Periodontal Plastic Surgery

Dr. Sexton will help prepare you for periodontal surgery by performing an in-depth examination of your mouth, including digital X-rays and similar forms of imaging. Together you’ll review your medical history, discuss treatment options, and decide which form of surgery will yield the best results. Dr. Sexton will provide a detailed care sheet to take home with you after surgery. You can expect to have some swelling, discomfort, and possibly light bleeding immediately at the surgery site. We recommend taking over-the-counter pain medication and an anti-inflammatory to reduce swelling and control discomfort. Dr. Sexton will direct you on which to take or provide a prescription. Periodontal surgery is a form of oral surgery that focuses on treating gum tissue. Periodontal surgery may also be referred to as gum surgery. The goal of gum surgery is two-fold.Firstly, if your periodontitis is active, periodontal surgery may be a part of your overall periodontal therapy treatment plan. In this case, diseased or damaged tissue will be removed and exposed areas surrounding the teeth repaired in order for healing to take place.

However, periodontal surgery is generally considered low-risk and its success rate is exceptionally high. From your very first evaluation to follow-up appointments post-surgery, Dr. Sexton does everything possible to ensure patients have success with their treatment.

Dr. Sexton will go over the “game plan” for your surgery before the appointment, including how long it will take and what the process is going to involve. You can even ask for details on the surgery itself if this helps you to feel more comfortable.What happens during your surgery largely depends on which form of periodontal surgery you’re undergoing. For minor surgery, you may only need a local anesthetic and be finished in about an hour. For more invasive surgery, you may need to be put under and the entire procedure may take two hours or so.The idea of oral surgery can feel very intimidating, but rest assured that periodontal surgery is generally a much easier and more comfortable process than many patients anticipate. Anesthetic ensures you won’t feel a thing during surgery and the option for sedation is available if you’re feeling nervous or anxious. You’ll also experience less swelling and discomfort following surgery thanks to laser dentistry. When you’re ready to move forward with your surgery, you can either call our office or use this online form. If you still have questions about the surgery, we welcome you to contact us and we’ll be happy to answer your questions.You can help yourself prepare for periodontal surgery by asking Dr. Sexton as many questions as you’d like or asking for additional resources you can read. Before the date of your periodontal surgery, we also recommend finding someone who can drive you home following the surgery. Stocking your fridge with plenty of soft foods will also help you to relax post-surgery.Periodontitis, the most advanced form of gum disease, often leaves patients with damaged teeth and gum tissue, even after the infection itself has been treated. While soft gum tissue does have some natural regenerative abilities, there is a limit to what your own body can and can’t heal. Gum recession and erosion or missing gum tissue require the assistance of periodontal surgery in order to make a complete recovery.

If you have or had periodontitis, Dr. Sexton will likely recommend periodontal surgery to repair any damage as well as prevent future risks of relapsing gum disease.Complications are always a possibility with any form of surgery, oral or otherwise. For periodontal surgery, some potential complications include prolonged post-op bleeding, prolonged swelling, gum tissue or teeth hypersensitivity, and infection.

Eat a soft food diet and be cautious of very hot or very cold foods and beverages. We also recommend not smoking or drinking alcohol during the healing process. Do continue with your normal at-home dental care routine, taking special care when brushing and flossing. If you were given a special antibacterial oral rinse, be sure to use this product as often as Dr. Sexton recommends.

The long-term goal of any periodontal surgery is to increase the life expectancy of the teeth and their usefulness; it is not to be considered a cure for active periodontal disease. Basically, periodontal surgery removes tissue that has been transformed by the disease and then reconstructs the gums and surrounding tissues to better support the teeth and to recreate a normal appearance.

At Peace Periodontics, we perform periodontal plastic surgery procedures to rebuild lost gum and/or cover the roots with natural gum tissue, which reverses gum recession, making your smile look younger while decreasing the tooth’s sensitivity and reducing the possibility of root cavities.Healthy gum tissue protects your teeth from disease and is cosmetically important to ensure a natural and healthy looking smile. Periodontal Plastic Surgery is designed to restore form and function to your gum tissue if it is experiencing periodontal disease. This procedure is also used to restore the periodontal ligament and the bone that supports your teeth or an individual tooth.

Dr Ward Piepgrass is an amazing Dentist and human being. I have had him as a dentist for 31 yrs. his work is excellent, he Has tremendous talent and is a kind gentle Person. He explains what the procedure will be, his staff are kind and courteous. I would highly recommend him!

