Gum Correction in London

Gum graft treatment is used to treat receding gums. 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 as well as having ‘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.

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 (otherwise known as the roof of your mouth).
• 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. This allows our dentist 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, your dentist will remove tissue (the graft) from the palate (roof of the mouth) and introduce it into the gums or between gums and periosteum (the outer layer of the underlying bone). Alternatively, your dentist could decide to use artificial grafts (such as Alloderm or Novomatrix) so they do not need to obtain a graft from your palate.

A small open wound remains at the removal site from where your graft has been taken but this normally heals quickly and 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). 

The procedure takes place under local anaesthesia. Despite its complexity, the procedure itself only takes around 45 minutes to one hour to complete. After the procedure, it might be difficult brushing your teeth as you usually would for up to four to six weeks, but this is something our team can offer you support and advice on. Both methods are highly successful, however, the transplantation of connective tissue without the covering skin is usually less painful after the procedure.

Stretching of tissue

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. This is commonly known as a “gum lift”.

In the first step, part of the gum tissue is carefully split from the underlying bone. The tissue can then be gently pulled upwards towards the enamel margin of the tooth and fixed there. Special cuts take the tension off the gum flap. The newly positioned gums are fixed with sutures so they can gradually heal. The procedure also takes place under local anaesthesia.

A gummy smile is where there is too much gum visible to high upper lip mobility (high muscle pull).  The key components that dictate your smile aesthetics are the teeth, lips, jaws, and gums. Each key component needs to be in harmony with the other. If one of the conditions 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 smiles can be caused by several reasons including a genetically small upper lip, teeth that are small in comparison to the gum due to wear or genetics, enlarged gums, an overgrown upper jaw or where teeth may not be fully erupted and remain partially covered by gum tissue.

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 “too much visible gum” is mild and due to the jaws or teeth, it can sometimes be fixed with braces or invisible braces such as Invisalign 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. This involves an oral surgeon re-contouring the upper jaw so that it is the correct size and then moving 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 due to wear or genetics.
• If too much gum tissue is the issue, a dentist or periodontist can perform gum reshaping by removing a little bit of the gums. In this procedure, the dentist removes the extra gum tissue and reshapes it to expose more of the teeth and improve the look of your smile.
• Crown-lengthening surgery can be used to contour the bone and the gums by removing gum tissue and/or bone to expose more teeth and let the gums retract back to their correct position. This gummy smile correction procedure is usually conducted under local anaesthetic injection. After three months a small gum reshaping might be needed. This procedure can be accompanied by veneers and/or teeth whitening.
• Lip repositioning surgery followed by orthodontic treatment can be a good alternative to jaw surgery if the gummy smile is the result of a short or hyperactive upper lip.
• In the case of a hypermobile upper lip, Botox can be used as a more affordable 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 is 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.

All our dentists and specialists have the experience necessary to understand the cause of your gummy smile and will also consider all the components of your smile and ensure they are harmonious.

During your initial consultation, your dentist will perform a comprehensive examination of 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 and without any inconvenience.

Sometimes you may hurt your gums by brushing too hard or slipping and injure your gums thus causing a “gingival recession” (otherwise known as receding gums). In such instances, your dentist may recommend a treatment plan of two gum grafts to rectify the problem.

The first graft re-establishes the damaged tissue, while the second gum tissue graft is harvested raising a small flap in the palatal side of your upper jaw and removing a small part of the underlying tissue – the so-called connective tissue graft.

These small procedures stabilise the situation and can prevent any further gum disease or recession.

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 tissue, especially around dental implants. This in turn can lead to bacteria entering through the gum and potentially causing inflammations and gum disease.

To re-establish the gum 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 procedure under local anaesthetic is usually completely painless. After removing the gum graft the wound is sensitive to spicy food for a few weeks.

Sometimes our patients may have a slightly uneven gumline that despite its small imperfection can lead to the patient feeling self-conscious and low in confidence about their smile. 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.

In some rare circumstances, amalgam filling material has been used to fill dental roots retrospectively 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. 

Some patients often report excessive gum growth that is caused by medication. Below you can find a list of medications which can cause medication-induced gum growth. If multiple drugs are given together, they could aggravate the condition.

• Phenytoin (PHT, or 5,5-diphenylhydantoin)
• Sodium valproate
• Phenobarbitone
• Vigabatrin
• Primidone
• Mephenytoin
• Ethosuximide 

The most effective treatment for drug-related gum enlargement is withdrawal or substitution of the medication. When this treatment approach is taken, it may take from 1 to 8 weeks for your gums to return to their original state.