Daryl E. Malena DDS  Periodontics
10838 Old Mill Road
Omaha, Nebraska 68154
402 330 4100

The visible crown of teeth can be too long, and it can be too short.  Teeth that appear "short" may be the result of extreme wear on the biting surface--which reduces the length of the enamel portion of the tooth, or the result of too much gingiva (gum) tissue which covers up the tooth from the root end. Sometimes poorly planned dentistry inadvertently creates an illusion of shortness. Some drugs and periodontal diseases cause gingiva to grow, and some patients simply have too much gum tissue as a result of their genetic make-up, usually a condition known as delayed passive eruption.

Of course, the solution for the problem must be determined individually because the cause of the problem varies and the role of each tooth in the smile is different.  Sometimes minor gingival surgery is the solution.  Sometimes the teeth need to be reshaped or resized with crowns or veneers, and sometimes an orthodontist needs to move teeth up or down in the smile.  Some cases need a combination of treatment.  In all cases the total effect on the smile and the appearance your face needs to be considered. 

There are several surgical methods to move the gum line up or down on the tooth.  A gingivectomy is an older procedure of just cutting off extra gingiva--it isn't used very often.  Gingiplasty is the term for simply reshaping the gums.  A "flap" procedure involves lifting the gingiva in order to revise the shape of the bone and then replace the tissue in a more desirable position. 

Most of the gingival reshaping and repositioning done in our office utilizes inverse bevel incisions largely made through the groove in the gums around the teeth.  Most of the bone changes are made here, often eliminating the need for sutures and resulting in very rapid healing--important because the final crowns and veneers are often delayed by long waiting periods for healing.  

The internet and dental advertising is filled with claims for laser surgery for these purposes.  We find that lasers are less precise than the tiny scalpels we use, and the healing following clean incisions is more predictable than those left by laser or electrosurgery burns.  We do use forms of chemical curettage to make minor changes in gingival shapes.  If you would like to read more about the use of lasers in periodontal surgery of all types you can read the American Academy of Periodontology's position paper on lasers: http://www.perio.org/resources-products/pdf/37-lasers.pdf

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