Cosmetic Tissue Recontouring

It is not uncommon for us to suggest to a patient who has absolutely no sign of periodontal (gum) disease to seriously consider having elective periodontal procedures performed. In these cases, the procedures are almost always needed to improve appearance. Sometimes they are suggested to promote future periodontal health or to attend to a potential problem that might develop.

When you smile or talk, your teeth are framed by your lips and the visible gum tissue. People looking at you notice your teeth. People notice missing teeth, tooth alignment, gum color, discolored fillings, silver fillings, toot color, and how much of your teeth actually show. If everything is integrated well and looks natural, people say you have a nice smile. If something does not look natural, it may be easy to define, such as crooked, stained or yellow teeth; periodontal disease shown by red-colored gum tissue; or discolored fillings. Or it may be something not as readily to determine. It’s just something that does not look right.

That “something” may be related to the teeth and gum architecture. The position of the gums where they meet the teeth is esthetically important. If your teeth look too short, there may be more gum tissue covering them than is considered attractive. You may show too much gum tissue when you smile. There may be a difference in height of the gum of one tooth versus an adjacent tooth or its partner on the other side of the mouth. This could be caused by recession from brushing too hard; gum disease; poor or defective restorations, especially crowns; or just a problem with the way the tooth erupted into place. All of these things can detract from your appearance.

Several different periodontal procedures, simple to accomplish, can correct most of these routine problems. Some involve removal of unwanted tissue; some involve grafting of tissue. Orthodontics might be helpful in some cases. The more expensive procedures will require referral to our specialists.

In one common type of cosmetic periodontal plastic surgery, the gum tissue is reshaped and recontoured without the use of sutures (stitches). This procedure is done in the office. One tooth or several teeth may benefit from treatment. Postoperative discomfort is usually minor. There may be tooth sensitivity when gum tissue is removed, but this usually disappears. The improvement generated by this type of procedure can be startling.

We will show you and describe in detail how you can benefit from cosmetic periodontal procedures. In many cases, the cosmetic periodontal surgery will complete the treatment you need. In some cases, it will be part of a larger treatment plan including crowns, veneers, or bonded restorations. 

If you have any questions about cosmetic tissue recontouring, please feel free to ask us!  

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Replacing Unesthetic Restorations

There are 2 types of life spans:
Everything has a life expectancy, even dental filling materials. Dental materials appear to have two different types of life spans - a functional life span and an esthetic life span. The better the original dental restorative material and the skills of the operator, the longer the restoration will last. Lab-processed materials will generally last longer than direct placement materials.

What is the functional life span?
The functional life span is defined as the length of time a material will last before it fails to function properly. This failure will either (a) weaken the tooth or (b) permit decay or gum disease to begin. For example, when a piece of the filling breaks off (or often in the case of an amalgam [silver metal] filling, it causes a piece of the tooth to break off), the tooth requires a new restoration.

How is the esthetic life span different from the functional life span?
An esthetic life span is somewhat different. In the case of bonded and tooth-colored restorations, it means that the material, while possibly still able to function, has begun to degrade. A filling may have matched the tooth beautifully when placed, but over time, the change in color of the filling material, as well as actually tooth color changes, cause an obvious mismatch between tooth and filling material. Since the restorative material does not have the same properties as tooth enamel, it will wear a little differently. The shape will change over time, too. Luckily, it is a very slow process.

With lab-processed restorations, crowns and bridges, the crown may still be working well, but age and changes in your mouth make it and the surrounding soft tissues look less acceptable that it was when first placed. Again, this happens slowly, over many years.

What other esthetic problems can be fixed? 
Other esthetic problems that can be corrected include notches in fillings or under crowns caused by improper brushing (or decay), recession of the gum tissue that exposes  darker root surfaces around crowns or fillings, porcelain crowns (caps) that no longer match the adjacent teeth, and metal margins of crowns that are visible due to gum recession (and this is quite common).

