The present-day esthetic dental philosophy, demonstrated by
people who have beautiful teeth and smiles, shows that there must be a certain
amount of enamel-covered tooth visible for an attractive smile. The ratio is
about 1.6:1, length to width. Teeth that are shorter than this look
progressively less attractive. They look short and stubby. If they are actually
worn down from a clenching or grinding problem, this is a different type of
problem. But it may not be that the teeth themselves are too short. It could be
that there is not enough of the crown of the tooth that can be seen. The remainder
that should be seen is covered with gum or gum and bone tissue. This is known
as altered passive eruption. It is
not entirely clear why this happens. It may become obvious as early as age 14.
The teeth may have a pleasing color and be very straight, but they still leave
something to be desired because they are too small and too much gum shows when
you smile.
This can be a severe cosmetic problem when coupled with the
type of lip line that frames the teeth. A low lip line will probably hide most
or all of the gum covered part of the tooth, so there is less of a need to
correct the defect. A medium or high lip line, especially a high lip line, will
show all of the tooth and gum. As the lip line gets higher, the attractiveness
of the smile goes down. The situation can be so severe that the patient will
train his or her muscles to artificially hold the upper lip stiff or cover the
mouth with a hand when smiling. In this way, the short teeth or the great
expanse of gum tissue will be hidden from view. It can cause significant
psychological problems.
The solution can be easy or complicated, depending on the
exact nature of the problem. If there is only a small amount of gum tissue to
be removed from a single tooth or multiple teeth, and there is a medium lip
line, then the tissue is easily removed with a laser or electrosurgical cutting
device. Scalpels and stitches are not needed in small cases. As more gum must
be removed and more tooth is exposed, there may be some underlying bone that
must be reshaped. Bone removal will be followed, about 2 months later, by the
soft tissue removal mentioned earlier. The first surgery must heal long enough
for the tissue to reach its final position before the second can be completed.
Remember, you are looking at differences of several millimeters to a fraction
of a millimeter that will cause the case to be a success or failure. A two-step
procedure is better than a one-step procedure.
The biting edges (enamel and/or dentin) of one or more teeth
may be reshaped if there is a need not only to lengthen the teeth but also to
make it appear that they have actually been placed higher in the smile line.
This is for top teeth, of course. If a great deal of tooth must be reshaped to
accomplish the desired effect, root or dentin may be exposed, making the tooth
sensitive. These teeth will need to be covered with porcelain veneers or crowns
to achieve the proper esthetics. Even if only a little amount of tooth is
reshaped, the veneers or crowns may be indicated to get the exact appearance
you want. We will discuss this with you before you begin treatment. It is
important that you know what is being done, how long it will take to complete,
and what you will look like when it is finished,
We will make the veneers or crowns and reshape the teeth. We
will determine what can be done. We may also do the soft tissue contouring. This
is most common. For procedures that involve a reshaping of the bone, you may be
referred to our periodontist. Since we will do the restorative treatment, we
know exactly where the soft tissue should be. We are the cosmetic specialists.
We will establish the final position of the gum line. In extreme cases, the
problem will be corrected with a combination of the above-mentioned procedures
and orthognathic surgery to reposition the jawbone and teeth. This can be done
by our oral surgeon. With a comprehensive examination, we can tell you what is
appropriate for you. You do not have to live with an unattractive smile because
you have short-looking teeth due to showing too much gum tissue. These problems
can be corrected. Let us know what you do not like about your smile or teeth.
More than likely, the smile you now have can be made into something you will
like to show off.
If you have any questions about altered passive eruption,
please feel free to ask us!
Hymeadow: (512) 250-5012
Jollyville: (512) 346-8424
West William Cannon: (512) 445-5721
