Gum lift

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A gum lift (also known as a gingivectomy) is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years[ as of? ] that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Contents

Causes of a gummy smile

The smile line relies on several factors, including the size and shape of the teeth, facial muscles, gum tissue, and the shape and size of the lips. Those same factors can cause a gummy smile. Gummy smiles occur because of:

Advantages

Disadvantages

The morphological characteristics of the dentition and gingiva influence a patient's smile greatly. This should be used in order to predict how a patient's smile should be restored. [4]

  1. A bony defect which cannot be corrected. If it can be corrected, this surgery must be carried out prior to the gum lift.
  2. If the gingiva is fragile.
  3. If the location of the base of the pocket is apical to the mucogingival junction. This would cause problems with healing. [5]
  4. If the patient is not affected by the aesthetics. [6]
  5. Depending on the shape of the anterior teeth, "black triangles" may develop in the area where there is labial or interproximal soft tissue recession following the gum lift. This leads to an undesired outcome. [7]
  6. A gum lift is not available on the NHS and so would need to be obtained privately, where the charge is variable. [8]

Techniques

Gingivectomy by electrosurgery

Electrosurgery is defined as "the intentional passage of high frequency waveforms or currents through tissues of the body to achieve a controllable surgical effect" [9] and has been used for over 50 years in dentistry. [10]

The presence of a circuit is essential for the process in order for a current to flow; changing the mode of activation of this current enables electrosurgery to both cut and coagulate the oral soft tissues, resulting in minimal bleeding and a clear field of view for the clinician.

Radiofrequency alternating current is used to heat the gingival tissues. The rapid alternating polarity in electrosurgery (300 kHz to 4 mHz) causes oscillation of the ions within the gingival cells resulting in friction being generated, which in turn converts electrical energy to thermal energy. [11] As the temperature is increased above 60 °C, the processes of protein coagulation and desiccation occur in which the water content of the cells is driven out. Desiccation coagulation is essential in order to achieve haemostasis and is continued until all the water is dissipated or until the temperature reaches 100 °C, whereby vaporisation of the cells occurs. [12]

There are two types of electrosurgical units; monopolar and bipolar. [13]

Monopolar units require a separate electrode which is usually in the form of a plate that the patient is lay on. The current passes through the patient's oral cavity through a wire as it completes the circuit from the active electrosurgical unit to the secondary return electrode, cutting the oral tissues as heat is produced.[ citation needed ]

Bipolar units do not require a patient return electrode as the active and return functions are performed by the cutting tip alone. Two electrodes are present on the cutting tip of the bipolar device and the current travels between these, consequently removing the need for a plate. Only the tissue contacted is included in the electrical circuit and a wider cut is achieved by this method. [11]

Surgical gingivectomy

Local anaesthetic is used to keep the patient comfortable during the procedure. The technique is completed with a surgical scalpel and involves trimming and removing the tissue around the teeth. The remaining gums are reattached in and around the teeth by sutures (stitches), and the area is cleaned with saline and patients.

After the procedure is completed, a surgical dressing, or pack, is placed in and around the teeth and gums. This dressing is left in place for about a week. [14]

Laser gingivectomy

Dental lasers, and in particular diode lasers, are being increasingly used, and gingivectomy is the most common procedure performed with dental lasers. All laser wavelengths can be used to precisely incise gingiva for restorative, cosmetic, and periodontal indications; however, diode lasers come with smaller set up and often better price. Rapid healing and reduced pain are commonly seen post-operatively and patients rarely need periodontal packing or sutures. [15] [16] [17]

Laser types include:

Scalpel vs. laser

Surgery performed by scalpel has advantages of ease of use, precise incision with well-defined margins, the healing is fast, and there is no lateral tissue damage. While the disadvantages of surgery are the need to manage operative and post-operative pain by the provision of giving anaesthesia and analgesia, as well as bleeding that results in inadequate visibility.[ citation needed ]

Laser treatment seems to have good patient acceptance as patients report minimal pain.[ citation needed ]

Diode laser is absorbed by haemoglobin and melanin, and therefore allows for easy manipulation of soft-tissue during gingival recontouring, and results in improved epithelization and healing of the wound. During the use of laser, heat will be generated which will result in coagulation, drying and vaporization around the site which will prevent bleeding by sealing the blood vessels and also inhibiting the pain receptors at the incision site.[ citation needed ]

The clinical use of a laser for gingivectomy involves repeated lasing and wiping away tissue remnants with moist gauze and this results in a bloodless operating field allowing better visibility and greater ease for the operator. The laser also sterilizes the tissues and eliminates the need for a post-surgical dressing. [18]

Better control of laser, less post-operative inflammation and pain and improved surgical site healing are benefits of laser surgery.

