TREATMENT TO FIX A GUMMY SMILE | GUM LIFT
Before treatment: This patient recently had a poorly done smile makeover. The dentist crowned all of her teeth. The unattractive treatment was overly aggressive with very little planning. Major bite, gum, and cosmetic issues were not addressed. The patient did not understand what was wrong. She was not happy with the results. She had told her previous dentist that she did not like her “gummy smile”. There was a large jaw defect above her upper right teeth. She was told that nothing could be done. The crowns she got did not address either of her complaints.
It has been estimated that 7 percent of men and 14 percent of women have too much gum showing more commonly called a “gummy smile”. One of the most dramatic and effective cosmetic tools available to fix a gummy smile is the gum lift.
By gently removing and contouring the extra gum tissue, dramatic smile improvements can be made. This fast to heal procedure will benefit your overall smile appearance. Your cosmetic dentist will evaluate how your gum displays when you smile and talk. The dentist will then create a gum scallop design that is right for you. Often a plastic guide is made to confirm how much gum is to be removed. This guide fits in the mouth during the removal process.
Gum lifts are planned by cosmetic dentists and done by gum specialists
The gum is removed by a gum specialist called a periodontist. Not all gum specialists have been trained to do this artfully.
After treatment: This patient really wanted a healthy nice smile and was highly motivated to achieve her goals. The gummy smile was corrected by perio-plastic surgery and the bone defect on the upper right was improved by gum grafts and jaw ridge recontouring. The prior treatment, which was only 3 years old, had already caused the loss of 4 teeth that were replaced with implants. The short crowns were replaced with new Empress crowns with the appropriate length to width ratios.
By removing the excessive tissue, the correct proportion and beauty of the underlying teeth is revealed. There are seven common causes of a gummy smile. Simple gum reshaping is the most common treatment solution for the first 4 gummy smile causes listed below.
Gum Lift Planning
The planning process of raising or evening out the gum tissue is often only a part of the artistic smile design process. Oversight of the surgery by the referring dentist is important. While many surgeons have cosmetic training, without having a plan for the long term from the regular treating dentist, the surgeon can only guess what will look good in the smile.
When ceramic veneers are planned or any restorative care in the smile, the surgeon and the restorative dentist must work as a team to deliver the exact shape and height of the gum to achieve the best overall results.
Before and after images of a patient who had a gum lift and veneers done
Gum Lift Treatment Sequencing:
- A diagnosis as to which cause is made and alternative options are explored
- The cosmetic dentist or prosthodontist will take models of your mouth, xrays, and video or photograph your smile. The video or photograph will be used to evaluate the lip movements and to measure exactly how much the gum shows in your smile when talking and smiling.
- An optional orthodontic consultation is often recommended if your condition can easily be fixed with braces
- Your dentist will create a treatment plan, make drawings of an aesthetically pleasing outcome on the photographs, and a guide that fits in the mouth that helps the surgeon. These are sent to the gum surgeon with your xrays before your appointment so the surgeon knows exactly the agenda. If your dentist doesn’t do this, go to a different dentist.
- A gum lift surgery to fix a gummy smile is done with simple novacaine in the periodontist’s office. Usually, you can go to work the next day and it generally heals in a week.
- Frequently cosmetic veneers are done after the gummy smile has been corrected.
CAUSES OF A GUMMY SMILE and treatment choices
1) Altered Passive Eruption
The teeth and bone are in the correct position but are covered with excessive amounts of gum tissue. This is a common variation of normal called “altered passive eruption”. Most common solution: Gum lift or crown lengthening
2) Altered Active Eruption
Teeth are in the correct position but are covered with excessive amounts of both bone and gum tissue. This is a common variation of normal called “altered active eruption”. The most common solution: Gum lift.
3) Super-eruption of upper teeth due to bruxism
Tooth positions throughout life are in a dynamic equilibrium. Tiny movements occur all of the time based on what is pushing or holding them in place. If an opposing lower tooth is suddenly lost or shortened, the upper tooth will start moving down (super-eruption) until if makes contact with something or a retainer is made to hold it in position.
Some people grind their teeth so much that much of the tooth length is lost. Super-eruption of the upper teeth due to tooth wear will bring the gum tissue along with the descending incisors causing a gummy smile. The most common solution: Gum lift
4) Short Upper Lip
The upper lip is too short and doesn’t fully cover the teeth and/or gums. The distance from the nose to the upper lip is shorter than normal. The most common solution: raise gum line
5) Super-eruption of upper front teeth due to jaw relationship discrepancy and lack of orthodontic stability
The upper jaw is bigger than the lower jaw and the upper teeth drift lower because there is nothing to stop them. As the teeth drift lower, the gum comes with them. The most common solution: Orthodontics with occasional surgical balancing of jaw proportions. Alternative solution: raise gum line and wear retainer
6) Hyper-Mobile Upper Lip
Think of the upper lip as a curtain that covers or hides the teeth and gums beneath it. This curtain rises up when you smile to reveal an excessive gingival display below. The smile muscles for some people will pull the upper lip up higher than normal when smiling. This is called “Hyper-mobility of the upper lip” and it allows more gum to show. The most common solutions: Botox or “lip tacking”. Alternative solution: raise the gum line or apply botox to the levator labii superioris muscles
7) Vertical Maxillary Excess
The upper jaw has a vertical dimension that is longer than it should be. The distance from the floor of the nose to the chewing surfaces of the teeth is abnormally long. This circumstance is called “vertical maxillary excess”. Most appropriate solutions: a) Orthognathic surgery/orthodontics b) Perio-plastic surgery or raise gum line c) lip tacking
Another before and after example of a patient who had gum surgery to fix a gummy smile
Reshaping the gum, gum contouring, and gum lifts are commonly done treatments when doing veneers or crowns in the front teeth. Creating more symmetry of the gum tissues allows for a more beautiful smile.
Learn more about the gum lift option to fix a gummy smile
Dr. Fondriest has written many articles on the cosmetic planning process. If you are interested in learning more about raising your gum line, contact Dr. Fondriest. We proudly serve patients from Chicago and all surrounding communities. To schedule a consultation, call our office today at (847) 234-0517.