Periodontal Plastic Surgery

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Why do my teeth look longer?
Why do I get Gum Recession?
What are my treatment options for Gum Recession?
Should I treat my Recession with a Gum Graft?
I have been told I need a Crown Lengthening. What is that?

Why do my teeth look longer?

In fact, this is the edge of your gum tissue that moves away from the crown of your tooth! Your tooth root becomes exposed and sensitivity to cold, sugar, or even brushing may result. Decay may also develop because bacteria prefer the soft, rougher, yellowish root surface than the glass-like enamel on the tooth’s crown. It is sometimes unsightly and consequently can prevent some patients from smiling and speaking without self-consciousness over the appearance of their teeth.

In a normal situation, teeth erupt into the mouth with the roots fully centered in and surrounded by the jawbone on every aspect. Overlaying this bone, the gum encircle and firmly hug the necks of the teeth-like the collar of a turtleneck sweater- forming a barrier medically known as “attached gingiva.” It is pink, firm, tightly bound (“attached”) to the underlying bone and covered by a keratin layer- the stuff your nails are made of.

It is a “wear and tear” tissue, which is resistant to the abrasive action of foods during eating, biting and chewing.

Hence, this band of attached gum tissue-of several millimeters in width- serves an important protective function: the stabilization of gum margin against frictional forces that might otherwise be contributing to unbind it from the tooth neck, allowing bacteria to percolate down the root.

Unlike the mucosa, this reddish, soft, thin, moveable tissue making up the lining of your oral cavity, the attached gingiva will not budge at all when pulling on your lip or cheek. You may experience it yourself in front of a mirror! Similar tissue covers the roof of your mouth.

Why do I get gum recession?

The main factors leading to gum recession are:

Tooth Position

If instead of erupting in the center of the protective bony housing, a tooth erupts outside of it, this can result in exposure of the tooth root. Because this bone acts as a scaffold for the tissues overlaying it, the attached gingiva will not be stable and will most likely slough. Thin or non-existent bone results in thin or no gum tissue. For instance, during orthodontic treatment, if tooth roots are moved outside the bony housing, gum recession is likely to follow.


Something else you can blame your parents for is your biotype, the genetically inherited characteristics that identify you. Some people are born with an inherently thicker type of gum tissue; on the other end of the spectrum, others have very thin tissues, with a great deal of variation in between. Broadly speaking, thick and thin tissues tend to respond differently to both trauma and disease. A thinner type is more prone to wear and tear — which manifests as gum recession.


Your oral health’s best friend can also be its worst enemy — your toothbrush. More often than not, gum recession is caused or aggravated by brushing too aggressively. Overzealous use in force can traumatize, inflame and tear gum tissues resulting in recession.

Cheek, lip, and tongue muscles sometimes can attach (frenums) very near the tooth crown, exerting a pull at the gum line which may create a recession.

Gum disease

This is a common cause of gum recession. Without proper dental hygiene and regular dental visits, bacteria and plaque can start to build up underneath your gums which can eventually cause inflammation of the gums, leading to gum recession. Learn more about gum disease.


Patients that grind their teeth suffer from something called bruxism. Not only does grinding and clenching wear down the enamel on your teeth, but it can also accelerate and worsen gum recession!


While smoking can have a huge negative impact on your overall health, smoking also wreaks havoc on your gums and can cause them to recede.

What are my treatment options for gum recession?

The specialty of periodontics has developed predictable surgical techniques to deal with recession. The field of plastic periodontal surgery has made enormous strides in the last 20 years. Essentially, it is about regenerating lost or damaged gum tissues. Because grafts are placed over root surfaces, which provide no blood supply, it is vitally important that the transplanted tissue gets its blood supply from the sides. This is why surgical technique and understanding of surgical tissue manipulation is so critical to success. There are two basic gingival grafting techniques, the so-called free gingival graft, and the connective tissue graft.

