An Overview

No one would ever say a ‘no’ to possess an attractive smile. Teeth are definitely important element of a sensational smile in the cosmetic dentistry, but not without the company of healthy gums. If the gum disease is present, teeth cannot be considered on firm foundation, howsoever straightening with braces or teeth whitening you may resort to. When it comes to a beautiful smile the gum or gingival tissue is just as important as overall dental health. Even the nicest teeth need nice framing. Often an unattractive smile results when the quality of gums is in question or when the actual gum between your teeth becomes weak. You can discuss your concerns with the dentists of India Dental Clinics prior to your dental India tour.

Aesthetic harmony is often disturbed if your dental hygiene is lacking, and you begin to lose gum tissue. Cosmetic gum surgery brings beneficial rescue in correcting a gummy smile where a lot of your gums are exposed and your teeth appear smaller or in the wrong place. This is why cosmetic gum surgery is something to consider along with other procedures of cosmetic dentistry or smile designing such as composite resin bonding, crowns, bridge (or both crown & bridge work), porcelain veneers or dental implants, if you’ve already lost a tooth or more to periodontal (gum) disease.

If your teeth appear short, the cosmetic gum surgery procedure lengthens them from the neck of the tooth upwards, also called crown elongation. In the resultant smile teeth appear longer and much less gum can be seen when you smile. Using different method teeth that appear too long can also be made to look balanced. Sometimes, as we age, our gums may shrink and recede which makes our teeth look too long. Though this is often age-related, it can also occur due to a bad bite or genetics.

Steps before Gum Surgery
In the initial stage of consultation your Periodontist would review medical and dental history, besides taking the dental x-rays and asking if you are under any medications for other health reasons. This is to ensure how good a candidate you are for the intended gum surgery before scheduling a date for same. Prior to the procedure, patients are urged to follow any preparatory recommendations made by the Periodontist. In addition, the Periodontist is likely to outline any temporary changes to oral hygiene methods that should be made following the procedure.

In order to ensure the healthy surroundings exist before the procedure, patients may be expected to undergo teeth cleaning. An advance procedure like scaling and root planing may be adopted to remove buildup of tartar. In a situation when crown lengthening on a single tooth is needed for reasons of preparing for dental crown a temporary one may need to be placed. This helps protect the tooth and gives the dentist a clearer view of how much soft tissue or bone needs to be removed during the lengthening procedure.

Cosmetic Periodontal Procedures

Crown lengthening (Crown Elongation)

In a situation when enhancement in the esthetics is aimed at, the extra ‘gummy’ portion is sought to be removed. Crown lengthening involves treating the ‘gummy smile’ a condition in which large amounts of gum tissues is evident around the upper teeth. Crown lengthening can be performed on a single tooth or on multiple adjacent teeth. An uneven gum line can also be distracting. In these cases, multiple-tooth crown lengthening can be done to give your teeth a longer and more attractive appearance. The Periodontist administers a local anesthetic and gently recontours excess gum and bone tissue to expose more of your natural teeth. The outcome is a much more esthetic and beautiful smile. In another situation a tooth (crown) elongation procedure is adopted. It is performed when there is not enough of the tooth exposed above the gum line of a tooth that is badly worn, decayed or fractured below the gum line to restore the tooth with a filling, crown, bridge or other restorative dentistry technique. The gum is moved back off the bone to expose the roots of the teeth and the surrounding bone. The bone level is then adjusted so more of the tooth is exposed, thereby allowing a better fit of a dental restoration.

Soft Tissue Grafts
The issues of receding gums making your teeth look longer or exposed tooth roots giving unsightly looks are addressed by aesthetic soft tissue graft procedures. The exposed roots also increase your sensitivity to heat, cold or sweets. In these cases, gum tissue can be placed in these areas to cover the lower portion of the exposed tooth. This can be done for one tooth or several teeth to even the gum line and reduce sensitivity. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may also help reduce tooth sensitivity and improve the aesthetics of the smile.