I am terribly scared of dentist from past experience! Thankfully the staff and Dr. Piepgrass made me so comfortable and fixed such a big problem I was having! You gave me so much out of this visit I cannot thank them all enough!! I highly recommend this dentist!!Though a lot of people initially assume that dental professionals solely work to repair teeth and diagnose problems with teeth, our work extends much further than this. At Post House Dental, our dental professionals also offer a wide range of periodontal plastic surgery treatments and this includes gum grafting. If you are unhappy with the way that your gums look or you’re worried that they are too noticeable, periodontal plastic surgery could help.

At Post House Dental, we are confident in our ability to provide an unmatched periodontal plastic surgery service. Regardless of the type of surgery that you’re interested in and the problem that you’re facing, we’re on hand to help. When you choose Post House Dental, you are choosing a team of skilled and experienced experts. We understand the problems that being unhappy with your gum structure can have, which is why we will do everything we can to improve things. Whether it’s reducing the appearance of a gummy smile or hiding exposing roots, you can count on us. Find out more about periodontal plastic surgery by getting in touch with Post House Dental today. All mouths are different, it’s one of the things that makes everyone individual. However, that’s not to say that everyone is happy with the way that their mouth looks. A lot of people have a gummy smile or an uneven gum line, which can cause problems with confidence. Though having a gummy smile or an uneven gum line is unlikely to cause any dental problems, you may want to have periodontal plastic surgery to improve the appearance of gums. Periodontal plastic surgery can fix a range of problems related to the gum, including hiding a gummy smile or improving an uneven gum line. In fact, it can even reduce the appearance of long teeth and hide exposed roots. There’s no need to live your life being unhappy with your smile, especially when there are excellent treatments available. Gingival plastic surgery is a fantastic option and it’s usually very straightforward.Some people suffer from gum recession and this can result in the root of the tooth becoming exposed, making teeth look long. Long teeth can cause you to look older than you are, even though recession can happen for a number of reasons. Luckily, periodontal plastic surgery can help. Using a gum craft, the tooth root can be covered and gum recession is hidden. Not only does this improve the appearance of the gum, but it also protects the roots from sensitivity or decay.

The term ‘plastic’ in periodontal plastic surgery has been derived from the Greek word, ‘plastic’. In Greek, it refers to modeling or sculpting. It is a sub-field of dentistry that specializes in correcting or restoring the function and form of teeth.

If you lose your tooth in an accident or as a result of dental issues, it will cause an indentation in the jawbone and gums. This happens because the jawbone is no longer the tooth it was holding earlier. The indentation looks unnatural every time you talk or laugh. To get rid of this issue, periodontal plastic surgery is done so that you can have a natural-looking smile and feel beautiful.If you are looking for the best cosmetic dentist in NYC or you are planning to get periodontal plastic surgery in NYC, our advice for you would be to make an appointment with ismile. With years of experience and a keen eye to understand the problems the patient is suffering from and advising the treatment that works best for them, the expert team of dentists at iSmile will ensure that you are satisfied with their medical advice and treatments.It is used to regenerate or create damaged or lost gum tissue. By using connective tissue grafting techniques, your periodontal surgeon will ensure that the exposed root surfaces are covered evenly.There are a number of procedures that surgeons use to help their patients get exactly what they want. Here are some of the most common issues that are solved by periodontal plastic surgery:

Also known as a gummy smile, the uneven gum line is a very common problem in the dental field. Have you ever felt insecure about the way your gums look when you smile? For instance, they might cover too much of a particular tooth while the rest look fine? If yes, you can get it corrected now with this procedure.With soft tissue graft, dentists help patients in restoring some of the issues they have lost previously. A small piece of tissue is either removed from the roof of your mouth or donor tissue is taken to place it in the areas where tissues are missing.It needs to be noted here that procedures might differ slightly, depending upon the patient’s condition. Once the preparation has been completed, your periodontist will ask you to bring along a family member/friend who would accompany you once the procedure is completed. A number of surgical options are available, chosen by the periodontist depending on your specific condition. Here are some of the common ones:Once you have gone through periodontal plastic surgery, it does not mean that taking care of your teeth or oral health is no longer a priority. It is a life-long commitment and you should always take care of your teeth.

