Dr Tom Bereznicki FCGDent, founder of the Tom Bereznicki Dental Educational Foundation, considers the vital role of gum aesthetics in digital smile design, an area of dentistry which early career practitioners are increasingly becoming involved in.
It is increasingly important to consider the appearance of the gum when treating aesthetic cases, particularly in digital smile design. But despite the crucial role of ‘pink aesthetics’ in aesthetic dental practice, it is a topic that is often not so well understood by early career dental professionals, mainly due to a lack of education in this area.
In many cases, paying attention to a patient’s pink gum can be as vital as treating the shape, position and colour of their dentition. Cultivating the right balance between the tooth and periodontal tissue may be key to achieving the ‘ideal smile’ and improving your patient’s confidence.
In days gone by, patients were happy with their appearance if they avoided dentures. These days, patients are much more discerning and restorations like the cases shown below from my archives, would now be regarded as aesthetically unacceptable.
If a patient has a low lip line, the position of the gum, in theory, is not an issue. However, many patients these days often judge outcomes by aesthetics when they lift their lips out of the way.
If a lot of gum is visible when the patient smiles, the appearance and position of the gingival tissue, as well as the teeth, will certainly need to be carefully planned – in particular matching zenith points and ideally showing no ‘black’ triangles.
Correct diagnosis is essential. In the two cases below, both patients attended asking to have their teeth veneered as they hated their smiles because they thought their teeth looked too short. However, neither case required procedures to lengthen their teeth, they merely had too much gum showing and required crown lengthening.
Correct treatment planning is also crucial to greatly improve the final aesthetics of treatment. In this case, crown lengthening around the lateral incisors prior to the provision of two veneers delivered the best result for the patient.
Improving a patient’s smile by treating the appearance of the gum does not have to be complex. Even the smallest minimal surgical procedure can have a dramatic effect on aesthetics and patient confidence.
Whereas carrying out crown lengthening procedures exposes more of the patient’s tooth to achieve a harmonious balance between the gum and the tooth, gingival recession can be treated through minor surgical procedures. In the cases shown below, a laterally repositioned flap provided a successful, long-term solution.
The upcoming Perio-Occlusion Symposium on 20 September addresses gum surgery cases similar to the cases covered in this blog. My introduction to the topic will be followed by a half-day lecture delivered by Dr Reena Wadia MCGDent, a well-known specialist periodontist. Reena will examine the indications and steps of crown lengthening surgery and the optimal aesthetics we aim for. In addition, she will discuss the indications of gum recession surgery and the various procedures available. The afternoon session will be delivered by Dr Andy Toy FCGDent on how occlusion can affect the long-term stability of treatment using aligner therapy.
Information will also be available on a postgraduate courses which cover these topics in greater depth, for those who wish to extend their knowledge further.
The Perio-Occlusion Symposium takes place on Saturday 20 September in London.