Cosmetic Periodontal Surgery

Cosmetic-Plastic Periodontal Surgery

Cosmetic-plastic surgery has enabled Canadians to age more gracefully. Periodontal plastic surgery has responded to this trend through the development of cosmetic surgical procedures designed to enhance the esthetics of your smile.

Options to Manage a Gummy Smile

Do you feel your teeth have become too short or your smile too gummy? Despite the appearance, your teeth may truly not be too short. Even in instances when teeth are just the right length, there may be too much gum covering what could otherwise be a beautiful smile. A Gummy Smile describes situations where teeth are covered with excess gum tissue creating a less then esthetically-pleasing smile.

Treatment for a Gummy Smile!

Although it can be argued that society places too much emphasis on looks, our body self image truly does matter. Research supports that the greatest improvement in facial esthetics results from changes to our smile.  A pleasing smile conveys a positive friendly demeanor that reflects happiness and self confidence. Our smile is viewed by all we meet as a critically important non-verbal method of communication that encompasses the interaction between our teeth, lips and gum scaffold. Currently, a medium smile with minimal gum display is considered the most esthetic. An excessive amount of gum (greater then 3mm) visible while smiling, is commonly referred to as a “gummy or horse smile” and has been reported to occur in 7% of men and 14% of women.

There exist a multiplicity of intra and extra oral causes for a gummy smile. With that said, extra oral causes for a gummy smile typically are characterized as follows,

i) Vertical Upper Jaw (Maxillary) Excess (VME)

ii) Hypermobile Upper Lip (HUL)

iii) Short Upper Lip (SUL)

Historically, when patients presented with excess mid-face skeletal growth, the only treatment option available involved a major oral surgical (Le Fort) procedure to separate the upper jaw (maxilla) from the cranial base and then reposition the entire upper jaw complex. Patients after major oral surgery typically require a hospital stay initially in Intensive Care followed by several weeks for recovery. Significant post operative complications have been reported following Le Fort upper jaw surgery.

Hypermobility of the upper lip (HUL) denotes a condition of hyper-function of the lip elevator muscles resulting in excessive gum display. HUL is considered the primary etiologic factor contributing to a gummy smile when upper lip length is within the normal range and the lower third of the face, proportionate with the remaining thirds of the face.

Treatment for the Gummy Smile – Current Options.

Our goal whenever possible is to provide patients with conservative treatment options that predictably manage serious and often intractable dental-periodontal issues. Dr. Novack has been at the forefront of refining techniques to treat a Gummy Smile while improving facial esthetics. A Lip Repositioning-Vestibular Reduction procedure involves reducing the tissue (mucosa) lining the inner aspect (vestibule) of our upper mouth to enable repositioning the upper lip down thus minimizing gum display.

Contraindications and Post Operative Sequelae Following Lip Repositioning

Adequate upper gum is required for Vestibular Reduction surgery. In severe cases, a multidisciplinary approach involving orthodontic and periodontal treatment followed by restorative procedures are required to optimally manage serious skeletal jaw issues. Each patient presents with a unique constellation of clinical issues that must be identified and appropriately addressed. From a surgical design standpoint, the extent of surgery varies dependent upon case specifics. As compared with major orthognathic Le Fort skeletal surgery, our patients typically experience only minor postoperative concerns (limited bruising, discomfort and swelling of the upper lip) following a Lip Repositioning-Vestibular Reduction procedure.

Conclusions:

Lip Repositioning-Vestibular Reduction surgery represents a paradigm shift away from major cranial-skeletal surgical procedures to an approach that can effectively treat excess gum display (VME &/or HUL). Lip Repositioning is a safe and predictable procedure with few postoperative complications. Our patients typically experience an easy recovery. The correct diagnosis, comprehensive evaluation as to  the severity of VME, HUL or a short lip along with case selection are essential prior to considering Lip Repositioning surgery. Fortunately, patients with a gummy smile now have a safe non- invasive, but nevertheless equally predictable treatment option.