Typically, a periodontist is perceived as the plastic surgeon of the dentistry field. Just like a plastic surgeon can mold or fashion any feature/part of your body according to your liking, a periodontist can change the formation of your mouth as you like.

When a gum disease results in the damage of surrounding tooth root, the dentists might decide to replace it with a graft. In this procedure, a bone graft is built by taking small parts of either your bone, a synthetic bone or a donated bone. This procedure helps in encouraging natural bone regrowth and prevents any future tooth loss.Periodontal plastic surgery procedures are done to correct or prevent traumatic or plaque disease-induced issues of alveolar, bone, mucosa and gingiva. Along with that, this treatment is also done to correct the anatomical development of the mouth.

If you are looking for the best cosmetic dentist in NY, feel free to get in touch with us and book an appointment. Do not take your oral health for granted. Cheers!

The aim of the present article is to summarize current knowledge in terms of the etiology, diagnosis, prognosis and surgical treatment of gingival recession. Whilst the main etiological factors (i.e. toothbrushing trauma and bacterial plaque) are well established, challenges still remain to be solved in the diagnostic, prognostic and classification processes of gingival recession, especially when the main reference parameter – the cemento-enamel junction – is no longer detectable on the affected tooth or when there is a slight loss of periodontal interdental attachment. Root coverage in single type gingival recession defects is a very predictable outcome following the use of various surgical techniques. The coronally advanced flap, with or without connective tissue grafting, is the technique of choice. The adjunctive use of connective tissue grafts improves the probability of achieving complete root coverage. Surgical coverage of multiple gingival recessions is also predictable with the coronally advanced flap and the coronally advanced flap plus the connective tissue graft, but no data are available indicating which, and how many, gingival recessions should be treated adjunctively with connective tissue grafting in order to limit patient morbidity and improve the esthetic outcome. None of the allograft materials currently available can be considered as a full substitute for the connective tissue graft, even if some recent results are encouraging. The need for future studies with patient-based outcomes (i.e. esthetics and morbidity) as primary objectives is emphasized in this review. Periodontal plastic surgery can successfully deal with problems such as excessive recession around teeth that cause aesthetic and sensitivity problems. Replacing lost gum tissue can restore the natural contour of your smile. Gum tissue can be augmented or replaced by a variety of means, including soft tissue grafts and relocating the existing gums in the correct position around the tooth.Soft tissue grafts are small pieces of tissue taken from other areas such as the palate and surgically implanted in the affected area. Grafts can correct those dental deformities and other problems such as severe gum disease, as well as cover exposed roots, stop bone loss, the recession of gums, and even reduce pain-causing root sensitivity. Practically the use of soft tissue grafts can increase the zone of keratinised tissue and cover exposed roots. They can also be used for ridge augmentation and papilla regeneration around implants.

Gum tissue can change or even shrink. There are many reasons for this, including receding gums (from gingivitis or periodontal disease), and loss of one or more teeth (which causes tooth-less gum tissue to shrink).A thorough examination of the area and discussion with the patient regarding their expectation and needs are of out most importance for this cosmetic procedure.

If there is excess gingival display in a gummy smile crown lengthening procedures can correct this problem and improve the smile line. A crown lengthening procedure is also indicated if there is an impingement on the biologic width, i.e. due to a subgingival crown margin. To optimize the healing process and the the surgical result, these procedures are best performed minimally invasive with enhanced vision (i.e. under the microscope). Recessions can be covered with gingival grafts. This can often improve hot-and-cold sensitivity of the teeth and improve the aesthetic appearance of the gum line.The early stages of gum disease are often characterized by red, swollen gums that bleed when brushed or flossed tooth sensitivity, exposed tooth roots, and pain at your tooth’s gum line. If left untreated, the inflammation will progress, and the gums will recede, revealing the tooth roots. The teeth may become loose and fall out when enough healthy gum tissue no longer supports them. If you notice any of these symptoms, contact your dentist or periodontist immediately to schedule an appointment.

However, when the damage is too extensive or when there has been significant bone loss, a gum graft may not be enough to restore the health of your gums. You may need to undergo dental implant surgery to replace lost teeth in these cases.Both types of grafts effectively restore the health and appearance of receding gums. Connective tissue grafts are often used when there is significant bone loss, as they can help rebuild the lost bone. Gingival grafts are typically used for cosmetic reasons, to cover up exposed tooth roots, or to improve the appearance of gums that have been damaged by receding.