Some of the commonly used soft tissues grafts are known as (1) Connective-tissue graft. By taking gum tissue from the donor source covers the exposed root. The underlying connective tissue is then removed so that only the outermost (epithelial) layer of tissue is left. The outer layer is stitched back into place and the tissue that was removed is slipped under the gum tissue around the exposed root surface and stitched into place. This is the most common treatment for tooth root exposure. (2) Free gingival graft. A strip of tissue is removed from the roof of the mouth (palate) and stitched to the gum in the area being treated. This method is adopted for patients having very little gum tissue around their teeth. (3) Pedicle graft. A flap of gum tissue from an adjacent tooth is partially cut away and the flap (pedicle) is slid sideways over the exposed root before being stitched into place. This can only be done if the adjacent tooth has enough gum tissue to share. Pedicle grafts may be more successful than free gingival grafts because some of the original blood vessels remain in the area to help feed the grafted section.

Gingival Flap Surgery
The periodontal procedure gingival flap surgery is also known as pocket depth reduction. It involves the Periodontist using a scalpel and other instrument to separating the gums from the teeth temporarily so that the dentist can access the roots of the teeth and the bone for removal of inflamed tissue, plaque and tartar. It is used primarily to treat moderate to severe cases of periodontal (gum) disease by removing tartar in deep pockets or reducing the size of periodontal pockets. The excess plaque and tartar is removed by performing scaling and root planing. Periodontal Flap surgery is recommended in many cases where pocketing depths have reached a level that makes maintenance or cleansing difficult. Sometimes, gingival flap surgery is performed in conjunction with osseous surgery which involves removing or reshaping inflamed bone. After the procedure is complete, the gums are stitched back into place. Either these stitches dissolve or they have to be removed later. Removing or smoothening damaged tissue allows the gum tissue to better reattach to healthy bone.

Gingivoplasty – Gum Trimming
Gingivoplasty is a periodontal procedure that Periodontist addresses to surgically reshape and re-contour the gum tissue for cosmetic, physiological, or functional purposes. The soft tissue around a tooth is restored to a more normal appearance and contour. It is used to treat gum tissue (gum trimming) malformed due to genetic factors, disease or trauma. Sometimes when this happens, the gum line can cover the top third of the teeth resulting in a so-called 'gummy smile'. Correction of this complaint serves one of the simplest cosmetic dentistry procedures. This procedure can give the gums a more natural look and is often performed during or after a gingivectomy or a soft-tissue graft. The Periodontist performs this procedure using an electrosurgery unit and a specially designed electrical cutting tip. The electrosurgery unit uses electricity to cut the gum tissues and at the same time, causes the gum tissues to clot and stop bleeding. After a gingivectomy procedure, the gingivoplasty procedure thins the remaining gums tissue so the tissue looks natural and pleasing. Gingivoplasty procedures are usually done with local anesthetics, and most patients experience very little post operative pain after the procedure.

Gingivectomy
In a situation when severe gum disease (periodontitis) is present, the cure with antibiotics or scaling and root planing may not be possible. You may need to undergo gingivectomy; a surgical procedure that Periodontist performs to remove and reshape loose, diseased gum tissue to get rid of pockets between the teeth and gums. Excessive gum tissue (gingival hyperplasia) and the presence of pockets are conditions that can be cosmetically unappealing and may trap bacteria around the teeth, which can make it difficult to perform good oral hygiene. A local anesthetic is used to numb your gums to remove the loose gum tissue. After removing the gum tissue, the doctor will put a temporary putty-like substance over your gum line. This will protect your gums while they heal. You can eat soft foods and drink cool or slightly warm liquids while the putty is in place aiding healing to healthy gums. Like Gingivoplasty a gingivectomy is a relatively simple surgical procedure. A small incision is made by the dental practitioner and the excess gum tissue is removed using a dental tool.

Gum Depigmentation
The presence of Melanin pigmentation of the gingiva is most common feature in all races. Melanin hyperpigmentation usually does not present as a medical problem, but patients may complain their black gums are unaesthetic. The concern is voiced more by patients with a “gummy smile” or excessive gingival display while smiling. Gingival depigmentation is a periodontal plastic surgical procedure whereby the gingival hyperpigmentation is removed or reduced by various techniques under local anesthesia. The first and foremost indication for depigmentation is patient demand for improved esthetics. The most commonly employed technique is the surgical removal of undesirable pigmentation using scalpels. The dark pigmented areas are removed to expose the naturally pink tissue underneath. A surgical dressing is applied to assist in the healing process, which should be quick and problem free if post-surgical care instructions are followed. The new epithelium that forms is devoid of melanin pigmentation. The end result is a healthy smile that looks natural and radiates confidence. Depigmentation of gums is a procedure that can be performed on individuals of all ages, whether they have their natural teeth, dental laminate veneers, dentures, a partial or dental implants.