The appearance of the gingival tissues surrounding the teeth plays an important role in the esthetics of the anterior maxilla and therefore a beautiful smile. Asymmetry, a “gummy smile” and incorrect gingival contours can significantly affect the harmonious appearance of the dentition. Esthetic crown lengthening to expose the anatomic crown of these teeth, in conjunction with restorative dentistry allows us to manage the excessive gingival display and the peg lateral this patient presented with. Orthodontic treatment (Dr Reid Brogden) did a great job of developing a healthy occlusion, moving the peg lateral into the proper position for restorative care and straighten the teeth, but an ideal esthetic outcome often requires additional treatment. Excessive gingival display or a gummy smile may adversely impact a patient’s appearance leading to esthetic concerns, especially in the formative teen years. 

A Deka CO2 laser was used to carefully remove excess gingival tissue, but more importantly leave adequate attached tissue for long-term periodontal health.

Full thickness flap reflection on the facial reveals excess bone in close proximity to the CEJ, osseous re-contouring corrects this and provides appropriate, longer clinical crown length. The flap is apically positioning and sutured for ideal clinical crown display.

Restorative care on tooth #’s 7 and 10 by Dr Tara Bell completes the case.
Did you know? Often short clinical crowns result from excessive, thick gingiva. Gingival tissues are described in the literature as being a “thick” or “thin” biotype. In the thick tissue biotype cases there is almost always excessive bone as well. Dr Dennis Tarnow says: “The tissue is the issue, but the bone sets the tone”, that’s so true for many periodontal or dental implant considerations. When excessive bone is present, osseous recontouring is necessary, otherwise tissue will come back and diminish the initial cosmetic result achieved.  
Treatment: There are several ways to remove excess tissue, I prefer the DEKA CO2 laser. This takes a little more time compared to a scalpel, but I find it much more accurate and precise. In this case a CO2 laser was used to carefully gain additional clinical crown length by removing excess soft tissue. A remaining adequate band of attached gingiva is necessary for long-term periodontal health. With out proper planning there is a risk of reducing the attached gingiva width too much. This width should be carefully evaluated and taken into consideration when planning all crown lengthening or resective periodontal procedures. Likewise, careful bone removal plays an important role in long-term periodontal health and the final location of the gingival margin after healing. The facial flap is positioned and sutured for ideal tooth display. Treatment is accomplished in one 60-minute visit.The ideal candidate for esthetic crown lengthening has good periodontal health and good oral hygiene, so that only cosmetic concerns need to be addressed. Uncontrolled periodontal disease or poor oral hygiene habits should be addressed prior to any cosmetic procedures. 

Content and Photography Credit:
Case Study of Local Periodontist Paul C. Kazmer, Jr. DMD, MS, PA
3550 NW Cary Pkwy., Suite 106 Cary, NC 27513 P: 919-468-6410