Gum recession is when the gum tissue recedes away from the teeth, exposing more of the tooth and root. Gum recession can be caused by periodontal disease or other factors contributing to poor oral health. Some things that may contribute to gum recession include:If you are experiencing symptoms of gum disease, it is vital to seek treatment as soon as possible. In the early stages, when there has been minimal damage and slight bone loss, gum grafting may be able to restore your gums to their original state.For more information about gum grafting or other periodontal treatments, do not hesitate to get in touch with Bergens Periodontics & Implant Dentistry. We would be happy to schedule a consultation with you and answer any questions about gum grafts.A gum graft is a minimally invasive procedure that can restore the appearance of your gums when they have been damaged by receding or when there has been a significant bone loss. The treatment may be performed for cosmetic or health reasons, and in most cases, it will help improve both. Gum recession can leave the tooth roots exposed and vulnerable to damage, and bone loss can lead to tooth loss.In some cases, when the gums have been damaged too severely to be treated with a gum graft, the best option may be to extract the teeth and replace them with dental implants. This is a more invasive procedure than gum grafting, but it can be very effective in restoring the health of the gums and preventing tooth loss.If your dentist has told you that you need gum grafting, it is essential to seek treatment as soon as possible. Gum grafting is a surgical treatment that can restore the health of your gums, but if left untreated, the damage may be too extensive for the surgery to be effective.

A traditional gum grafting procedure is performed by removing a small amount of tissue from the roof of your mouth or a different donor site like a tissue bank. The tissue is then cleaned and prepared for implantation. The grafted tissue is then inserted into the space between the teeth and the gums, growing and attaching to the existing gum tissue. This procedure is performed under local anesthesia, and it usually takes less than an hour to complete. It is relatively painless when performed by a skilled periodontist, and little recovery time is necessary.Dr. Bryan Bergens is a Diplomate of the American Academy of Periodontology and an Assistant Professor in implant surgery at the University of Florida, School of Dentistry. Dr. Bergens is a Fellow, International Congress of Oral Implantologists and received his training at Louisiana State University. He recently became a Diplomate of The American Board of Anti-Aging Health Practitioners. He has over 31 years of practice experience. As a Board-Certified Periodontist, he practices the full scope of the specialty with expertise ranging from dental implants to periodontal surgery, sinus augmentation and gum grafting, including Laser and Pinhole surgical techniques and extractions.

Many times, by the time you notice that your gums are damaged or receding, they may be too far gone to be treated with gum grafting alone. However, if you act quickly when you first notice the signs and symptoms of periodontal disease or gum disease, you should be able to prevent more extensive damage from occurring.

If you are experiencing any of the symptoms of gum disease, it is important to seek treatment as soon as possible to protect your oral health. Early intervention is the best way to prevent more severe damage from occurring and restore your healthy gums.

Tissue grafting is often used to reconstruct receding gums and restore the protection they are designed to provide. Tissue grafting involves removing a thin piece of tissue from the roof of the mouth and then placing it between the receding gum and tooth, which allows it to grow into healthy gum tissue.Non-surgical gum disease procedures are reserved for less severe cases, like gingivitis and mild to moderate periodontitis. When caught early, these conditions can benefit from the following:

Receding gums result from the destruction of gum tissue, and when this happens, your tooth roots and underlying bone become more vulnerable to the destructive effects of periodontitis.The first visible sign of gum disease is red, inflamed gums that often bleed. When allowed to progress, the gums start to separate from the teeth, and pockets develop. Bacteria accumulate in these spaces, destroying gum tissue and bone, eventually leading to tooth loss.

During this procedure, tooth roots are cleared of all debris, and the underlying bone is reshaped. Pocket reduction is a tried and true technique in the treatment of advanced periodontal diseases; however, it cannot save teeth that are loose due to severe bone deterioration.Periodontal (gum) disease results from bacterial infections in the gums. When gum disease goes untreated, it also endangers the underlying tooth-supporting jaw bone.

During this procedure, areas of degenerated bone are cleaned and prepared to receive a bone graft, while a tissue membrane is placed between the gum and bone. The bone and gum tissue will immediately start growing. Within six months, the regenerated dental structures are strong enough to stabilize teeth that otherwise would have been lost, or receive a dental implant if the teeth could not be saved.If you have advanced periodontal disease (periodontitis), treatments are available to help you save your teeth. However, time is of the essence, as tooth loss is imminent when severe gum disease is allowed to progress.

