Crown augmentation surgery improves smile gums, an
Miss Wu underwent full orthognathic treatment. Although the teeth have been arranged neatly, the appearance of the teeth seems to be far from "beautiful".
Before I evaluated him, the orthodontist had already told her that because the left and right lateral incisors on her upper jaw are "peg-shaped teeth" (peg lateral), it is expected that after the braces are removed, braces or all-ceramic veneers should be used to improve the shape and close the gaps between the teeth.
Before I evaluated him, the orthodontist had already told her that because the left and right lateral incisors on her upper jaw are "peg-shaped teeth" (peg lateral), it is expected that after the braces are removed, braces or all-ceramic veneers should be used to improve the shape and close the gaps between the teeth.
Pictured: Teeth that are too small in shape cause obvious gaps in the front teeth, and braces or veneers are needed to close the gaps.
Pictured: Miss Wu’s circumferential panoramic X-ray. The teeth have problems such as cavities, discolored fillings, large gaps between teeth, and poor proportions.
If you smile with exposed gums and large gaps between teeth, first evaluate the treatment plan with circumferential panoramic X-rays
Through intraoral examination and circumoral panoramic X-ray examination, we found the following problems with her teeth and gums:
1.Teeth with cavities, discolored fillings, and short and flat appearance
Miss Wu’s teeth themselves had caries, and the resin fillings had discoloration and gap problems. In terms of the ratio of incisor width to length, the beautiful incisor width to length ratio is about 80%, and hers is about 60%, so the teeth generally look flat and short.
2.Inflamed gums, showing gums when smiling affects appearance
In addition, her gums were also red, swollen and inflamed. At this time, using a periodontal probe for detection and examination, we found that the periodontal pockets are generally deep and bleed easily during detection. This is a phenomenon of abnormal tooth eruption (altered passive eruption), which causes part of the crown of the tooth to be covered by the tooth pulp without being fully exposed. When the crown itself is covered with too much gum, in addition to aesthetic problems, it can also easily trap dirt and grime, making it difficult to maintain periodontal health.
In terms of appearance, usually the position of the teeth themselves, gums and lip frame will affect the curve and beauty of the smile. After analysis, we found that Miss Wu has a gummy smile.
Many patients have similar problems and are concerned about appearance but don’t know the cause or how to deal with it. According to research and statistics, in the eyes of ordinary people or dentists, if more than 4mm of gums are exposed when smiling, it will look unsightly.
（Original research paper：“Comparing the Perception of Dentists and Lay People to Altered Dental Esthetics” , Journal of Esthetic and Restorative Dentistry, July 2007）
1.Teeth with cavities, discolored fillings, and short and flat appearance
Miss Wu’s teeth themselves had caries, and the resin fillings had discoloration and gap problems. In terms of the ratio of incisor width to length, the beautiful incisor width to length ratio is about 80%, and hers is about 60%, so the teeth generally look flat and short.
2.Inflamed gums, showing gums when smiling affects appearance
In addition, her gums were also red, swollen and inflamed. At this time, using a periodontal probe for detection and examination, we found that the periodontal pockets are generally deep and bleed easily during detection. This is a phenomenon of abnormal tooth eruption (altered passive eruption), which causes part of the crown of the tooth to be covered by the tooth pulp without being fully exposed. When the crown itself is covered with too much gum, in addition to aesthetic problems, it can also easily trap dirt and grime, making it difficult to maintain periodontal health.
In terms of appearance, usually the position of the teeth themselves, gums and lip frame will affect the curve and beauty of the smile. After analysis, we found that Miss Wu has a gummy smile.
Many patients have similar problems and are concerned about appearance but don’t know the cause or how to deal with it. According to research and statistics, in the eyes of ordinary people or dentists, if more than 4mm of gums are exposed when smiling, it will look unsightly.
