Gum Correction
A beautiful bright white smile captivates not only because of the teeth, but also with healthy and beautiful gums. Long and exposed tooth necks, receding gums, discolouration of the gums or even too much gum can disturb the aesthetic appearance of the teeth. With minimally invasive corrections of the gums we can eliminate these aesthetic flaws.
Why Wimpole Street Dental Clinic?
Our specialists in our clinic in the heart of the medical district here in London combine nearly a century of experience and hundreds of periodontal (gum) operations between them. In addition our ultramodern high tech set-up, state-of-the-art facilities, numerous national and international publications and performing all operations under magnification makes our clinic one of the centres for this treatment.
When is a gum correction the right choice
The look and health of your gums — known to dentists as gingiva — are influenced by factors such as hereditary components, oral hygiene and lifestyle. Depending on the cause and the diagnosis we decide together with you which gum correction technique is best for you.
What are the most common problems?
The gum anatomy can be associated with a large variety of cosmetic flaws. To name a few:
– receding gums due to grinding or periodontal disease
– Exhibiting too much gum due to a high upper lip mobility (high muscle pull) the so call “gummy smile”
– Mechanic and traumatic injuries leading to gum loss (e.g. Stillmann cleft)
– Unstable gums due to missing keratinised (attached) gingiva
– Uneven gum line
– Discoloured gums
– Excessive gum growth due to medication
How do we address each of the problems?
Independent of the type of the gum problem, the first step to a perfect aesthetic result is always a fastidious examination and diagnosis of the aesthetic problem during the initial consultation. After establishing the right type of cosmetic dentistry and agreeing on the way how to achieve a beautiful smile. To visualise the final result either an imitation of the final situation on a stone plaster model (known as a wax-up) or a virtual aesthetic plan (Digital Smile Design®, digital smile planning) is produced. Thus we can not only analyse the problems in the best possible way and determine the necessary corrections, but also simulate the aesthetic changes before the actual treatment starts and discuss them with you. If the bone and root surface covering gum is receding due to grinding or periodontal disease or a combination of both, it is important to address and solve these issues first before starting any cosmetic procedure. As a rule the preconditions for aesthetic gum surgery are healthy and decay free teeth, no root canal infections present and no active periodontal disease.
Gingival corrections:
Regain a nice smile thanks to surgery
Asymmetric gums can be corrected by minimal invasive surgery. Our video shows how the treatment works.
We perform these treatments in these situations:
Periodontal plastic surgery to correct receding gums (Gum Graft)
There are various causes of gum recession. Minor inflammation of the gums (gingivitis) does not normally cause recession; however, Periodontitis (severe inflammation of the gums and surrounding supporting structures of the teeth) can cause permanent damage to the gums with recession being a common result.
Gum recession not only can cause medical issues such as tooth sensitivity but can also be aesthetically displeasing. Common complaints from patients with recession are that they look ‘long in the tooth’ where the tooth roots are exposed, also that they have ‘black triangles’ in between the teeth where the interdental gum has been lost leaving large gaps. This in turn leads to other functional problems such as food trapping and makes the teeth harder to keep clean. Since gums do not regenerate themselves, surgical correction in the form of gum grafts is the only solution to replace the gum tissue that has been lost.
Preparation for Gum Graft treatment
To ensure a successful result of a periodontal surgery, teeth and gums must be healthy.
Bone loss, which is often associated with advanced periodontal disease, should not be too severe.
Gum disease, such as gingivitis or periodontitis, should be treated in advance. Your Dentist may also recommend a nightguard to prevent damage from teeth grinding (bruxism).
For diabetic patients, the blood sugar level should be adjusted before the Gum Graft surgery takes place.
Two methods for Gum Graft
In order to correct gum recession, there are usually two methods available: the transplantation of tissue – the so called connective tissue graft from the palatal side of your upper jaw or the stretching of tissue – the coronally advanced flap. In most cases, both techniques are used in combination. In our clinic, all cases are planned virtually using modern technology. It allows the Dentists to have a more precise analysis and offers the opportunity for patients to view the potential result of their treatment in advance.
Tissue transplant from the palate
In this procedure, the Dentist will remove tissue (the graft) from the patient’s palate and introduce it into the gums or between gums and periosteum (outer layer of the underlying bone). The procedure takes place under local anaesthesia. Despite its complexity the procedure itself only takes around 45 minutes to one hour to complete. An alternative to soft tissue grafting with grafts from the palate for soft tissue augmentation is using artificial grafts like Alloderm or Novomatrix.
