Periodontal (Gum) Considerations

Healthy gums should be pink, stippled (orange peel-like), firm and should exhibit a matte surface. The papillae should be pointed and should fill the embrasures (between the teeth) right up to the contact area. This will avoid unsightly “black triangles” and food traps.

Periodontal health should be established prior to placement of the final restorations and if at all possible even before commencement of restorative treatment. In order that the health of the gums be preserved, special care must be paid to all aspects of treatment from preparation and impression taking to temporization. The temporaries must display excellent fit, marginal adaptation, emergence profile, gum contour, incisal contour, and a properly developed occlusion (bite) in all directional movements.

In producing a smile that is esthetically healthy and proportionately correct, many times the gums need to be re-contoured. Many times they can just be reshaped with a laser but sometimes the bony crest beneath them also needs to be re-contoured. There is something called the “biologic width” which dictates that the crest of bone beneath the gums needs to be at least 3mm from where you would like the crest of the gums. If this width is violated, gum recession, pocket formation and periodontal disease may ensue.

So if you cosmetically re-contour the gums and then probe the crest of bone beneath to be less than that 3mm, you would then have to reduce the height of bone. In the past it was done by performing gum surgery and then waiting 12 weeks for the gums to fully heal before initiating restorative treatment. Now with the use of laser technology, this procedure can be done at the time of preparation and the healing phase is drastically reduced due to the elimination of open surgery and stitches. Post operative discomfort is very minimal requiring usually only ibuprofen afterwards. We are a high tech office which uses such laser technology.

Gum Shape and Position

The gum height of the central incisors should be symmetrical and can also match that of the canine. It is acceptable for the laterals to display the same height, however, the resultant smile may be too uniform so it is more esthetic for it to be abit shorter than the centrals.

The gum shape on the lower incisors and the upper laterals should exhibit a symmetrical half-oval or half-circular shape. The upper centrals and canines should exhibit a gum shape that is more elliptical, with their zeniths (highest point) placed more towards the back of the tooth.