Laser Gum Contouring

So much talk about teeth, we can’t forget the gums!! (Above is a case I did recently.) In terms of esthetics, the gums (or “gingiva”) is the “frame” that displays the teeth. All paintings need a good frame. One of the easiest smile-improving procedures in dentistry (with minimal investment) is “Laser Contouring”.

Laser contouring is when you contour or “shape” the pink gums around the top of the tooth. This can make the tooth look longer, wider, more symmetrical, and overall balance the esthetic display of teeth in the smile.

I love doing this procedure, especially in cases of tissue overgrowth. If you’ve ever heard the term “gummy smile”, this refers to cases when the tissue has grown to a swollen-like appearance around the base of the tooth. This can happen to people who are “mouth breathers”, particularly when they sleep. Orthodontic problems like a severe overbite (often combined with short upper lip line) can expose the gums constant air drawn over its surface. Days and years and decades of this exposure causes the tissue to react by overgrowth, leaving the teeth looking short, small, and “gummy” in presentation.

Also, in situations of crowding or orthodontics (where teeth are moved together to close gaps between teeth), the gums may appear “squished” or “bunched up”. Laser contouring can remove this excess tissue, leaving a more esthetic, symmetrical, and overall healthy gingival condition.

There are also many drugs that can cause this problem.
Some examples are the following:

1) Anticonvulsants (such as phenytoin, phenobarbital, lamotrigine, vigabatrin,ethosuximide, topiramate and primidone NOT common for valproate)
2) Calcium channel blockers (antihypertensives such as nifedipine, amlodipine, and verapamil)
3) Immunosuppresants. (Cyclosporine)

Whenever I propose Laser Gum Contouring as an option, I’m always sure it’s done in combination with orthodontic treatment to reverse the “mouth breathing” condition and/or cessation of the offending drug causing the condition. Whether the problem is dramatic (like tissue overgrowth described above) or a slight asymmetry to the tissue surrounding the teeth, laser contouring a great and simple option.

Crown Lengthening (as described in the “Crown Lengthening” section of the website) is reserved for extreme cases of tissue movement. You can’t move tissue if it’s going to expose bone. If tissue movement encroaches on bone position, then bone must also be removed in a specified distance from the target tissue position. (I will reserve the discussion here for NON Crown Lengthening cases of minor movement and tissue over growth.)

HOW LASER CONTOURING IS PERFORMED

Laser Contouring is performed by first numbing the patient. Then, my “initiated” laser acts just like a pinpoint magnet. In my mind, I know the symmetry and scalloped architecture I would like to achieve by “sculpting” the tissue. Measurements and planning has been done before the procedure. I use my laser “magnet” to gently “draw” (like with a pencil) around the top of each tooth, removing unwanted or excess tissue. I’m constantly stepping back and looking at the entire smile line, like an artist would look at a painting, until ideal proportions are achieved.

I often will give the patient a mirror to look at the smile architecture while I am contouring. I love feedback and any personal finishing touches as requested by the patient.

After the procedure, I give the patient a prescription of Chlorhexidine (or Peridex), and an antibiotic such as Amoxicillin or Clindamycin when indicated. Chlorhexidine is a non-alcoholic antimicrobial rinse that helps keep the area clean without irritating the tissue. Usually, ibuprofen is sufficient for the mild discomfort following Laser Contouring, but I will give the patient something stronger at their request.

Its amazing the results you can achieve with a VERY SIMPLE and SHORT procedure. It often only takes me about 30 minutes to contour, but gives the patient a lifetime of a more attractive and beautiful smile.