“I HATE MY GUMMY SMILE”
Many patients present with this complaint. There are multiple reasons why teeth look short, which could include one or several of the following:
- Inflammation associated with poor oral hygiene, periodontal (gum) disease and faulty restorations.
- Altered passive eruption: Teeth are the correct length, but covered by excess gum tissue or the teeth have not erupted fully out of the bon
- Tooth wear
- Excessive growth of gum tissue due to medication. e.g. Drugs for epilepsy (Phenytoin), Cardiac problems (Calcium channel blockers), Cyclosporin & many others.
- Incorrect alignment of the teeth (dental malocclusion).
- Untreated fracture of tooth, leads to tooth moving out of correct alignment.
- Congenital gingival enlargement from hereditary or metabolic disorders.
- Vertical maxillary excess (the upper jaw bone is too long)
- Hyperactive upper lip muscle causing the upper lip to rise excessively when smiling.
The following are some examples of cases I have treated over the last 20 years :
Case 1.
This patient’s gum tissue was reshaped surgically to remove excess gum and bone to expose the full length of her front teeth to provide a more pleasing smile.
Before Treatment
After Treatment
Case 2
This patient was unhappy with the appearance of her teeth after orthodontic treatment. The gums were reshaped with a laser to better frame the teeth.
Before treatment
After Treatment
Case 3
This patient did not wish to have orthodontic treatment to close the space between her teeth. Reshaping her gums with a laser improved the symmetry of her smile.
Before Treatment
After Treatment
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Not every case can be treated to provide the patient with the ideal smile. Patients may not wish to have orthodontic treatment to correct the alignment of the teeth or the gummy smile may be caused by a skeletal discrepancy.
Case 4
This patient’s right lateral incisor looks short. There is an excess of gum tissue, but also the tooth is poorly aligned. The gum was reshaped and a replacement crown was provided to hide the exposed root.The shape of the crown was designed to improve the alignment of the tooth, giving a more natural look.
Before Treatment
After Treatment
Case 5
This is a case where the patient has both excessive gum tissue and a long maxilla. Aesthetic periodontal surgery was carried out to reshape the gum and bone around her teeth. She was happy with the result and decided not to have orthognathic ( jaw) surgery to reduce the height of her maxilla .
Before Treatment
After Treatment
Each case needs to be fully assessed to determine the cause and the nature of treatment required.
The treatment could include any or all of the following:
Aesthetic Periodontal surgery: Laser or surgical re-contouring of the gum and /or bone to expose the full length of the crowns of the teeth and align the gum margins to provide a pleasing smile. Think of the gums providing a photograph frame for the teeth.
Orthodontics: To straighten the teeth. Some cases will need aesthetic periodontal surgery on completion of the orthodontic treatment.
Orthognathic surgery: To reduce the length of the maxilla ( upper jaw bone ).