Free gingival graft

A very thin layer of tissue is taken from the palate. Grafts are shaped from the donor site and transplanted to the adequately prepared recipient site to create new gum tissue; both sites will heal in a very predictable and uneventful manner. The free gingival graft is so-called because it is “freed” from the donor site completely before being inlaid on to the recipient bed.

Allografts, such as Alloderm® (human tissue donor) can also be used for gingival grafting to create new gum tissue without using tissue from the palate.             

Connective tissue graft

It involves delicate and sophisticated microsurgical techniques to prepare both the donor and recipient sites. This requires great skill, art and care.  Donor tissue is traditionally taken from beneath the palate surface. One advantage of this procedure over free gingival grafting is that the surface wounds are minimized so that healing is generally quicker and more comfortable. Modern periodontal plastic surgical techniques are limiting the necessity for taking donor material from the palate, thereby eliminating the issues of palatal discomfort. Particularly when larger or more extensive areas need grafting, allograft materials (human tissue donor) can be used safely, predictably, and effectively.

Should I treat my recession with a gum graft?

It depends! An important treatment consideration is whether the recession is stable or progressive. If it is stable and you still have adequate zones of attached gingiva (at least 1mm), there may not be a reason to do anything but monitor the situation at your scheduled hygienist therapy. When there is progression, you definitely need to intervene.

If your recession is due to periodontal disease, the first step usually involves a special cleaning, called scaling and root planing. For many patients, this treatment—along with excellent oral hygiene at home, regular dental checkups and hygienist therapy —can help stop periodontal disease and prevent further gingival loss. When you become free from periodontitis, you eventually may contemplate plastic procedures. Learn more about gum disease.

I have been told I need a crown lengthening. What is that?

Basically, there are a couple of situations where this procedure may be needed.

Functional reasons (to help restore your oral health)

If you have a cavity or if you broke your tooth at or below the gum line, your tooth can’t be restored with a filling or a cap in the usual way because gum tissue is covering the area that needs to be treated.

This minor surgical procedure aims to reposition the gum tissue further away from the neck of the tooth, down the root, so that an adequate core of healthy tooth structure becomes available for the restoration to hold on to. If the tooth stump does not stick enough above the gum, a cap cannot be securely fastened for the long term.

Alternatively, failure to perform crown lengthening results in the placement of fillings or crowns so deep under the gums that it may become a chronic source of inflammation, and discomfort.

Because gums are lining tissues, some bone must be taken away from around the tooth root, but in a very small amount. Not more than a few millimeters in height.

Your gums should heal for two to three months before the tooth is prepared for the final crown. Gums can shrink as they heal. If you don’t wait long enough, the edges of the crown could show.

Aesthetic reasons

In addition to dental restorations, crown lengthening is popular in cosmetic dentistry. This procedure—also called a “gum lift”—shall improve aesthetics if you feel that your teeth are too short, or that too much gum tissue shows when you smile. By changing the gum-to-tooth ratio, or gum contour, crown lengthening can greatly improve a “gummy” smile, make teeth appear longer and straighter, and improve symmetry.

Gummy smiles can be unsightly and consequently can prevent some patients from smiling and speaking without self-consciousness over the appearance of their teeth.

The procedure is essentially carried out in the same fashion as for a functional crown lengthening except that it extends over multiple adjacent teeth. It requires greater skills, experience, and art though.

Once a tiny “flap” of gum tissue has been lifted out of the way, the underlying bone is reshaped and artfully festooned to properly support the gum tissue in its improved position. The flap of tissue is then repositioned and sutured into place. This exposes sufficient tooth surface to reestablish the proper size of the teeth for an appealing and very natural look.

Contact Us Today

If you have questions about crown lengthening and gummy smile and are looking for a highly knowledgeable and trustworthy dentist to help, then look no further. As a board-certified periodontist, Dr. Gaumet is one of the top crown lengthening and gum recession specialists in Switzerland. Contact us today to schedule an in-person consultation.

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