Gum aesthetics covers periodontal procedures aimed at bringing the amount, level, symmetry and color of the gums in a smile into harmony with the teeth. When the gums show prominently while smiling, this is commonly called a “gummy smile.” Treatment depends on correctly identifying the cause, because a similar appearance can result from quite different causes.
What is a gummy smile?
A gummy smile is when a noticeable amount of gum shows above the upper teeth while smiling. Showing some gum when smiling is normal and a natural part of a smile. Whether the amount of visible gum is excessive is assessed according to facial structure, lip movement, tooth length and the person's own perception. For this reason, a gummy smile is usually an aesthetic concern rather than a medical problem.
For more information on this topic, see our article what is a gummy smile?
What causes a gummy smile?
- Altered passive eruption: After the teeth have come into place in the mouth, the gum does not recede to the level it should; the teeth look short and square.
- Gum overgrowth: Inflammation, certain medications (some anti-epileptic, blood pressure and immunosuppressive drugs) or plaque buildup during orthodontic treatment can cause the gums to overgrow.
- Overeruption of the teeth: The front teeth, together with the bone, have moved too far downward.
- Lip structure: A short upper lip, or an upper lip that rises excessively when smiling.
- Jaw structure: Excessive vertical growth of the upper jaw.
Only some of these causes can be corrected with procedures performed on the gums. In cases caused by jaw structure, an assessment by other specialties such as orthodontics or jaw surgery may be needed.
What treatments are used in gum aesthetics?
Gingivectomy and gingivoplasty
A gingivectomy is the removal of excess gum tissue; a gingivoplasty gives the gum margin a natural, harmonious contour. They are chosen when the bone level is appropriate and there is only excess soft tissue. The procedure can be performed with a scalpel, electrosurgery or a laser.
Aesthetic crown lengthening
This is performed when the bone level needs to be adjusted along with the gum. For the healthy tissues surrounding the tooth to become established, there needs to be a certain distance between the gum margin and the bone; this zone is known as the biologic width. If only the gum is trimmed without preserving this distance, the tissue may tend to return to its previous level over time or inflammation may develop. In aesthetic crown lengthening, a small flap is raised and the bone margin is also reshaped.
Gum depigmentation
Dark patches on the gums are usually due to melanin pigment and do not pose a health problem; however, they can cause aesthetic concern. Depigmentation is the removal of the pigmented surface layer with a scalpel, laser or similar methods. Pigmentation may reappear to some extent over time; this possibility is discussed before the procedure. Color changes related to smoking or other causes are first evaluated from a medical standpoint.
Other options
Where the problem is caused by excessive movement of the upper lip, botulinum toxin injections may be considered as an option in some cases. Where it is caused by overeruption of the teeth or jaw structure, orthodontic treatment or orthognathic surgery may be considered.
Who is gum aesthetics suitable for?
Gum aesthetic procedures may be considered for people whose gums cover more of the teeth than they should, whose teeth look short, whose gum levels are asymmetrical, or who have pigmentation of the gums that causes aesthetic concern. The prerequisites for being a suitable candidate are healthy gums, good oral hygiene and realistic expectations. General health problems such as uncontrolled diabetes, smoking or active gum disease can affect the timing and planning of the procedure. In a pronounced gummy smile caused by jaw structure, gum procedures alone may not be sufficient; in that case, the assessment is carried out together with other specialties.
How is the treatment planned?
Planning begins with a detailed examination. The amount of gum visible when smiling, lip movement, tooth length and proportions, gum thickness, pocket depths and bone level are assessed; radiographs are taken if needed. Photographs and, where needed, digital smile planning help discuss the target gum level in advance. The length-to-width proportions of the teeth, the position of the midline and the symmetry of the gum levels on the right and left sides are also taken into account in planning. The goal is not simply to reduce the gums but to contribute to a smile that is in harmony with the teeth and the face.
Gum aesthetics is often planned as part of the smile design process, together with prosthetic or restorative treatments. Treatment is determined individually after the examination and any necessary tests.
Aesthetic gum procedures are planned on healthy, inflammation-free gums. If gum disease is present, it is treated first; this supports both the safety of the procedure and the preservation of the result achieved.
How is the procedure performed, and how long does the process take?
The procedures are performed under local anesthesia; the aim is for you not to feel pain during the procedure. The duration varies depending on the number of teeth to be treated and the technique used. Gingivectomy and gingivoplasty, which involve only the soft tissue, take less time, whereas crown lengthening, which requires bone reshaping, is a more extensive procedure and requires stitches.
For superficial soft tissue procedures, initial healing usually takes place within a few days to two weeks. In crown lengthening, it may take a few months for the gum margin to settle into its final position. If a restoration such as a crown or veneer is planned afterward, the appropriate waiting period is determined by the clinician.
What should I keep in mind after treatment?
- Avoid very hot, spicy, acidic and hard foods in the first few days.
- Clean the treated area gently with a soft toothbrush, as your clinician recommends.
- Use the recommended mouthrinse or medications for the period indicated.
- Smoking can delay healing and may contribute to repigmentation after depigmentation.
- Attend your follow-up appointments regularly.
The correct brushing technique is important for protecting the newly formed gum margin; brushing hard and with pressure can put strain on the gum margin. For details, see our guide to proper brushing and interdental cleaning.
What are the risks and possible side effects?
Temporary swelling, tenderness and mild bleeding may occur after gum aesthetic procedures. After crown lengthening, tooth sensitivity may develop because part of the root surfaces may become exposed. Triangular gaps between the teeth may become more noticeable, small asymmetries in gum level may be seen, or the gum may tend to return somewhat to its previous level over time. After depigmentation, pigmentation may partially reappear. Results vary from person to person; these possibilities are discussed in detail before treatment.