If mucosal tissue and the covering skin has been newly transplanted, an small open wound remains at the removal site (the donor site), which normally heals quickly. The risk of infection is extremely low.
When only using connective tissue for the transplant, the wound on the palate can be sutured with the residual gingiva (fixed gums).
After the procedure, it might be difficult brushing your teeth as you usually would for four to six weeks, but this is something our team can offer you support and advice on.
Both transplantation methods are highly successful, however, the transplantation of connective tissue without the covering skin is usually less painful after the operation.
Stretching of tissue (coronally advanced flap technique – gum lift)
If there is enough attached gingiva (fixed gums) below the receding gum, the exposed tooth root surface can be covered without removing a transplant from the palate. The procedure also takes place under local anaesthesia. In the first step, part of the gum tissue is carefully split from the underlying bone. For root coverage the tissue can then be gently pulled upwards towards the enamel margin of the tooth (=gum lift) and fixed there. Special cuts take the tension off the gum flap. The newly positioned gums are fixed with sutures and can then gradually heal.
This procedure can also be used in the lateral direction. The Dentist does not push the loosened gums in the direction of the tooth, but laterally in the direction of the neighbouring tooth root surface thus achieve root coverage. Compared to the transplantation of tissue, this technique only creates one surgical area, but is also limited to minor gum defects.
Generally thin gums can often be compensated for with a connective tissue graft from the palate. However, if the gum recession has already extensively progressed, surgery can only help to achieve an improvement, not the original form of the gum anatomy.
Ready to feel confident in your smile?
If you’re ready to transform your smile, it’s time to consider the award-winning professionals at Wimpole Street Dental Clinic in London. Book an appointment today to get started on your new and improved smile.
Book online or call 020 3745 7455
Exhibiting too much gum due to a high upper lip mobility (high muscle pull) the so called “gummy smile”
What can be the reasons for a gummy smile?
There are a number of reasons for of a gummy smile, the most common ones are:
- Teeth might have erupted improperly and remain partially covered by gum tissue
- Too small teeth in comparison to the gums due to genetics or wear
- A too short upper lip
- A hyperactive upper lip that is normal in length when the face is resting but lifts too high when smiling exposing a lot of gum tissue
- Enlarged gums, known as gingival hypertrophy
- A too largely grown upper jaw, that makes gums bulge out
The key components that dictate your smile aesthetics are the teeth, lips, jaws and gums. Each key components needs to be in harmony with the others. If one of the condition behind a gummy smile is genetic there is not much you can do to prevent it from happening, but there are plenty of options to correct it.
Gummy smile treatment
The appropriate treatment for a gummy smile or excess gum tissue will depend on what is causing it. Options include:
If the underlying reason for excessive gingival display is mild and due to the jaws or teeth, it can sometimes be fixed with orthodontics or Invisalign alone to shift the bite into the correct position and make the gums appear less prominent.
In case of a more severe jaw protrusion, the best course of action is orthognathic surgery. An oral surgeon will re-contour the upper jaw so that it is the correct size and then move it upward into its ideal position before securing it with plates and screws.
Veneers, fillings or crowns can make the teeth appear longer and improve the tooth-to-gum ratio if the teeth are too short thanks to wear or genetics.
If too much gum tissue is the issue, a dentist or periodontist can perform gum reshaping by taking of a little bit of the gums. In this procedure, the dentist removes the extra gum tissue and reshape it to expose more of the teeth and improve your smile aesthetics.
If the teeth in the fully erupted one of the most common ways to reduce or eliminate a gummy smile is crown-lengthening surgery. This involves to newly contour the bone and the gums by removing gum tissue and/or bone to expose more tooth and let the gums retract back to their correct position. This gummy smile correction procedure is usually conducted under local anaesthetic injection using a free guide to establish were the prospective gingival margin should be. After three month a small gum reshaping might be needed. This procedure can be accompanied by veneers and/or whitening.
Lip repositioning surgery followed by orthodontic treatment can be a good alternative to jaw surgery if the excessive gingival display is the result of a short or hyperactive upper lip.
In case of a hypermobile upper lip Botox could be a much cheaper gummy smile treatment option than surgery. However, the results are temporary and last about three to four months and it will only work when the upper lip the reason for the exposed gums. A doctor injects the lip with Botox, which paralyses the muscle and prevents it from lifting too high when you smile.