Soft tissue laser surgery has some disadvantages, including higher cost.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Dentist</span> Health care occupations caring for the mouth and teeth

A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.

<span class="mw-page-title-main">Gums</span> Soft tissue surrounding the roots of the teeth

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance of teeth, gums and/or bite. It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Dental extraction</span> Operation to remove a tooth

A dental extraction is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease, or dental trauma, especially when they are associated with toothache. Sometimes impacted wisdom teeth cause recurrent infections of the gum (pericoronitis), and may be removed when other conservative treatments have failed. In orthodontics, if the teeth are crowded, healthy teeth may be extracted to create space so the rest of the teeth can be straightened.

Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel.

<span class="mw-page-title-main">Gingival recession</span> Exposure in the roots of the teeth

Gingival recession, also known as gum recession and receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting in adolescence, or around the age of 10. It may exist with or without concomitant decrease in crown-to-root ratio. 85% of the world population has gingival recession on at least one tooth with denuded root surface ≥1.0 mm.

A dental laser is a type of laser designed specifically for use in oral surgery or dentistry.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

<span class="mw-page-title-main">Frenectomy</span> Surgical removal of a frenulum

A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of the upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure that is performed on infants, children, and adults. A similar procedure frenulotomy is where a tight frenulum may be relieved by making an incision in the tight tissue.

<span class="mw-page-title-main">Tooth impaction</span> Prevention of tooth eruption by a physical barrier

An impacted tooth is one that fails to erupt into the dental arch within the expected developmental window. Because impacted teeth do not erupt, they are retained throughout the individual's lifetime unless extracted or exposed surgically. Teeth may become impacted because of adjacent teeth, dense overlying bone, excessive soft tissue or a genetic abnormality. Most often, the cause of impaction is inadequate arch length and space in which to erupt. That is the total length of the alveolar arch is smaller than the tooth arch. The wisdom teeth are frequently impacted because they are the last teeth to erupt in the oral cavity. Mandibular third molars are more commonly impacted than their maxillary counterparts.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Jaw abnormality</span> Medical condition

A jaw abnormality is a disorder in the formation, shape and/or size of the jaw. In general abnormalities arise within the jaw when there is a disturbance or fault in the fusion of the mandibular processes. The mandible in particular has the most differential typical growth anomalies than any other bone in the human skeleton. This is due to variants in the complex symmetrical growth pattern which formulates the mandible.

Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva. It can cover teeth in various degrees, and can lead to aesthetic disfigurement. Fibrous enlargement is most common in areas of maxillary and mandibular tissues of both arches in the mouth. Phenotype and genotype frequency of HGF is 1:175,000 where males and females are equally affected but the cause is not entirely known. It mainly exists as an isolated abnormality but can also be associated with a multi-system syndrome.

Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.

<span class="mw-page-title-main">Gummy smile</span> Show of the anterior gingiva above the teeth when smiling

Gummy smile, also known as excessive gingival display, is a smile that shows gum under the upper lip. It is a common clinical condition, which can be caused by an abnormal dental eruption, hyperfunction of the upper lip elevator muscle, excessive vertical growth of the maxilla bone, over-eruption of the maxillary anterior teeth, or a combination of the above described factors. Several treatment options have been proposed to enhance the smile display and to reduce the gingival exposure.

<span class="mw-page-title-main">Gingival grafting</span> Surgery in which gum tissue is grafted

In periodontology, gingival grafting, also called gum grafting or periodontal plastic surgery, is a generic term for the performance of any of a number of surgical procedures in which the gingiva is grafted. The aim may be to cover exposed root surfaces or merely to augment the band of keratinized tissue.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to the root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal disease control, oral hygiene maintenance, maintaining proper embrasure space, addressing gingiva–alveolar mucosa problems, and esthetic improvement. Surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

