Are your teeth too short, too long, or are the gums uneven? “Periodontal Plastic Surgery” may be able to help. Having an attractive smile is all about balance – teeth which are an appropriate size and shape – the balance between the amount of whiteness (tooth crown) and the amount of pink (gum tissue). In the anterior zone, gum tissue can be added or removed to achieve the appropriate balance. In other areas, the teeth can be made longer to increase the tooth structure available so your dentist can place a restoration, or crown, on sound tooth structure to give it a longer lifespan.
The recession may have occurred for a variety of reasons including aggressive tooth brushing, periodontal disease or a combination of factors. The benefits of Periodontal plastic surgery treatment include improved appearance, protection to the teeth and reduced tooth sensitivity. Treatment can be provided for a single area or multiple teeth can be treated at one appointment.
Do you show a lot of gum when you smile? Is there a lack of tooth in your smile? This can be due to either excessive wear of the tooth structure, or overgrowth of the soft tissue. Overgrowth can be in response to certain medical conditions, or the tooth may have ‘dragged’ too much gum with it when it erupted into your mouth as a child.
Treatment for this involves gently removing and sculpting the excessive gum (and sometimes underlying bone) to reveal more of your natural tooth structure. When this treatment is done correctly you will have a balanced and stable result. This treatment is called ‘crown-lengthening’ treatment and can be performed on anterior teeth (for both aesthetic or functional reasons) or posterior teeth (primarily for functional reasons). See case studies of functional crown lengthening and aesthetic crown lengthening.
Do you feel like your teeth appear long when you smile? Receding gums can be a result of gum disease, or overzealous tooth brushing with incorrect technique or a hard toothbrush. A tooth that does not fully sit within the natural ‘envelope’ of bone is also more at risk of gum recession. Recession can result in sensitive teeth, increased risk of tooth decay, poor aesthetics and could even lead to progressive loosening of the tooth.
Treatment varies considerably depending on what is required. A root coverage procedure is where we can move excessive adjacent tissue into the area of recession to cover the defect, we can either use your own soft tissue, or there are also commercially alternatives available to regenerate the lost gum tissue.
Is your gum line uneven when you smile? Gum recession or gum overgrowth can occur for several reasons (see above) and can lead to an unbalanced smile. By combining root coverage and crown lengthening procedures we can balance your smile to give you the optimal outcome. A balanced and natural smile depends on the balance between the pink (gums) and the white (tooth crown). Periodontal plastic surgery can help to achieve this.
The term ‘gum graft’ describes several techniques which are performed to correct the effects of gum recession. It is a surgery in which a periodontist undertakes treatment of the gums to either alter the location or consistency of gum tissue to prevent further recession. A gum graft may involve either, taking excessive gum tissue from an area adjacent to the recession and placing over the receded area (coronal advancement flap), taking gum from the roof of the mouth and placing it over the area of recession (free gingival graft or connective tissue graft), or using a tissue substitute (donor tissue) (coronal advancement flap with allograft or xenograft) to thicken up the tissue and cover the recession.
Some people choose to have a gum graft for cosmetic reasons, such as to have a better smile; while for others, a gum graft is necessary to protect the exposed tooth from damage and repair any damage already done.
See a case study of a gum graft.
The term ‘crown lengthening’ relates to any treatment undertaken to make the crown of the tooth longer. It can be done for functional and/or aesthetic reasons. Sometimes teeth are either relatively short and the existing fillings may finish below the gum line. The issue with restorative margins finishing below the gum line is that this leads to reduced tooth structure for your dentist to bond the filling or crown, as well as an inability to adequately remove decay or bond the restoration under favourable conditions (no moisture or blood):