we can prevent chances of relapse if the dentist ensures that the bone underneath the gums is 3mm below the newly contoured gum margin. If there is too much bone underneath the gums, it will "push" the gums back to its original position, leading to relapse.
The dentist doing the gum recontouring procedure will check on this biologic distance when your gums are numb. We usually use a measuring instrument called a periodontal probe to determine this.
As X-rays are only 2 dimensional, it is usually difficult to predict if bone needs to be removed on that particular tooth surface. Usually, it is best to confirm if bone needs to be removed during the procedure when you are already numb.
Hope this helps! :)
Thanks for the D2D. It is wise to consult both an Orthodontist and a Periodontist before treatment is started so both specialists are in agreement with the treatment plan.
Usually, braces (Orthodontic treatment) is done first as it is sometimes possible to intrude the teeth with braces and reduce the height of gum display.
Also, if braces are done first, sometimes we need to remove less bone and gums during gummy smile surgery. Also, the gums levels will move during braces so it would be much better to level off the gums when the teeth have stopped shifting and are in their final position.
So in general, it is better to do braces first before gum surgery! Although there are exceptions to the rule.
Thanks for the D2D. Yes, you are right in that there are many ways to fix a gummy smile! I can only guess from the picture, but it looks like your gummy smile is caused by a longer mid face and overactive upper lip.
Your teeth appear to be the correct length so lengthening of the teeth with a laser or gum surgery would not be an option for you.
A simple option would be to treat the overactive upper lip. It might possible to Botox your lip so it doesn’t move so much when you smile, thus exposing less gums.
The best results could possibly be achieved with a vertical maxillary impaction, where the surgeon embarks on corrective jaw surgery, and the whole upper jaw is repositioned upwards. Needless to say, this procedure is much more invasive and you will need much more time to heal compared to a Botox injection.
If you are considering either option, it would be wise to consult an oral surgeon so they can better advice you after seeing your lips move in real life and the true proportions of your face.
Hope this helps! :)
Thanks for the D2D.
There are measurements given in dental textbooks about the “ideal” amount of gums to be shown when smiling, but I honestly think beauty is in the eyes of the beholder. So I may think that the patient is too “gummy”, but the patient may be very satisfied with his or her smile.
It all depends on what the patient wants to achieve. If both the patient and dentist agree that the smile is too gummy, I usually use an instrument to show the patient where I would trim to the gums to. And the patient has to agree that that length is good for him/her.
Sometimes I even “fake” the future length of the teeth by putting tooth coloured material on the gums to allow the patient to visualise how he or she would look with longer teeth and less gums showing.
Thanks for the D2D. Your Periodontist and Restorative dentist will have to work closely together to determine the length, width and shape of your future crowns and veneers. So ask to speak to both dentist together BEFORE you embark on treatment.
Usually, the gums are trimmed to the right height first, then given time to settle and heal. It is only after a period of healing that crown and veneer treatment is started.
Thanks for the D2D. That is a very genuine concern! The purpose of gummy smile surgery is to trim away EXCESSIVE gum and bone tissue. So your dentist will only remove what is necessary and make your teeth the correct length.
Since we are just “normalising” what you are supposed to have, it will not make you more prone to gum recession in the future compared to the normal population.
Hi Jia Hui,
Thanks for the D2D. In a gingivectomy procedure, only the gums are trimmed away to even out the gums.
Usually there is discomfort for 24 hours but your dentist will give you painkillers to keep you comfortable. The procedure sounds scary, but it will be done in a jiffy. In my opinion, a gingivectomy is more comfortable than an extraction or wisdom tooth surgery!
Thanks for the D2D. It really depends on what the cause of your gummy smile is. If it is due to an overactive upper lip, you might be able to avoid surgery by having Botox injections done!