Please use this form for general information purposes only. DO NOT send personal health information through the form below. Specific patient care questions must be addressed with your doctor during an appointment. We monitor our contact requests several times a day and will usually reply within one business day during open hours. Dr. Afshin Salamati is a periodontist in Beverly Hills, specializing in advanced gum disease care. His practice provides both traditional and regenerative treatments, and he may combine procedures to meet the needs of his patients. Cosmetic periodontal surgery can refer to a variety of treatments meant to improve the appearance of your smile in different ways. This can include esthetic crown lengthening to expose more of your natural teeth so that they don’t appear too short in comparison to the gums, or it may include gum grafting to cover up a tooth that looks overly long. We’ll go over all of your options for cosmetic surgery so that you understand what kind of changes we can make and what treatment may be best for you.If you’re not sure how you could benefit from periodontal plastic surgery, take a look at your smile in the mirror. Does it seem like there’s an excessive amount of gum visible when you pull back your lips to show your teeth? Are the roots of your teeth exposed, making them look longer than they should? These issues can make you feel reluctant about showing off your grin, but we can correct them with periodontal plastic surgery. Crown lengthening is the process of removing gum tissue to expose the parts of the tooth that are currently covered up. While this is often done to make room for a crown or another type of restoration, it can also be done to adjust the visible length of a particular tooth. If one tooth looks shorter than its neighbors, it can draw unwanted attention; we encourage you to call our periodontal office so that we can look at the area that’s bothering you and determine if crown lengthening can help. A gum graft is a procedure where soft tissue is taken from another area in your oral cavity (typically the roof of your mouth) and placed on the teeth where gum tissue has been lost or is otherwise inadequate. This procedure is often done to protect tooth roots that have become exposed due to gum recession, but it can also be used as a cosmetic procedure to even out the gum line and make sure that the teeth appear to be proportional to the soft tissues in your mouth.

Gingival recontouring (sometimes called gum recontouring) is the process of adjusting the shape and length of the gums. It’s often performed to correct a gummy smile that makes all of your teeth look particularly short. It may also be done on a specific area of your smile because one tooth appears to be lopsided compared to its neighbors. The goal is to give the gumline a more natural and even appearance so that it properly frames the teeth.

Adult tooth loss should be avoided at all costs because it is both inconvenient and expensive to correct. So while surgery may not be preferable, it is necessary for avoiding serious, and costly, complications.

Gingivitis, the most mild form of periodontal disease, starts when bacterial plaque builds up and hardens into tartar (calculus). Tartar can lead to gum irritation, inflammation, and bleeding. Because the symptoms of gingivitis are generally mild and the teeth remain stable, people often do not realize they have it. Regular dental checkups can identify early signs of gingivitis and if treated early, can prevent it from worsening into periodontitis.

A simple cleaning could heal the gums if gingivitis is relatively minor. However, if gum disease if not treated, the condition will progress, and gum surgery may be required. Because prompt action is needed, patients should consult a dentist as soon as possible at the first sign of problems.

Newark Periodontics & Dental Implant Specialists Proudly Services Neighboring Communities Included But Not Limited To : Alexandria Atherton Ben Brownsville Buckeye Lake Canyon Villa Estates Claylick Cokesbury Corners Cottage Hill Edgewater Beach Fairfield Beach Firemans Park Fleatown Fredonia Goddard Corners Granville Har-Win Acres Harbor Hills Heath Hebron Hickman Highwater Hollywood By The Lake Jacksontown Lloyd Corners Marne Nashport New Way Newark Outville Pinecrest Estates Purity Rain Rock Reform Rock Haven Park Rocky Fork Saint Louisville Sandstone Canyon Scott Corners Shell Beach Swans Thornport Thornville Tilton Crossroads Toboso Union Station Vanatta Walser Welsh Hills Wilkins Run Wooded Hills Yost Professional dental treatments, such as scaling and root planing, that remove tartar and plaque from under the gumline, may be able to treat periodontitis. But if the gums do not respond to these treatments, surgery may be required. Gum surgery aims to restore the shape, size, and overall health of the gums. There are various forms of gum grafting procedures that involve stitching synthetic or real tissue around the gums and teeth. Other treatment options use lasers to regenerate gum growth. Because there are multiple treatment options for gum issues, patients should consult with their dentist or periodontitis to determine which is most appropriate for their situation.

