The need for cosmetic correction of the appearance of short teeth is very common following orthodontic treatment procedures,  taking certain kinds of medications, having less than ideal hygiene, or as a result of patient nightly or daily tooth grinding.  Often the natural teeth will have an appearance of being too small or too short for a pleasing smile.  A "GUMMY" smile then is often the result, Fig 1.  Also if any spaces are present between the anterior teeth it maybe the result of the natural teeth being to narrow, as  illustrated in Fig 3 & 4.  If this is present, (usually it's the lateral incisor) and orthodontic treatment can not correct this, rather the soft tissues or gum tissues grow and fill the space(s).  This makes the cosmetic correction of tooth size less predictable and more challenging for the dentist when closure is attempted using only cosmetic composite "Bonding" or porcelain cosmetic "Veneer" procedures  alone.  Porcelain veneers also have to be replaced every few years and/or FULL CROWNS may be needed for replacements.

The most natural looking conservative & cosmetic dental result will be achieved by first correcting the excessive soft tissue contours to restore natural tooth length and contour.  Cosmetic Periodontal Surgery can be done either with or without sedation dentistry and can be combined with wisdom teeth removal, when sedation dentistry is used.  The soft tissue corrections can be done without discomfort or bleeding with primary closure as illustrated in Fig. 7.  The final results of the Conservative and Cosmetic Periodontal Care, will enable teeth to have a normal length to width ratio and will often achieve the ideal golden proportion appearance as illustrated in Fig. 10, 11, & 12.  The teeth may then be bleached if necessary to improve their color and the tooth with the space(s) next to it, can be bonded with a composite resin and not have to be cut down to place a veneer or FULL CROWN.  The esthetic future of the bonded composite restorations  may eventually dictate its replacement, and the restoration can easily be removed & replaced if needed and again not have the tooth  cut down for either a porcelain veneer or a FULL CROWN.         

 Many cases have been completed to date using a one surgical visit technique to correct the gummy "Short Tooth Syndrome" problem and wisdom teeth removal at the same appointment.  The natural shape of the anterior teeth is usually very pleasing and the treatment results are very rewarding, partially because of the conservative treatment and partially because of the decreased costs.  Treatment time has been compressed with reduction from 3-6 weeks for veneers to one surgical visit for Cosmetic Periodontal Care.  Ninety five percent of the treatment is completed in 1 surgical visit and 2-4 prosthetic visits. A Conservative and Cosmetic technique that decreases treatment time and costs with an excellent aesthetic result is possible with this approach.

             Fig. 1.  Excessive soft "GUM" tissue & short                        Fig. 2.  Excessive soft "GUM" tissue & short appearing teeth

              appearing teeth "GUMMY" smile                                                                                                                                     

              
Fig. 3.  Excessive soft "GUM" tissue filling spaces                           Fig. 4.  Excessive soft "GUM" tissue filling spaces
 

Fig. 5.  Initial Radiographs

Fig. 6.  Initial Panoramic Radiograph

Fig. 7.  Completed Treatment Panoramic Radiograph

Fig. 8.  Day of Surgery & Treatment Completed                                     Fig. 9.  One Week After Surgery Completed

           
Fig. 10.  One Week After Surgery Completed                             Fig. 11.  One Week After Surgery Completed

           
Fig. 12 & 13.  Four Weeks After Initial Visit, Composite Bonding Completed without Cutting ANY Teeth

           
   Pre-Operative                           Post-Operative

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