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The Art of Reshaping Gingival Borders

There are times when treating patients that we need to think outside the confines of the teeth. As dentists, we treat the whole mouth. This includes the gingiva encroach on the beauty and borders of the teeth. Whether treating the teeth orthodontically and battling oral hygiene compliance (as in this case), prior to or during a cosmetic case, or due to a medication causing gingival overgrowth, when the gingiva become this hyperplastic, we need to do something to rejuvenate the smile.

While treating this 16-year-old orthodontic patient, it became clear that the combination of poor oral care at home and a slight metal sensitivity were causing significant gingival growth and irritation. We also closed large diastemas and spaces in her maxilla, and the tissue did not thin as we pulled the teeth closer together. The patient improved her home care, but the gingiva still did not respond as favorably as I would have liked. I also noticed that the frenum was a big impediment to definitively closing the midline diastema. The tissue had bunched up in this area and the frenum appeared quite exaggerated and prominent. I suggested using a diode laser to gently reshape and reestablish the gingival architecture. The patient and her parents were totally on board. First I anesthetized with carbocaine in all four quadrants, and then I used my diode laser to quickly and painlessly reshape the contours of her anatomy and remove excess tissue. I also used the laser to complete the frenectomy which frees the attachment from the maxilla and prevents the pull between #8 and 9 and the future relapse and spreading of these teeth.

The after photos shown are directly after the procedure was over. Note the absence of bleeding and immediate improvement of the bulkiness of the tissues. The appearance of the gingiva will continue to improve markedly each day. More photos to come!

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