A radiant smile is an important factor in making a positive first impression in modern society. There are, however, many factors that can affect it. There are cases where the teeth have a harmonious shape and colour, but the gums show irregularities in shape (gingival recession) or are not in harmony with the lips (a gummy smile). Such a deviation from the ideal shape of the gums may be found on individual teeth, in certain areas of the mouth, or even across an entire jaw. Although a large number of people have such problems, they do not address them, either because they do not know that they can be corrected or because they do not know how easily this technique is carried out.

Gingival "recession" is defined as the retreat of the gums that leads to exposure of the tooth, so that the teeth look longer. Beyond a possible aesthetic problem, the patient may have discomfort with cold or difficulty in brushing, while because of the exposure of the root the tooth may become more vulnerable to caries. The causes are:

  • Periodontitis: The loss of the supporting bone of the tooth is accompanied by a corresponding loss of gum.
  • Traumatic brushing with vigorous movements and hard toothbrushes (img. 1): The recession mainly affects the front surface of the tooth, while gum remains in the area between the teeth.
  • Incorrect position of the tooth in the jaw, when the tooth has erupted more buccally than normal.
  • High attachment of the frenum (img. 2): When the frenum (soft tissue, the colour of the gum, that connects the gums to the lips) reaches high enough between the central incisors and «pulls» the gum.

When the recession is due to periodontal disease, in most cases it cannot be treated. In the remaining cases, with periodontal plastic surgery we can achieve anything from a 75% reduction of the recession up to 95% root coverage. For the procedure to bring the desired results, however, a change of toothbrush and of brushing technique is necessary. The patient needs to learn to use only a soft toothbrush and always to make gentle movements when brushing.

Another common aesthetic problem is the «gummy smile», that is, when the gums are revealed excessively and the teeth (or a single tooth) appear short and square.

Periodontal plastic surgery is the treatment whose main aim is to correct the aesthetic problems of the periodontal tissues. It is a very conservative technique of aesthetic periodontology with which we can correct the shape of the gums and create a beautiful, harmonious smile.

Coverage of the exposed root is carried out microsurgically, usually by placing a gingival graft taken from the palate. In more extensive recession an artificial graft may be used. Depending on the type and degree of the recession, the periodontist can assess the degree of the expected result before the correction. In the case of a gummy smile, the part of the gum judged to be excessive is removed, and it is possible that a small part of the bone around the teeth will also be removed. In both cases, the procedures are carried out at the practice, under local anaesthesia, and last approximately 1 hour. The special fine sutures are removed after 10-14 days, the post-operative pain is mild and controllable, and healing is complete within a few weeks.

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Image 2:

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