（Original research paper：“Comparing the Perception of Dentists and Lay People to Altered Dental Esthetics” , Journal of Esthetic and Restorative Dentistry, July 2007）
Reasons for smiling and showing gums
In fact, smiley gums can be divided into many types depending on the cause, which is often not caused by a single factor, so a complete examination, analysis and diagnosis is required, and sometimes it may require comprehensive treatment by professionals in various fields.
■ Bones: Vertical maxillary excess often requires evaluation by an oral surgeon or plastic surgeon for orthognathic surgery.
■ Position of the teeth: The front teeth of the upper jaw are overprotruded or overgrown. This type of tooth needs to be evaluated and adjusted by an orthodontist.
■ Lips: The upper lip is too short (short lip) or has an excessive range of motion (hypermobile), which is often evaluated and treated by a dentist or plastic surgeon.
■ Abnormal tooth eruption and development and periodontal disease: Characteristically, part of the crown of the tooth is covered by the tooth pulp and is not completely exposed. The prevalence of abnormal tooth eruption is about 10%, and it may be caused by gums alone, or by both gums and alveolar bone. There is also a type of gingival hyperplasia disease. At this time, it is suitable to be evaluated and implemented by a periodontist. The treatment is often combined with laser crown augmentation surgery.
Therefore, Miss Wu’s treatment plan needs to consider both periodontal aspects and dental restoration aspects. With current dental technology, she is suitable to apply the concept of digital smile design to communicate and design treatment plans.
In fact, smiley gums can be divided into many types depending on the cause, which is often not caused by a single factor, so a complete examination, analysis and diagnosis is required, and sometimes it may require comprehensive treatment by professionals in various fields.
■ Bones: Vertical maxillary excess often requires evaluation by an oral surgeon or plastic surgeon for orthognathic surgery.
■ Position of the teeth: The front teeth of the upper jaw are overprotruded or overgrown. This type of tooth needs to be evaluated and adjusted by an orthodontist.
■ Lips: The upper lip is too short (short lip) or has an excessive range of motion (hypermobile), which is often evaluated and treated by a dentist or plastic surgeon.
■ Abnormal tooth eruption and development and periodontal disease: Characteristically, part of the crown of the tooth is covered by the tooth pulp and is not completely exposed. The prevalence of abnormal tooth eruption is about 10%, and it may be caused by gums alone, or by both gums and alveolar bone. There is also a type of gingival hyperplasia disease. At this time, it is suitable to be evaluated and implemented by a periodontist. The treatment is often combined with laser crown augmentation surgery.
Therefore, Miss Wu’s treatment plan needs to consider both periodontal aspects and dental restoration aspects. With current dental technology, she is suitable to apply the concept of digital smile design to communicate and design treatment plans.
Pictured: A recent photo of Miss-Wu’s upper front teeth before treatment
Crown augmentation surgery improves smile gums, and a series of all-ceramic veneers are used to rebuild a "perfect smile"
DSD Digital Smile Design: Anticipating Try-On Post-operative Smiles
After intraoral scanning and bite recording, the proportions and relative relationships of teeth and gums are referenced, and the smile curve of the lips and facial appearance are analyzed. After we work with dental technicians to design the shape of the teeth, we use special temporary materials to temporarily put them into the mouth. This allows patients to foresee and experience the design direction of our future finished products. It’s similar to the concept of trying on clothes when you buy them to know exactly whether you like or suit them.
After this step, Miss Wu was immediately able to understand our suggestion. We will first use crown augmentation surgery to modify the gums and alveolar bone to conform to the aesthetic and physiological shape, improve the width-to-length ratio of each tooth, and make the gum line harmonious with the lips. After the gum condition stabilizes, the tooth will be restored with all-ceramic veneers.
After intraoral scanning and bite recording, the proportions and relative relationships of teeth and gums are referenced, and the smile curve of the lips and facial appearance are analyzed. After we work with dental technicians to design the shape of the teeth, we use special temporary materials to temporarily put them into the mouth. This allows patients to foresee and experience the design direction of our future finished products. It’s similar to the concept of trying on clothes when you buy them to know exactly whether you like or suit them.
