Introduction

A procedure to correct the gum shape and contour thus improve the smile line. Cosmetic gum surgery is usually done on the upper front teeth (can be up to the premolar region) where the gums here can be seen when smiling.

Most of these gum defects are usually caused by gum diseases (eg. periodontitis). However, in certain cases, the gum recedes due to over brushing or probably just because the gum itself is thin (thin biotype).

Here, is a case of a young male presented with receded gum due to over brushing…

He didn’t like his teeth and gum for a few aesthetic

reasons:

  • The teeth are uneven
  • The gums on his left are simply too high!!

We found out that he was a right-handed person, using his toothbrush to brush his left teeth too hard!! That causing the gum to shrink upwards.

Secondly, his gums were thin biotype and the previous dentist had over-filled his abrasion cavity  with composite preventing the gum from ‘coming down’

Objectives of treatment:

Correct his over-brushing technique

  • Modified the over-filled composite restoration
  • Correct the Shape of his teeth
  • Gum surgery to thicken his thin biotype gum and bring his gum down at the same time

Final Result

How do we do it…

Correcting the shape of the teeth and correct the old composite filling

We trimmed the edge of the incisal edge to make the teeth straight and equal.

The teeth that were tilted or rotated were trimmed at their surfaces to level them.

Before trimming

 

After Trimming

After the trimming done, we went on to the gum surgery

 

Gum Surgery

Gum Surgery here involved:

  1. Preparing the gum area by raising a partial thickness flap from tooth 11 to 23

2. Harvesting a connective tissue graft (CT graft) for the hard palate

3. After the CT graft was successfully taken, the hard palate mucosa was stitched together with nylon suture.

4. The CT graft was soaked in the cold normal saline to low the metabolism rate before it was being flatten and thinning.

5. The CT graft was then, transferred to the recipient site where the graft was inspected if it was enough to cover the defect area of the gum.

6. The CT graft was tugged under the partial thickness flap that was created earlier to increase its thickness

7. Finally, the flap was secure and ‘pull down’ by fine nylon sutures. The sutures get to hang to the contact area of the teeth

Healing Outcome

Palate after 7 days

Gum after 7 days

Palate after 2 weeks

Gum after 2 weeks

Palate after 1 month

Gum after 1 month

Final Result