Why should you consider getting new dental restorations?
When you can see these types of changes, you can be sure that others who look at you when you are speaking or smiling will see them too. If you place a high value on your personal appearance, this is the time to consider having the restorations replaced with newer materials. Newer dental restorative materials look better, last longer, are more color-stable, and more wear-resistant than older-generation bonded materials. You can expect them to look good for many years.

What fillings look the best?
In our opinion, silver metal fillings never look "good." Even at this best, polished and shined, they do not represent a picture of health. As the metal ages, it corrodes, pits, and darkens. Its constant expansion and contraction due to hot and cold foods we eat weakens the tooth. The darkening of a filling can cause a darkening of the tooth itself. After time, the tooth will become permanently dark gray. The wider your smile is (and the more teeth you show when talking and smiling), the more of a problem this can be. The most esthetic filling are tooth-colored.

What happens if I choose to keep my old fillings?
Broken, stained, worn, and visible fillings detract from your appearance. When you look at a tooth (from about 2 feet away) that has been restored, you should not see the filling. While these types of problems are, of course, non life-threatening, consider attending to them before they get worse - and difficult and expensive to correct.

In our office, we place a high value on the appearance of your teeth and how you feel about your smile. We want you to look your best. We use the best materials and techniques available in dentistry today to ensure a healthy smile. We will be happy to evaluate your particular condition and discuss options with you.

If you have any questions about replacing unesthetic restorations, please feel free to call our office to discuss restoration options at 512-250-5012.

Smile (Lip) Line

What is the lip line?
How many teeth you show when you smile or speak and how much of each tooth (length) is displayed when you smile broadly, or (at the opposite end of the spectrum) when your lips are at rest, are functions of where your upper lip attaches to your face and how old you are.

3 classifications

There are 3 classifications of "lip line" that dentists use - low, medium, and high. 

A low lip line is one in which very little of your teeth are visible when you talk or smile. Someone with a low lip line will show, at the most, a millimeter or two of the edge of the biting edge of the tooth. 

A medium lip line will allow most of the tooth, up to and including a millimeter or two of the gum tissue, to be visible. 

A person with a high lip line will show all the top front teeth and a significant amount of gum tissue when speaking or smiling.

High Lip Line

Changing your lip line
Dentists (and plastic surgeons) have not been very successful in surgically changing the low, medium, or high lip line. There are some dental "tricks" that can be used in limited situations to reduce the amount of gum display evident with a high smile line. Most of the corrective procedures to improve the esthetics of the situation require significant investments of both time and money. Periodontal (gum) surgery, alone or in conjunction with porcelain veneers or ceramic crowns, is more likely. In extreme cases the only option may be to surgically reposition the entire maxilla (with or without orthodontics). Conversely, the appearance of showing no teeth when talking or smiling is regarded as one associated with advanced aging.

There is another component to how much of your teeth show when your lips are at rest, and it has to do with gravity and time. Your face and lips are composed of soft tissue that is under a constant gravity challenge. Gravity always wins, given enough time. There skin and subskin tissues drop over the years. If, with your lips at rest, you showed about 3 mm of the biting edges of the top two front teeth when you were 20 years old, by the time you are 40, you may show only 2 mm of edge. Someone 50 years of age would show 1 mm, and at 60 years, maybe no tooth is seen when the lips are at rest. The tissues of the human face will drop about 1 mm every 10 years, beginning around age 40. As the facial tissues lose elasticity, they slowly drop. Obviously, some lucky people have better genetics and their faces will stay tighter and the tissue drop will be slower. Correcting the age-related facial tissue drop can be done with plastic surgery - the common face lift.

High, medium. and low lip lines

Genetics or Gravity? 
If you are reading this, then you have either asked questions about your smile and lip line or this issue has been addressed in the broader context of cosmetic dentistry procedures you require. After a thorough examination, we will explain what situation you have and what corrective measures are possible.

If you have any questions about your smile line, please feel free to call our office for a consultation at 512-250-5012.