Episode 98: Crown Lengthening – Fixing the Gummy Smile

Eon Engelbrecht – E-Radio-SA (0:05 – 0:49)
Welcome back to another episode of Save Your Money, Save Your Teeth. I am Eon, and as
always we are joined by Dr Clifford Yudelman from OptiSmile to help you achieve a healthy,
beautiful smile without unnecessary costs.
Today we are discussing a procedure that sits right at the intersection of health and aesthetics.
Many people feel self conscious about what is often called a gummy smile. That is where the
teeth appear a little short and the gums take centre stage when someone smiles. But there is
actually a biological solution for this that does more than simply improve appearance. It can also
help protect the teeth themselves.
So today we are talking about crown lengthening.
Dr Yudelman, welcome back.
Dr Clifford Yudelman – OptiSmile (0:49 – 1:09)
Thank you, it is great to be back. Yes, we are changing things up a little today from cracked teeth
and some of the other episodes we have done. This is something we do quite often and we
receive many questions about it. The gummy smile is something we are going to discuss in detail
today.
Eon Engelbrecht – E-Radio-SA (1:10 – 1:33)
Sometimes if you ask someone why they do not smile in photographs they will say something
like, “No, I am all gums.” Then I always wonder what they mean exactly.
So what is a gummy smile and what causes it?
A gummy smile is more of a description than a diagnosis. It simply means that more gum tissue
than normal is visible when someone smiles.
Dr Clifford Yudelman – OptiSmile (1:34 – 3:31)
The important point is that there are different causes, and the treatment depends entirely on
which one is present.
In some people the teeth are actually normal in size, but the gums sit too low on the tooth
surface. We recently had a case like this. A few months ago we treated a patient who even made
a testimonial video on our YouTube channel.
She had Invisalign because her two front teeth were positioned slightly further back. We moved
them forward with aligners. But the gum line on those teeth was very low, so the teeth appeared
much smaller compared to the ones next to them.
This condition is called altered passive eruption, and it is actually quite common.
There are also other situations where the position of the upper lip or the jaw relationship can
contribute to the appearance of a gummy smile. So the key is to identify the underlying cause
before deciding on the treatment.
Eon Engelbrecht – E-Radio-SA (3:31 – 3:38)
What exactly is aesthetic crown lengthening, and how does it change the appearance of the
teeth?
Dr Clifford Yudelman – OptiSmile (3:38 – 6:08)
Aesthetic crown lengthening is sometimes called a gingivectomy or gum contouring, depending
on the situation. I will try to simplify it as we go.
Think of it a bit like a manicure. When someone has a manicure, the cuticle around the nail is
pushed back or trimmed slightly. In a similar way, we sometimes adjust the gum around the
tooth.
In the simplest cases this can be done with a scalpel, which is the traditional method. Today we
often use a diode laser. In more complex cases the procedure may involve reshaping some of the
bone as well.
The goal is not to artificially make the teeth longer, but to expose the part of the tooth that is
already there but hidden under excess gum tissue.
When it is done correctly it changes the proportions of the tooth.
For example, when we do injection moulded composite bonding, we sometimes contour the
gums slightly with a laser first. Then we place the bonding. The teeth that previously looked
short or square suddenly look well proportioned and natural.
From a scientific perspective, the procedure is based on periodontal biology. Periodontal simply
means the tissues around the teeth. “Peri” means around and “dontal” refers to teeth.
The gums and bone must sit at a specific distance from the tooth structure in order to remain
healthy.
Aesthetic crown lengthening respects these biological rules while improving the appearance of
the smile.
When properly planned and executed the results can be dramatic and very stable.
Eon Engelbrecht – E-Radio-SA (6:09 – 6:14)
Is this a major surgical procedure and what is the recovery like?
Dr Clifford Yudelman – OptiSmile (6:15 – 8:15)
If we are only doing a gingivectomy or gum contouring with a laser, it is actually very simple
and minimally invasive.
Patients usually have local anaesthetic and generally experience very little discomfort. The gum
may look slightly grey at the edge the following day where the laser was used. Within a day or
two it looks almost healed, and after about a week it is normally perfect.
However, true crown lengthening surgery is different.
In that case the periodontist lifts the gum and reshapes the underlying bone to the correct level.
That is proper surgery.
There can be some swelling and mild to moderate discomfort, but most patients return to normal
activities quite quickly.
The surface tissues heal in a week or two, but the gums continue to remodel and stabilise over
several weeks.
This is important because if bone reshaping has been done we normally wait about six to twelve
weeks before placing veneers or crowns.
When we only use a laser, however, we can often continue treatment immediately or within a
week.
Eon Engelbrecht – E-Radio-SA (8:15 – 8:28)
You mentioned something called biological width. What is that and why must dentists
respect it?
Dr Clifford Yudelman – OptiSmile (8:28 – 11:10)
Biological width refers to the natural space between the margin of a restoration and the
underlying bone.
That space allows the gums to attach and remain healthy.
If a crown or filling invades that space the body reacts with chronic inflammation. We see this
often when a crown is placed too deep under the gum line.