Receiving a correct diagnosis is key to all. All our dentists and specialist have the experience necessary to get to the bottom of excessive gingival display and to look at all of the components of a smile and ensure they are harmonious. In a comprehensive consultation we will examine your teeth, lips, jaws and gums, give you a diagnosis and help you decide on the best treatment option for your needs. We are well-versed in taking a team approach with other in house dental health professionals, so if you require the services of a periodontist, cosmetic dentist or oral surgeon, we can ensure the process runs smoothly.
Mechanic and traumatic injuries leading to gum loss (e.g. Stillmann cleft)
Sometimes it happens that you hurt your gums when you are brushing too hard or slip and injure your gums thus causing a gingival recession. In case you exceeded the mucogingival line two gingival grafts placed in two stages will be needed. The first graft re-establishes the keratinised tissue, while the second subepithelial gum tissue graft is harvested raising a small flap in the palatal side of your upper jaw and removing as small part of the underlying tissue – the so called connective tissue graft. These small operations stabilise the situation and can prevent any further gum disease or recession.
Unstable gums due to missing keratinised (attached) gingiva
The top part of the gums right next to the neck of the tooth is used quite heavily while chewing and is firmly attached to the underlying bone and the tooth. Gum disease, grinding your teeth or accidents lead to the loss of this keratinised tissue especially around dental implants. This in turn can lead to bacteria entering through the gum line and potentially causing inflammations and gum disease. To reestablish the fixed gingiva a small flap is raised in the upper jaw and a small piece of skin is taken out and transplanted to the lower jaw. This small tissue grafting operation under local anaesthetic is usually completely painless. After removing the gingival graft the wound is slightly susceptible to spicy food for a few weeks.
Uneven gum line – gum reshaping – laser gum contouring
Sometimes only small contours of the gum line are uneven preventing you from smiling heartily. Gum reshaping under local anaesthetic with either a scalpel (called gingivectomy) or a laser (laser gum contouring) can be used to correct that. As dental procedures go, gum reshaping is extremely safe and has an extremely low risk of infection.
Discoloured gums
In some rare circumstances amalgam filling material has been used to fill dental roots retrogradely when conducting apicectomies (cutting the inflamed tip of a tooth root). The silver part of the amalgam sometimes diffuses into the soft tissue and discolours them with a silver/grey colour. In a small surgical procedure the discoloured tissue is removed and a graft from the palate (the roof of your mouth) replaces the missing tissue.
Excessive gum growth (mostly due to medication)
Below you can find a list of medications which can cause medication induced gum growth. If multiple drugs are given together, they could act synergistically and aggravate the condition.
– Phenytoin (PHT, or 5,5-diphenylhydantoin)
– Sodium valproate
– Phenobarbitone
– Vigabatrin
– Primidone
– Mephenytoin
– Ethosuximide
The most effective treatment of drug-related gingival enlargement is withdrawal or substitution of the medication. When this treatment approach is taken, it may take from 1 to 8 weeks for resolution of gingival lesions.
Ready to feel confident in your smile?
If you’re ready to transform your smile, it’s time to consider the award-winning professionals at Wimpole Street Dental Clinic in London. Book an appointment today to get started on your new and improved smile.
Book online or call 020 3745 7455
Summary
Gum graft are among the safest surgical procedures in the dental world with a very low infection risk. During the initial check-up an evidence based treatment plan is established together with you. We need to exactly understand what parts of your smile you want to have improved. Additionally, it needs to be established what is achievable. We perform all procedures microsurgically using magnifying optical systems and under local anaesthesia. The procedures themselves are usually pain-free. We have a post-operative pain management concept which is very successful at keeping pain levels down. After about a week, the healing process is complete and we can remove the sutures. You will see the final result after about four to eight weeks.
How do gum treatments work?
We perform all procedures microsurgically and under local anaesthesia. After about a week, the healing process is complete and we can remove the sutures. You will see the final result after about four to eight weeks.
Excess gums are painlessly removed using a scalpel or electronome. Afterwards, we perform a plastic correction of your gums so that a harmonious tooth shape is created. If your teeth are still too small after the plastic gum correction we can visually enlarge them with veneers. In this way, we bring the relationship of lips, gums and teeth back into balance.
There are two ways of reducing gum disease - first, we can extract tissue from the palate and transplant it to the exposed neck of the tooth. The tissue heals there, replacing the missing gums. In the second method, we loosen the existing gums and stretch them so that they can cover the exposed tooth necks again after some time. For patients with uneven gum distribution, we combine these procedures.
For more information regarding this treatment
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