Gum surgery is necessary for some patients whose gum disease has become severe. After conducting an examination, a dentist generally makes a surgical recommendation. Frequently, surgery is the only option to restore gums that have receded and pulled from the tooth structures. When gums recede, the teeth can appear longer than normal and because more of the tooth and root surfaces are exposed, the risks of developing decay and infection increase. Some patients also develop pockets in their gums making surgery necessary to restore the appearance and health of the gums.Nobody likes hearing they have to have surgery but there are serious risks if appropriate treatment is avoided. Adults that experience tooth loss, often do so because of untreated gum disease. As gum disease progresses, these patients wind up losing additional teeth as additional recession continues.

Dr. Zakaria is one of the very few Periodontist in the greater Detroit area, as well as in the state of Michigan to have earned the title of Diplomate in addition to his state board certifications. Dr. Zakaria has been involved in Dental Implants, and Periodontal Plastic Surgery since 1992. Dr. Zakaria is also certified in light Parenteral Conscious Sedation.Periodontist Samir F. Zakaria, D.D.S., M.S.D. in Livonia, MI practices a full scope of conservative non-surgical and surgical services for periodontal disease (gum conditions) and a full range of Dental Implant treatments. Contact us today to schedule an appointment!Lade die kostenlose Kindle-App herunter und lese deine Kindle-Bücher sofort auf deinem Smartphone, Tablet oder Computer – kein Kindle-Gerät erforderlich. Weitere Informationen

Kundenbewertungen, einschließlich Produkt-Sternebewertungen, helfen Kunden, mehr über das Produkt zu erfahren und zu entscheiden, ob es das richtige Produkt für sie ist.Wenn Sie damit einverstanden sind, verwenden wir auch Cookies, um Ihr Einkaufserlebnis in den Stores zu ergänzen. Dies wird auch in unseren Cookie-Bestimmungen beschrieben. Dies beinhaltet die Verwendung von Cookies von Erst- und Drittanbietern, die Standardgeräteinformationen wie eine eindeutige Kennzeichnung speichern oder darauf zugreifen. Drittanbieter verwenden Cookies, um personalisierte Anzeigen zu schalten, deren Wirksamkeit zu messen, Erkenntnisse über Zielgruppen zu generieren und Produkte zu entwickeln und zu verbessern. Klicken Sie auf „Cookies anpassen“, um diese Cookies abzulehnen, detailliertere Einstellungen vorzunehmen oder mehr zu erfahren. Sie können Ihre Auswahl jederzeit ändern, indem Sie die Cookie-Einstellungen, wie in den Cookie-Bestimmungen beschrieben, aufrufen. Um mehr darüber zu erfahren, wie und zu welchen Zwecken Amazon personenbezogene Daten (z. B. den Bestellverlauf im Amazon Store) verwendet, lesen Sie bitte unsere Datenschutzerklärung.

Um die Gesamtbewertung der Sterne und die prozentuale Aufschlüsselung nach Sternen zu berechnen, verwenden wir keinen einfachen Durchschnitt. Stattdessen berücksichtigt unser System beispielsweise, wie aktuell eine Bewertung ist und ob der Prüfer den Artikel bei Amazon gekauft hat. Es wurden auch Bewertungen analysiert, um die Vertrauenswürdigkeit zu überprüfen.This book will benefit periodontists, dentists, residents and students alike by strengthening understanding of mucogingival surgery through a thorough appreciation of each part of the procedures involved.

