by the maxillofacial surgeon.
What was the reason for the failure of the gingivectomy I underwent previously?
Many times, the cause for the failure of gingivectomy can be traced back to poor decision making, either by the dentist or the patient. There is a tendency to immediately request a simple cut that can only be achieved through an electrosurgical unit, and the dentist may give in to the patient’s request to make them happy, or they may believe that it is the most suitable solution at the time. In these cases, the results of the gingivectomy appear satisfactory, even a month after healing, but over time the gum will start to grow back to its original position.
This is because there are specific guidelines in dentistry that must be followed, and in the case of gum cutting, this guideline is known as the biological space. When the gum is only cut and not the bone, it will eventually heal and return to its original position. Thus, in cases where bone cutting is necessary, it must be performed in order to achieve a successful and long-lasting treatment outcome.