References

  1. ↑ Allen, EP (April 1993). "Surgical crown lengthening for function and esthetics". Dental Clinics of North America. 37 (2): 163–79. doi:10.1016/S0011-8532(22)00275-0. PMID   8477863.
  2. ↑ Al-Harbi, F.; Ahmad, I. (February 2018). "A guide to minimally invasive crown lengthening and tooth preparation for rehabilitating pink and white aesthetics". British Dental Journal. 224 (4): 228–234. doi:10.1038/sj.bdj.2018.121. PMID   29472662. S2CID   3496543.
  3. ↑ Yeh, Simon; Andreana, Sebastiano (November 2004). "Crown Lengthening: Basic Principles, Indications, Techniques and Clinical Case Reports". New York State Dental Journal. 70 (8): 30–6. PMID   15615335. ProQuest   213340828.
  4. ↑ Majzoub, Zeina A.K.; Romanos, Alain; Cordioli, Giampiero (September 2014). "Crown lengthening procedures: A literature review". Seminars in Orthodontics. 20 (3): 188–207. doi:10.1053/j.sodo.2014.06.008.
  5. ↑ Thakkar, P. (10 January 2012). "Gingivectomy". Slideshare.net. Retrieved 18 March 2019.
  6. ↑ Miron, Hagai; Calderon, Shlomo; Allon, Dror (January 2012). "Upper lip changes and gingival exposure on smiling: Vertical dimension analysis". American Journal of Orthodontics and Dentofacial Orthopedics. 141 (1): 87–93. doi:10.1016/j.ajodo.2011.07.017. PMID   22196189.
  7. ↑ Tarnow, Dennis P.; Magner, Anne W.; Fletcher, Paul (December 1992). "The Effect of the Distance From the Contact Point to the Crest of Bone on the Presence or Absence of the Interproximal Dental Papilla". Journal of Periodontology. 63 (12): 995–996. doi:10.1902/jop.1992.63.12.995. PMID   1474471. S2CID   8637161.
  8. ↑ nhs.uk. (2019). Understanding NHS dental charges. [online] Available at: https://www.nhs.uk/using-the-nhs/nhs-services/dentists/understanding-nhs-dental-charges/ [Accessed 18 Mar. 2019].
  9. ↑ Osman, FS (October 1982). "Dental electrosurgery: general precautions". Journal of the Canadian Dental Association. 48 (10): 641. PMID   6754035.
  10. ↑ Krejci, Robert F.; Kalkwarl, Kenneth L.; Krause-Hohenstein, Udo (November 1987). "Electrosurgery - a biological approach". Journal of Clinical Periodontology. 14 (10): 557–563. doi:10.1111/j.1600-051x.1987.tb01516.x. PMID   3320098.
  11. 1 2 Bashetty, Kusum; Nadig, Gururaj; Kapoor, Sandhya (2009). "Electrosurgery in aesthetic and restorative dentistry: A literature review and case reports". Journal of Conservative Dentistry. 12 (4): 139–144. doi: 10.4103/0972-0707.58332 . PMC   2879725 . PMID   20543922.
  12. ↑ Caffee, H. Hollis; Ward, Dennis (September 1986). "Bipolar Coagulation in Microvascular Surgery". Plastic and Reconstructive Surgery. 78 (3): 374–377. doi:10.1097/00006534-198609000-00016. PMID   3737761. S2CID   46435712.
  13. ↑ Lepsevich, B. D. (1 January 1986). "Book Reviews : Report Writing for Business and Industry. Steven Golen, Glenn Pearce, and Ross Figgins. New York: John Wiley & Sons, 1985". Journal of Business Communication. 23 (1): 76–79. doi:10.1177/002194368602300111. S2CID   145610140.
  14. ↑ Colgate.com. (2019). Gingivectomy Surgery | Colgate Oral Care. [online] Available at: https://www.colgate.com/en-us/oral-health/conditions/gum-disease/gingivectomy-surgery-what-you-need-to-know-0816 [Accessed 21 Mar. 2019].
  15. ↑ Dentalcare.com. (2019). Gingivectomy | Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice | CE Course | dentalcare.com. [online] Available at: https://www.dentalcare.com/en-us/professional-education/ce-courses/ce394/gingivectomy [Accessed 21 Mar. 2019].
  16. ↑ Borzabadi-Farahani, A; Cronshaw, M (2017). "Lasers in Orthodontics". In Coluzzi, D; Parker, S (eds.). Lasers in Dentistry—Current Concepts. Textbooks in Contemporary Dentistry. Springer, Cham. pp. 247–271. doi:10.1007/978-3-319-51944-9_12. ISBN   978-3-319-51943-2.
  17. ↑ Borzabadi-Farahani, A. (2017). "The Adjunctive Soft-Tissue Diode Laser in Orthodontics". Compend Contin Educ Dent. 38 (eBook 5): e18 –e31. PMID   28509563.
  18. ↑ Elavarasu, Sugumari; Naveen, Devisree; Thangavelu, Arthiie (2012). "Lasers in periodontics". Journal of Pharmacy and Bioallied Sciences. 4 (6): S260-3. doi: 10.4103/0975-7406.100245 . PMC   3467892 . PMID   23066266.

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