Periodontal therapy is commonly seen as intensive “deep cleaning” of gums, bone grafting and implant placement. If it’s true that these procedures represent the core of this specialty, there is also another aspect that regards it as the “plastic surgery of the mouth”. Besides the fore mentioned procedures, one of the esthetic techniques that a periodontist can offer to a patient is the so called “esthetic crown lengthening.”
Some patients present with an excessive display of gingiva in the anterior area of the mouth commonly defined as “gummy smile”. The result of this increased amount of tissue can lead to functional and/or esthetic problems. As far as the functional issues, this increased amount of tissues may cover the majority of teeth crowns leading to increased incidence of dental decay and subgingival accumulation of calculus. These outcomes occur due plaque accumulation and patients’ difficulties in cleaning efficiently the covered portion of the tooth. If this represents the medical indication for intervention, there is also an important factor that leads most of these patients to request treatment: esthetics. In fact, the excessive amount of tissue leads to a shorter tooth appearance that bothers most of the patients.
It is important to understand the reason why this overgrowth occurred. It is important to differentiate between drug induced gingival overgrowth (drug induced gingival hyperplasia), alterations of physiological tooth eruption or increased dimension of
maxillary bone (upper jaw). The common outcome is that teeth appear to be shorter and the gums showing more than they should. After reaching a correct understanding of the causes, one of the procedures used to treat this condition is called “esthetic crown lengthening”. This term describes the reason, the location (esthetic will improve the aspect and it’s done in the anterior area of the mouth) and the effect (tooth/crown lengthening) of the procedure (Fig 1 a and b). This intervention can be listed as plastic surgery since it’s generally minimally invasive and it aims to remodel the shape of the gums bringing them to a normal appearance.
Sometimes the dimension of the teeth can’t be completely restored by this procedure since their original dimensions are under normal limits. In these cases the restorative dentist can help the periodontist to recreate the ideal tooth dimension and gum shape (Fig 2 a and b). The results are usually very stable in time provided a correct identification and treatment of the causes and the patient’s correct maintenance.
Esthetic crown lengthening procedure is a refined and delicate procedure that can change the smile and esthetic of a patient with a minimally invasive surgical intervention. The periodontist is specifically trained for this task and plays an important role in improving a condition that often affects patients self esteem and social relationships.