Gum contouring – everything you need to know

Manrina Rhode explores different gum contouring techniques, when to use them and why the treatment is sometimes associated with ego.

Today we are going to talk about gum contouring, which is actually one of my favourite topics. I would say veneers are my favourite topic, but gum contouring is right up there. I started doing my own gum contouring in 2008, so I’ve been doing it for a while now.

It’s typically a treatment that’s referred to a periodontist, but actually, as a cosmetic dentist, quite often it’s a treatment that we want to do ourselves so that we’ve got control of the cosmetic outcomes of our treatments.

Let me talk to talk to you a little bit about how it’s done and when it might be done…

It’s all about symmetry

When you’re doing a smile makeover, the gum architecture is a really important part of your final result. There’s a particular design that your gum architecture should follow – your gingival xenith – which is the highest point of your gum margin.

Your centrals should be level, and then the laterals should be slightly lower, and then the canines should be up again and at the same level as your centrals. And then they follow back, so they come down again and premolars follow back.

If you don’t have that shape and the gum margins are visible, the smile won’t look optimised, and if the gun margins aren’t symmetrical, then what we need to remember in cosmetic dentistry is symmetry is beauty, and so that will detract from your final result.

Symmetrical result

I would rather have a symmetrical result than a result that followed those perfect smile design rules, because symmetry is so important. So, for example, if the canine zenith was really high, I’d rather have the other canine zenith also really high so that there was some some symmetry there.

The thing to think about with gum contouring is sometimes, as a cosmetic dentist, it can be associated with ego. So if the patient has a low smile line and they are hiding their gum margins when they’re smiling, then for you as a cosmetic dentist to still want to perfect those those gum positions, is just you catering to your own ego, because it’s only ever going to be you and the patient that will see those gum margins.

And as much as we want to say the way that you look is for you, it’s not for the rest of the world, if literally the rest of the world is never going to see the work that you’ve done, I think you need to question whether it’s correct to be doing cosmetic treatments in that scenario. Especially if it’s not going to add to your overall beauty when you look in the mirror or when other people see you.

The traditional gum contouring method

So regarding gum contouring, the way that I traditionally did it was reasonably gruesome, and I would say to patients, please don’t watch a Youtube video about how this is done before coming for your appointment, which inevitably meant that they did look at the YouTube video and see how gruesome it was.

The way it worked was removing gum with a scalpel, then lifting the gum up and measuring from the edge of the tooth to the bone so it is three millimetres higher than where you want the ideal new gingival zenith to be. So you cut gum to the right position, you peel the gum back, you’d remove bone, and then you’d sew the gum back down again. And there were sutures involved, there was blood involved, and it all looked a bit gruesome at the end of it.

The great thing about it was that it was really a reasonably comfortable procedure. As gruesome as it sounds, the gum gingival area has a really great blood supply, and so it healed very well. But again, because of this blood supply, it looked a bit gory. So long as the patient wasn’t smiling really big at anyone, they were just talking and living their normal life, it didn’t really impact their life while it was healing.

Laser dentistry

My practice has now evolved, and I use lasers for my gum surgeries, which I absolutely love. It means that the procedure is now truly pain free, blood free and suture free.

So I take my my soft tissue laser and I cut off the gum to the position that I want it to be. And then I take my hard tissue laser, which is the same laser at a different setting, pop it underneath the gum and remove a bit of bone. So there’s no blood, there’s no pain, there’s no stitches, there’s no downtime, and they can see that their result immediately.

If you asked an eye surgeon if he would do eye surgery without a laser, he’d be like, are you joking? And I feel like that’s the way dentistry is evolving, that we will use more and more lasers. I like my toys, and so I have all the cutting edge technology from around the world – and that’s one of them.

Bringing gum contouring into practice

There’s some really great courses out there for general dentists so they can learn and bring lasers into practice. Also, you want to make sure that you’re being mentored after you’ve done the course, so that if you’ve got questions, you’ve got someone that you can ask.

There’s no harm in learning initially the conventional way of doing a surgical gum lift, because in some cases lasers aren’t appropriate. Sometimes you may want to use a laser, but you don’t necessarily want to go in blind.

For example, if there was a really thick bone, then you wouldn’t necessarily know if you were going in underneath the gum if you had removed all the bone. So in those cases, you may still want to peel the gum back and be able to go in.

Understanding both modalities is important, even if you’re planning on using a laser. Learn a conventional lift and then move on to laser dentistry. It’s a reasonably straightforward treatment that gives really fantastic results to a small makeover. So I would encourage you to learn about what the gum position should be, and then learn how to do the procedure yourself as well.

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Visit Manrina’s website here: www.drmrlondon.co.uk.

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