After this step, Miss Wu was immediately able to understand our suggestion. We will first use crown augmentation surgery to modify the gums and alveolar bone to conform to the aesthetic and physiological shape, improve the width-to-length ratio of each tooth, and make the gum line harmonious with the lips. After the gum condition stabilizes, the tooth will be restored with all-ceramic veneers.
Crown augmentation surgery: Gum plastic surgery, no longer showing gums when smiling
In order to improve the accuracy of the surgery, we made a surgical template as an auxiliary to the crown augmentation surgery. The scope of the surgery will be a total of 6 teeth in the front area of the upper jaw. By wearing the surgical template during the surgery, we can accurately trim the gums and alveolar bone to the planned position.
Illustration: Using a surgical template to assist the "crown growth" procedure, the gums can be accurately restored to the expected position.
Pre and post surgery comparison, we have improved the length of the teeth and harmonized the gum line. At the same time, the color of the gums also improves from dark red to a healthier pink.
Illustration: Using a surgical template to assist the "crown growth" procedure, the gums can be accurately restored to the expected position.
Usually we may follow up for about 3-6 months after this type of surgery. After the gum is completely stabilized, we can start making dentures or all-ceramic veneers for the front teeth.
All-ceramic patch: minimally invasive grinding, natural and realistic tooth shape
The six front teeth were restored with all-ceramic veneers, which can have the effect of changing the shape of the congenital nail-shaped teeth with poor tooth shape. The most commonly used material is lithium disilicate. Its hardness is close to enamel, and the appropriate color or transmittance can be selected according to needs, so it can be realistic, natural and without visible artificial traces after being adhered to the teeth.
The tooth surface is prepared conservatively, and the thickness of the veneer usually only needs 0.3-0.5mm (if it is prepared into a crown, it usually needs at least 1.0mm). A digital oral scanner is used to obtain a 3D digital model file of teeth, which is extremely accurate and can replace traditional impressions. In addition, we work with digital dental technicians to produce high-quality finished products through digital all-ceramic design (CAD: computer-aided design) and digital grinding machines (CAM: computer-aided production). Finally, after surface treatment of the teeth and the patch in the clinic, adhesive is used to adhere the patch to the teeth.
The tooth surface is prepared conservatively, and the thickness of the veneer usually only needs 0.3-0.5mm (if it is prepared into a crown, it usually needs at least 1.0mm). A digital oral scanner is used to obtain a 3D digital model file of teeth, which is extremely accurate and can replace traditional impressions. In addition, we work with digital dental technicians to produce high-quality finished products through digital all-ceramic design (CAD: computer-aided design) and digital grinding machines (CAM: computer-aided production). Finally, after surface treatment of the teeth and the patch in the clinic, adhesive is used to adhere the patch to the teeth.
Pictured: Six all-ceramic patches and the simulated finished product on the 3D digital model
Pictured: With natural and lifelike all-ceramic veneers attached, Miss Wu’s upper row of teeth after surgery
Although Miss Wu's course of treatment was very long, it took more than two years from the orthodontic treatment. She can trust and understand the team of doctors and technicians for their careful treatment and insistence on details. We experience the perfect combination of advanced digital dental technology and high-quality materials. The final treatment result is that the teeth, gums, and lips are in perfect harmony. I believe it will be worth it.
Pictured: Miss Wu’s newly upgraded front teeth aesthetic area
Pictured: Miss-Wu after periodontal aesthetic surgery, greatly improving the appearance of her front teeth.
Pictured: Miss-Wu after periodontal aesthetic surgery. All-ceramic veneers gave her a brighter smile.
Remark:
1.Physician cooperating with this treatment –Dr. Lin Zongyou.
2.The effects of treatment vary depending on individual conditions. Please consult a professional physician to develop a suitable course of treatment for you.
1.Physician cooperating with this treatment –Dr. Lin Zongyou.
2.The effects of treatment vary depending on individual conditions. Please consult a professional physician to develop a suitable course of treatment for you.
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