Patients may develop bleeding gums, discomfort and sometimes bone loss.
Crown lengthening creates the correct biological width before placing crowns or veneers.
By moving the gum and sometimes the bone we create space so that restorations can sit
comfortably without irritating the tissues.
This principle is fundamental and supported by many years of research. It directly affects the
longevity of both the natural teeth and the restorations.
However, modern biomimetic dentistry has introduced another concept called deep margin
elevation. In some cases we can place a filling under the gum line and then place the crown on
top of that.
Different dentists use different techniques. If a dentist tells you that you must have crown
lengthening surgery before a crown can be placed, it can sometimes be worthwhile seeking a
second opinion from someone who practises biomimetic dentistry.
Eon Engelbrecht – E-Radio-SA (11:10 – 11:16)
Can crown lengthening help if a tooth has broken under the gum line?
Dr Clifford Yudelman – OptiSmile (11:16 – 12:40)
Yes, in certain situations it can.
If a tooth breaks below the gum line there may not be enough exposed tooth structure to support
a crown. Crown lengthening can expose more of the tooth so that a stable restoration can be
placed.
In this procedure the bone around the tooth is reshaped to expose more tooth structure.
It is usually preferable to try to save a natural tooth rather than replace it with an implant or
bridge whenever possible.
That said, with modern implants we see fewer crown lengthening procedures done purely to
expose tooth structure. Today we often perform gum contouring simply to improve aesthetics
when enough tooth structure already exists.
Eon Engelbrecht – E-Radio-SA (12:41 – 12:52)
How does laser technology make the procedure less invasive?
Dr Clifford Yudelman – OptiSmile (12:52 – 14:44)
Laser technology is quite remarkable.
I use a diode laser called a Picasso laser. It has a very fine tip about 0.3 millimetres wide, which
allows extremely precise trimming of gum tissue.
Interestingly, these diode lasers have not changed much since I first bought one in 2004 when I
was practising in Perth.
They are very effective for small gum adjustments.
Some dentists also use specialised lasers that can reshape bone as well. These include water
lasers or bio lasers.
Instead of using a drill to reshape bone, the laser can gently remove small amounts of bone
tissue.
It sounds dramatic, but in skilled hands it can improve comfort and reduce recovery time.
Fortunately, in most cases we only need to use the diode laser to reshape the gum slightly.
Eon Engelbrecht – E-Radio-SA (14:44 – 14:49)
Does the bone grow back after the procedure?
Dr Clifford Yudelman – OptiSmile (14:49 – 15:30)
The bone does not grow back to exactly the same position.
Sometimes after laser gum contouring we may adjust the gum slightly again later if needed. But
when bone reshaping has been performed and sufficient healing time has passed, research shows
that the results are stable.
As with many dental procedures, success depends on careful planning and doing it correctly the
first time.
Eon Engelbrecht – E-Radio-SA (15:30 – 15:36)
How long should a patient wait after surgery before getting veneers or crowns?
Dr Clifford Yudelman – OptiSmile (15:36 – 16:19)
If bone has been reshaped, healing time is very important.
The gums continue to remodel for at least six to twelve weeks. For predictable aesthetic results
we prefer to wait before placing final restorations.
If it is only minor laser contouring, treatment can continue much sooner.
Eon Engelbrecht – E-Radio-SA (16:20 – 16:24)
Is this procedure purely cosmetic or does it offer health benefits as well?
Dr Clifford Yudelman – OptiSmile (16:25 – 16:57)
It is often performed for cosmetic reasons, but it also has important health benefits.
It allows crowns or restorations to be placed in a way that respects gum health. It can reduce
plaque accumulation and improve long term stability of restorations.
So although the improvement in the smile is obvious, the biological benefits are just as
important.
Eon Engelbrecht – E-Radio-SA (16:57 – 17:07)
Finally, how does the cost compare with other treatments such as Botox for a gummy
smile?
Dr Clifford Yudelman – OptiSmile (17:07 – 19:20)
Botox is sometimes used to reduce a gummy smile by relaxing the muscles that lift the upper lip.
However, it must be used very carefully and it is only suitable in specific cases.
In Cape Town there are only a few practitioners who do it appropriately for dental indications.
Botox also requires repeat treatments because the effect wears off.
Crown lengthening, on the other hand, is a structural and biological correction. Once it is done
properly, the result is usually stable and long lasting.
So while Botox may be appropriate in certain cases, crown lengthening often addresses the
underlying cause.
Eon Engelbrecht – E-Radio-SA (19:20 – 19:50)
You have been listening to Save Your Money, Save Your Teeth.
If you feel your teeth look too short or you have been told that a tooth has broken under the gum
line, it may be worth exploring crown lengthening.
You can learn more by doing a digital smile analysis at OptiSmile.co.za.
We will see you again next time.
Keep smiling.
Narrator (20:11 – 20:56)
Discover the world of dental excellence with OptiSmile.
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If you are looking for advanced dental care in Cape Town, visit OptiSmile or book directly
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