The Gummy Smile Online 2nd Opinion Guideline

Question #2: How do I have the correct amount of gum tissue removed
with the gummy smile surgery?

This is an issue that you must discuss with your periodontist in order that you are satisfied with her or his answer. The amount of tissue to be removed is not an exact science. There are a number of factors which must be taken into account by your periodontist. It is reasonable for you to expect your periodontist to show you, on your own gums, an outline of where the anticipated surgery will extend. Not all factors can be readily visualized prior to surgery, but some of them can be addressed by your periodontist. The following items that I discuss will hopefully help you to understand what may be done for you.

The amount of the gum tissue that is to be removed by the surgery is determined by the size of the enamel crown which is covered by the gum tissue. This can be visualized by looking at the exposed part of the teeth. If nature created normal or large enamel crowns for your teeth, a simple excision of the gum tissue usually will give you a satisfactory appearance. If you have teeth which nature created as small (including their size under the gum tissue), or are worn down, you usually need the more invasive flap type of surgery.

If the teeth are small (naturally small or worn-down to appear small), then simply uncovering the enamel crown with the more-invasive flap procedure may not give you the appearance that you desire. In this type of case, it will be necessary to expose some of the root of the tooth. This requires the removal of some bone in order to expose some of the root. If it was necessary to expose some of the root, you will usually need crowns or facings placed in order to achieve the best cosmetic appearance. This is because not only is the root somewhat yellow, but its contour is different from the crown.

With regard to the issues about the above background information, your dentist can look at accurate x-rays of your teeth in order to obtain an opinion of whether you have small, large or normal sized crowns on the teeth, hidden under the gums, that you desire to have lengthened. A good, but not perfect, opinion can be made from the x-ray evaluation. The x-ray that is best is the “peri-apical” individual x-rays since they usually have less distortion than a panoramic x-ray (the type that is one film and goes “around your head”). However some panoramic x-rays can still show your doctor the size of the crowns.

Before you have your surgery done, you need to discuss these issues of tooth size with your surgeon. If your teeth are anatomically small and you aren’t prepared to have facings or crowns made, you may request that the surgery expose only the enamel that is covered by the excess gum tissue -- even though this extent of surgery won’t provide the ideal cosmetic result. The following photos show a compromise surgery, using the less-invasive gingivectomy technique, that worked on badly-worn teeth.

Questions to ask the periodontist: “Based on what you see in my mouth and on my x-rays, do you think that you will need to expose any of my roots in order to satisfy my cometic wishes?” “If you are unhappy with the amount of enamel crown that will be exposed, will you give me the option as to whether or not you expose any of the root?”

Question #45: With my high lip problem, I am not sure that reducing the extent to which the lip can go up is the only issue. What else should I look for?

When the surgery is being planned or projected to you in your consultation, you must inquire regarding whether there are any problems with the teeth being too long or uneven. Additionally, you must have your doctor address the issue regarding whether the teeth are too small (gum tissue needs removed to expose a better tooth length) or if there is too much “attached gingiva” (too much attached gingiva reduces the amount of high lip line correction that can be achieved).

Question for your surgeon:“In addition to doing the surgery to reduce my high lip line, do you see any problem with tooth length or size, as well as too much attached gingiva?”

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