It is not unusual for orthodontic patients to need very small amounts of gum tissue removed in association with their orthodontic treatment. In some cases, gum tissue must be removed (a.k.a. gingivectomy) prior to bonding the braces to the teeth because not enough of the crowns of the teeth are exposed to place the braces. More frequently, gingivectomy is performed following the orthodontic alignment of teeth as a final step in producing the “perfect smile.”
Excessive gum tissue can be the result of:
- Poor Oral Hygiene - gums become inflamed during treatment and do not shrink back to pretreatment levels following removal of the braces.
- Drug-Induced Overgrowth - excessive gum tissue caused by a medication (most often seen in transplant recipients and patients with cardiovascular disease).
- Altered Passive Eruption - as teeth erupt into the mouth, gum tissue and bone work their way down the crowns of the teeth toward to root, resulting in the full exposure of these crowns in the mouth. Altered passive eruption is when this process does not occur.
The first set of clinical￼ photographs presented to the right show a patient who had excessive gums as a result of altered passive eruption.
The orthodontist treating the patient asked that the lower gum tissue be removed so that the patient’s braces could be placed in a ideal position on the crowns of the teeth. You can appreciate how short the lower teeth￼ appear. A gingivectomy combined with an apically positioned flap was performed. Three weeks following the procedure, the patient was ready to have her braces placed. In a second procedure, gum tissue was removed from the upper teeth after orthodontics, and you can see that the teeth are considerably longer in the second photograph.
The second set of clinical photographs presented show a patient who had undergone a kidney transplant three ￼years prior to having his braces placed.
It was originally thought that his gums had overgrown due to poor oral hygiene.
Following a thorough prophylaxis (cleaning) and oral hygiene instruction, a gingivectomy was performed, but the gums grew back within a few months! A closer examination of his medical history pointed to a common gum reaction to an anti-rejection medication he was taking. The medication was changed and a second gingivectomy was performed on the upper front teeth. The ￼postoperative photograph was taken one week following the gingivectomy, hence the erythematous (red) gums. To date, the surgical result has been maintained.
THE THOUGHT OF HAVING GUM TISSUE REMOVED MAY BE A LITTLE OVERWHELMING, BUT THE PROCEDURE IS SURPRISINGLY BENIGN. THE RESULTS ARE WELL WORTH THE VERY MINIMAL DISCOMFORT. PATIENTS RARELY NEED ANYTHING OTHER THAN OVER-THE-COUNTER ANALGESICS, SUCH AS IBUPROFEN OR ACETAMINOPHEN, TO ADDRESS THE POSTOPERATIVE DISCOMFORT.