A gummy smile, gingival hyperplasia, is very common following orthodontic treatment. While this condition usually resolves with time it happens very slowly. Cosmetically it is more desirable to show more tooth and less gum, so a simple procedure called a gingivectomy is employed. The gingivectomy is performed to remove the redundant gum tissues around the tooth to expose more of the natural tooth. There are many techniques for removing the gingiva – scalpel, electro surgery or a dental laser.
This case uses a CO2 laser to remove the tissue. This procedure can be performed quite comfortably with routine local anesthetics, though some patients will still opt for adjunctive IV conscious sedation. Following anesthesia, the base of the tooth is approximated. The laser is used to expose the natural tooth. There are proportions of the anterior teeth that must be respected for a natural looking outcome. The maxillary frenum was dissected at the time of this procedure as a preventive measure. Healing takes place in days following this procedure. The patient is usually given a chlorhexidine mouthwash and ibuprofen. They are instructed to brush normally following this procedure.
There are many nuances involved with treating a gummy smile. Other factors to consider are lip posture and bone levels around the teeth. This case was simplified as it did not require bone removal and the patients lip posture was normal.