Smile Enhancement

Cosmetic Periodontal Surgery: Smile Enhancement

Procedures can be performed to enhance a smile by either adding” or removing” gum tissue in key places for the desired cosmetic outcome. When adding” tissue, we can predictably cover unsightly, sensitive, or exposed root surfaces as well as prevent future gum recession. When removing” tissue, we can expose what appears to be short unsightly teeth and create a more natural smile with the full shape and contours that our teeth naturally provide. These periodontal procedures can be done in combination with veneers or crowns for truly enhanced esthetic results.

Simple Smile Enhancement

Esthetic Crown Lengthening: Although teeth can appear short, they may actually be the proper length. The teeth may be covered with too much gum and bone tissue. We can correct this by performing the periodontal plastic surgery procedure, esthetic crown lengthening.

During this procedure, excess gum and bone tissues are reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even the gum line, and to create a beautiful smile.

Gummy Smile: Correcting the Gummy Smile The gummy smile makes the teeth look short and not in proportion with the patient’s face. By sculpting the gum to make the teeth appear more natural, the smile can be greatly enhanced.

Correcting the Uneven Gumline

gummy smiles

Gummy smile results in short teeth with uneven gumline

tissue sculpting

After tissue sculpting and veneers, a beautiful smile with teeth the proper size for the patient’s face

gummy smiles

Overgrowth of gum tissue during orthodontics

tissue sculpting

Tissue surgically trimmed to normal contour


healed tissue

Healed tissue with a pleasing appearance

Soft tissue graft: Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession, and protect the roots from decay and eventual loss. We can re-establish an ideal smile line with correct inter-relationships between the tooth to gum proportions.

Root Coverage: When there is gum recession, the root of the tooth often shows and is unsightly. Gum grafting is needed to restore health, but root coverage may also be desired to improve appearance. This is generally accomplished with a connective tissue graft, which provides new attached gingiva while covering the root surface.

Correcting Gum Recession


Recession of canine gum producing a “fang-like” appearance

root coverage

Complete root coverage with normal gum contour


front tooth root exposed

Front tooth with unsightly root exposed

After Root Coverage

Improved cosmetics after root coverage


upper premolar

upper premolar

upper molar

upper premolar

Root coverage of upper premolars, left and right

anterior recession
anterior recession

Unsightly anterior recession

recession corrected

recession corrected

Recession corrected with root coverage procedure

Bone grafting: Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, an appearance of general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to your original teeth.

Bone grafting an extraction socket following tooth loss can preserve the jaw bone in the immediate tooth extraction site. This will help to minimize gum and bone collapse in the area. This will ensure a more aesthetic outcome with the final tooth replacement with an implant crown or fixed bridge.

Extraction Sites: After a tooth extraction, the gum heals down in the socket before the bone has time to completely reform, leaving a resorbed ridge. To prevent bone resorption after extraction, we suggest the socket be filled with a material (bone graft) that reduces gum shrinkage or the socket be isolated with a membrane that prevents gum downgrowth (See Guided Tissue Regeneration). Treating the problem before it occurs is ideal.

Bone Loss from Tooth Extraction
Socket / Jaw Bone Preservation


Without treatment, gum downgrowth into the socket after extraction.

membranced placed

Membrane placed over extraction site to prevent gum downgrowth, allowing bone time to fill the socket.

Lip Repositioning

A new and revolutionary approach is available called “Lip Repositioning”. It is a newly developed procedure that corrects gummy smiles caused by a hyperactive lip (high upper lip). Lip repositioning is a short and minimally invasive surgical procedure that lowers the junction of the upper lip to the inside of the mouth. The procedure restricts upper lip movement in full smile and dramatically reduces the amount of gum exposure on full smile. This is accomplished through removal of a small strip of tissue from the inside of the upper lip. Once the small strip of tissue has been removed, the upper lip is sutured into a new, lower position. In some cases, a ‘Trial’ Lip Repositioning can be performed prior to surgery by suturing of the lip into this new lower position without tissue removal. This will allow the patient to try out their new smile prior to surgery. If unhappy with the results, the ‘Trial’ Lip Repositioning is completely reversible.

The procedure generally takes about 30-45 minutes with local anesthesia (Novocaine). All incisions are in the mouth and result in little or minimal scarring in the inside of the lip. Other than restriction of lip movement on full smile, no other effects on facial muscle movement or speech are seen.

The Benefits of Lip Repositioning:

  •   Immediate correction of a ‘Gummy Smile’
  •   Results in a more esthetic, confident smile with a proportional amount of teeth and gums.
  •   Fast recovery with no external scarring.