2. Biniraj KR, Janardhanan M, Sunil MM, Sagir M, Hariprasad A, Paul TP et al. A combined periodontal – prosthetic treatment approach to manage unusual gingival visibility in resting lip position and inversely inclined upper anterior teeth: a case report with discussion. Journal International Oral Health. 2015;7(3):64-7.In this case report, care was taken regarding the preservation of a healthy periodontium, because this is a critical point for the long-term success of the restored tooth . The Dentists must constantly balance the restorative and esthetic needs of the patients with the periodontal health. A factor of particular importance is the potential that results in the periodontium damage when the margins are subgingivally. The crown margins positioned subgingivally were associated with gingival inflammation, leading to the invasion of the biological space, while the crown margins located supragingivally were associated with a lower gingival inflammation . Supragingival placement of the restoration margins allows ease of impression, cleaning and secondary caries detection and is associated with the maintenance of probing depths. Subgingival restorations can have harmful effects on neighboring hard and soft tissues, especially when they invade the junctional epithelium and the connective tissue above the bone crest. These restorations subgingivally placed have been associated with gingival inflammation, loss of connective tissue insertion and bone resorption. We agree with Simon et al. by saying that one of the goals of restorative dentistry is to create an esthetic ideal for the patient’s smile. Advances in dental materials and laboratory techniques have led to excellent mimicking of natural dentition with crowns, veneers and composite resin restorations. However, some patients with gingival and skeletal deformities may require a more complex esthetic rehabilitation. For these challenging patients, a multidisciplinary approach may be beneficial to improve the balance and harmony between all three components of the smile: lips, teeth and gums. From the dentist’s point of view, we agree with Deliberador et al. , who claims that it is important to keep in mind that the gingival excess may be the result of various etiological factors; and when the cause of this condition is identified and a precise diagnosis is obtained, a well formulated plan will produce aesthetic and functional results, a statement also claimed by Mezzalira . This study aimed to present a surgical restorative protocol, including periodontal surgery of gingival recontouring with osteotomy and rehabilitation with porcelain crowns to improve esthetics and function in a patient with over-exposed gingival smile and short clinical crowns. The patient received post-operative instructions and the following medications were prescribed: antibiotic (Amoxillin – 500 mg) every 8 hours for 7 days, analgesic and anti-inflammatory (Ibuprofen-600 mg) every 12 hours for 4 days, and mouthwashes with 0.12% chlorhexidine digluconate every 12 hours for 14 days. The suture was removed after 10 days. Elapsed 4 months, the patient was released to start the prosthetic treatment. After the end of treatment, the patient was followed-up for 1 year, without changes in the restorative and periodontal outcome. The proportionality between the teeth depends on the height and the width, with great application in extensive reconstructions, aiming to obtain the harmony between the smile and face. A nice and essential feature of the maxillary anterior teeth is the length proportionately greater than the width. The labial surface of these teeth must have, whenever possible, grooves at the horizontal direction, to “reduce”, and vertical grooves, to “increase” the length of the tooth. Also, the upper lip line determines the height of the gingival margin, which must be parallel to the contour of the upper lip. The lower lip line may have various forms and its curvature should be more or less pronounced, determining the length of the upper teeth. The incisal edge is formed by the line of the upper teeth and should be parallel to the contour of the lower lip. All these parameters are important for the dental recontouring, allowing the total balance between the analyzed structures and the teeth, making the esthetic treatment successful. 4. Caroli A, Moretto SG, Nagase DY, Nobrega AA, Oda M, Vieira GF. Avaliação do contorno gengival na estética do sorriso. Revista Instituto Ciência Saúde. 2008;26(2):242-54.

3. Cairo F, Graziani F, Franchi L, Defraia E, Prato GPP. Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. International Journal of Dentistry. 2012;1-6.6. Deliberador TM, Vieira JS, Lopes TR, Giovanini AF, Zielak JC, Brambilla CFF. Cirurgia plástica periodontal para correção de sorriso gengivoso. Revista PerioNews. 2013;7(3):281-6.

23. Zanetti GR, Brandão RCB, Zanetti LSS, De Castro GC, Borges Filho FF. Integração orto-perio-prótese para correção de assimetria gengival – relato de caso. Revista Dental Press de Estética. 2007;4(4):50-60.

Currently, health is no longer characterized only as the absence of disease, but also as a state of mind; and that state of mind of the person can be evaluated by facial expression, identified mainly by the brightness of the eyes and the smile . In this context, the teeth, especially the anterior teeth, can be considered essential to the beauty of the individual, providing freedom to smile, favoring a good social conviviality and thus promoting health at the widest aspect.The gingival contour’s zenith, as clinical parameter to restore the dental and gingival esthetics at the anterior region of the maxilla, is a key factor . It is suggested to locate the gingival contour of canines at similar level or slightly apically than at central incisors, while a more coronal gingival contour is suggested for the lateral incisors.

10. Holanda DBV, Simões DMS, Khalili JB. Recontorno cosmético em dentes anteriores superiores: relato de caso clínico. Revista Dental Press de Estética. 2006;3(1):49-58.

