A procedure to correct the gum shape and contour thus improve the smile line. Gingivoplasty surgery is usually done on the upper front teeth (can be up to the premolar region) where the gums here can be seen when smiling.
Most of these gum defects are usually caused by gum diseases (eg. periodontitis). However, in certain cases, the gum recedes due to over brushing or probably just because the gum itself is thin (thin biotype).
In gingivoplasty, a gum graft can be done where the tissue is taken from the roof of the mouth (this is called a graft) and then stitched into place on either side of the tooth that is recessed.
Here, is a case of a young male presented with receded gum due to over brushing…
He didn’t like his teeth and gum for a few aesthetic
The teeth are uneven
The gums on his left are simply too high!!
We found out that he was a right-handed person, using his toothbrush to brush his left teeth too hard!! That causing the gum to shrink upwards.
Secondly, his gums were thin biotype and the previous dentist had over-filled his abrasion cavity with composite preventing the gum from ‘coming down’
Objectives of treatment:
Correct his over-brushing technique
Modified the over-filled composite restoration
Correct the Shape of his teeth
Gum surgery to thicken his thin biotype gum and bring his gum down at the same time
Periodontium is the tissue that immediately surrounds and supports the teeth. It consists of alveolar bone, periosteum, periodontal ligament, gingival sulcus, and gingiva; each of these components contributes to stabilizing the tooth within the jaws. Continue reading Gum Anatomy→
Gingivitis is the inflammation of the gingiva due to bacterial infection that can occur at any age but most frequently arises during adolescence. It is a disease that requires the presence and maturation of bacterial plaque
Gingivitis is diagnosed by bleeding and by changes in the colour, contour and consistency of the gingiva. Features include red swollen marginal gingiva; loss of stippling; red-purple, bulbous interdental papillae; and the increased fluid flow from the gingival crevice. Gingival bleeding and pain are induced by tooth-brushing and slight probing.
Treatment of gingivitis consists of frequent and regular removal of plaque through dental scaling and root planing. If gingivitis is left untreated for a long period of time, it will lead periodontitis which will result in loosing teeth.
After the age of 35, gum disease or periodontitis is the major cause of tooth loss in adults, far more so than tooth decay. In fact, about 80% of tooth loss can be ascribed to periodontal disease in this age group. A lot of time and money could be saved by early detection and treatment of the disease and many more people would keep their teeth if they were aware of this fact.
Periodontal disease affects the support structures of the teeth: the bone, gums and ligament (Click here for Dental Anatomy). It is long-term and slow-moving disease: painless in its initial stages, but later presenting as a chronic inflammation that damages both the gums and bone holding the teeth in place. Bacterial plaque is the main culprit here, and only fastidious daily brushing and flossing can effectively remove it.
The most common form of periodontitis is adult periodontitis. It can be localized or generalized and appears to progress episodically. During periods of exacerbationthere is advancing loss of epithelial attachment, increase periodontal pocket depth, increased gingival crevicular fluid, loss of alveolar bone and connective tissue attachment and gingival bleeding.
The predominant species associated with adult periodontitis ace Actinobaccillus actinomycetemcomitans (25-30%), Actinomyces naeslundii, Bacteriods forsythus, Campylobacter rectus, Eikenella corrodens, Eubacterium species, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia, Prophyromonas gingivalis, Selenomonas sputigena, Streptococcus intermedius and Treponema species
Types of periodontitis
Adult periodontitis can be devided into 3 types base on severity:
i) Mild (Early) Adult Periodontitis
3mm epithelial attachment loss or less (gum recession)
periodontal pocket depths of 3-5mm (determine by using a periodontal probe)
class I furcation involvement
alveolar bone loss of 2mm or less (Alveolar bone loss is determined by vertical periapical bitewing radiograph)
ii) Moderate Adult Periodontitis
4-5mm epithelial attachment loss
periodontal pocket depths of 4-6mm
alveolar l bone loss of 3-5mm
gingival exudate and bleeding
horizontal, vertical bone loss and osseous defects
mobile teeth and class II furcation involvement
iii) Advanced Adult Periodontitis
At least 6mm epithelial attachment loss
periodontal pocket depths exceed 6mm
alveolar crestal bone loss is more than 5mm
significant tooth mobility and class III furcation involvement (A through-and-through bony defect)
Other types of periodontitis
Early-onset periodontitis which can be prepubertal periodontitis and juvenile periodontitis
Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.
A study in the Journal of Periodontology found that poorly controlledtype 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.
Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.
This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.
Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease. – American Academy of Periodontology
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.
Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
When you have heart disease, maintaning goor oral health is important. Remember:
Make sure your dentist and hygienist know you have a heart problem
Have regular dental checkups
Maintain good oral health by brushing and flossing twice a day
Air polishing is an alternative, non-contact, method of polishing teeth using a polishing cup and paste after teeth scaling. It requires a special ultrasonic unit (e.g. Air Flow from EMS) that allows use of this insert in the handpiece.
Air polishing uses medical-grade sodium bicarbonate and water in a jet of compressed air to “sandblast” the surface of the enamel smooth. Examples include the Prophy-Jet® and Cavitron Jet® (Dentsply Ltd.). The nozzle is held 3 to 5 mm from the tooth, centred on the middle third of the tooth. Use at 60° to the long axis of the root. Do not direct into the gingival sulcus.