Next, the osteotomy and osteoplasty was executed with the aid of a spherical diamond bur at high speed (under irrigation with saline) and Ochsenbein micro chisels, aiming to restore the biological distances between the bone and the end of the future prosthetic preparation, according to the surgical template. After osteotomy and osteoplasty (figure 9), copious irrigation with saline was performed and a continuous suture was executed with nylon 5-0 (figure 10). The patient was anesthetized with 2% mepivacaine vasoconstrictor. The bisacrylic resin mockup was used as a surgical template. An inner bevel incision was performed (figure 6) following the gingival margins of the surgical template, from the left to the right maxillary premolars. The template was removed, and a second intrasulcular incision (figure 7) was performed on these teeth to allow the removal of the gingival tissue. A full-thickness no-relaxing flap was raised, exposing the local bone tissue (figure 8). The surgical guide was placed on the position again to evaluate the distance between its end and the marginal bone tissue. The etiology of gummy smile is related to several factors: changed passive eruption, increased gingival volume due to plaque accumulation or use of drugs and vertical excess of maxilla . For health promotion, the teeth need to be within the current adopted standards of beauty, that is, well-positioned and aligned clear teeth with defined shape as equal as the contralateral teeth. And with a great relationship with the group of teeth to which they belong. Similarly, the anterior teeth must present an excellent relationship with the lips, smile and face. The integration of restoration with the gums, lips, smile and face of the patient is paramount in the success of esthetic restorative procedure. 22. Sousa SJB, Magalhães D, Silva GR, Soares CJ, Soares CJ, Soares PFB et al. Cirurgia plástica periodontal para correção de sorriso gengival associada a restaurações em resina composta: relato de caso clínico. Revista Odontológica do Brasil Central. 2010;19(51):362-6.18. Rocha EP, Meireles GCS, Ramacciato JC. Avaliação da percepção de profissionais da implantodontia sobre estética. Ciência & Desenvolvimento. 2013;6(1):132-45.

13. Kaku M, Kojima S, Sumi H, Koseki H, Abedini S, Motokawa M et al. Gummy smile and facial profile correction using miniscrew anchorage. The Angle Orthodontist. 2012;82(1):170-7.

Introduction: Today, the appreciation of aesthetic dentistry by society brought to the search for materials and techniques that improve the appearance of smile, which is essential in maintaining physical and mental health of the patient. Objective: This study aimed to report a case of gummy smile involving Periodontics and Restorative Dentistry. Case report: This case, despite other possible alternatives, was solved through periodontal surgery (clinical crown augmentation associated with osteotomy) and indirect restorations with porcelain crowns. Conclusion: In our experience this procedure is safe, predictable, with minimal risks or side effects, and it is a treatment option for these cases.

The appearance of gingival tissue also has an important role in the overall aesthetic structure, especially in patients with a medium or high smile line. Harmony of color, texture, shape and architecture of the gingival tissue is extremely important in the aesthetic appearance of the smile. Ideally, the outline of the gingival margin would be parallel to the incisal line and follow the guidance of horizontal reference lines . In addition, it shall provide a suitable scalloped design, with presence of interdental papillae. This ideal contour tends inevitably to change in cases where there is loss of periodontal support. In this case report, the patient had gummy smile caused by excessive vertical maxillary growth, disharmony of width/height proportion and of the gingival zenith contour of the maxillary anterior teeth. For psychological and financial issues, the proposed treatment plan for the patient was an association of periodontal plastic surgery with osteoplasty and osteotomy, with subsequent indirect esthetic restoration with porcelain. Understanding the etiology and the treatment options is crucial in the treatment process of the patient with gummy smile. The use of silicone template establishes a predictability about the size and shape of the teeth, promoting faster work. The interaction between Periodontics and Restorative Dentistry demonstrated a potential and advantageous interactivity between the areas. Periodontal plastic intervention targeted to the supporting and covering tissues demonstrated adequate gingival recontouring, while restorative procedures enabled effectively reconstruction and cosmetic of the area rehabilitated. Therefore, the multidisciplinary actions allowed providing the functional and esthetic rehabilitation, raising the patient’s self-esteem and well-being.Various methods have been documented including gingivectomy, flap surgery bone contour, apically repositioned flap surgery, orthodontic therapy . Excessive gingival exposure is sometimes caused by vertical maxillary excess and the middle third of the long face. Surgical crown augmentation is not sufficient in these cases and the maxilla must be treated surgically with orthognathic surgery. The risk-benefit ratio must be carefully evaluated in such cases. An interdisciplinary approach is vital in such cases when the patient is unwilling to undergo major surgery.