Gingivoplasty: What to Expect from the Procedure

Also known as gum contouring or gingival sculpting, gingivoplasty is a surgical procedure to alter the shape and contour of your gums. Your gums play an important role in your smile. Too low, too high, or too thick gums alter your appearance, which can directly impact your self-confidence. Therefore, to address the aesthetic concerns of the patients, periodontists surgically resculpt the gums to impart a more pleasant look. In this article, we shed light on the gingivoplasty and see what the procedure and the post-op recovery are like.

Gingivoplasty Indications 

Gum contouring can be indicated for aesthetic and functional improvements. It is a type of periodontal surgery.

Note: Gingivoplasty and gingivectomy are similar but not the same procedures. Both are types of periodontal surgeries. Gingivoplasty involves only the reshaping and contouring of the gums (with minimal removal of gum), while gingivectomy is the removal (excision of gums).

There are several conditions for which periodontists advise a gingivoplasty procedure:

Gummy Smile:

Gingival recontouring is a common periodontal procedure for patients with a gummy smile. The majority of such patients have an excessive display of gums, which becomes more prominent when they smile. Therefore, doctors opt for a respective gingival surgery like gingivoplasty to reposition the gingival margin more apically (towards the root of the tooth), thereby sparing the anatomical crown. This recontouring of the gums improves aesthetics. Sometimes, doctors pair gingival recontouring with upper lip surgery (traction + containment of the elevator muscle of the upper lip and the wind of the nose).¹Storrer, C. L. M., Valverde, F. K. B., Santos, F. R., & Deliberador, T. M. (2014). Treatment of gummy smile: Gingival recontouring with the containment of the elevator muscle of the upper lip and wing of nose. A surgical innovation technique. Journal of Indian Society of Periodontology, 18(5), 656-660.

Periodontal Problems:

Your doctor may advise you to undergo gum contouring to correct periodontal problems. The main aim of every professional is to treat a condition non-surgically. However, for unresolved issues, specialists go for surgical interventions. Modern clinics offer modified gingivoplasty for various hereditary gingival infirmities, like hereditary gingival fibromatosis. While most professionals think gingivectomy is the ideal way to treat such conditions, studies have shown that gingival contouring helps resume the natural appearance of the gingiva with minimal (or no) tendency of recurrence.²Huang, X., Zhu, W., Zhang, X., & Fu, Y. (2022). Modified gingivoplasty for hereditary gingival fibromatosis: two case reports. BMC oral health, 22(1), 523. Gingival sculpting can also help patients with idiopathic gum enlargement in attaining the ideal gum look.

Post-Orthodontic Treatment:

Orthodontic movement of the teeth promotes gingival overgrowth. Fixed orthodontic treatment is known to cause anterior tooth gingival enlargement.³Pinto, A. S., Alves, L. S., do Amaral Zenkner, J. E., Zanatta, F. B., & Maltz, M. (2017). Gingival enlargement in orthodontic patients: Effect of treatment duration. American journal of orthodontics and dentofacial orthopedics, 152(4), 477-482.

In mild cases, dentists perform gingivoplasty procedures to reshape the overgrown gingiva. However, in most cases, resculpting is paired with excision of the gums, i.e., gingivectomy.⁴Shirbhate, U., Bajaj, P., Solanki, D., Dare, S., & Sarangi, S. (2023). Management of orthodontic-induced gingival enlargement: a case report. Cureus, 15(10).

For advanced cases with deep periodontal pockets, doctors go for a pocket reduction surgery.

Gingivoplasty Benefits

There are numerous benefits associated with gingivoplasty. Patients report the following therapeutic advantages of undergoing gum contouring:

• Improved aesthetics: Reshaping and recontouring of malformed gums (especially gummy smile) completely revamps a person’s smile. There are significant improvements in facial aesthetics.
• Boosted self-confidence: With a better smile profile, the patients report better acceptance of their bodies and a boost in self-confidence. 
• Improved oral hygiene: Enlarged gums can interfere with your ability to clean the gums and teeth. So, by reshaping the gums, doctors allow you to improve your brushing efficiency.
• Lesser chances of infection: Repositioning of the gums can reduce the periodontal pockets (which are breeding grounds for infection). Therefore, gingivoplasty can potentially reduce your chances of gum infection. 

Gingivoplasty Procedure 

The procedure of gingivoplasty is simple and does not last very long. Usually, a specialist (periodontist or cosmetic dentist) performs this in-office procedure. Generally, it takes a couple of hours for the process to complete. The procedure of gum contouring is as follows:

Anesthesia:

The first step is the administration of anesthesia. It is done under local anesthesia. So, you stay awake during the entire procedure but won’t feel any pain. Anxious patients can ask the dentist for conscious sedation.

Process Of Sculpting:

Your doctor removes the excess, overgrown, or malformed gum tissue and resculpts the gumline. This reshaping can be done using different techniques depending on the tools used and the individual case.

The main types of gingivoplasty include:

Conventional (Scalpel) Gingivoplasty:

In the conventional method, the dentist cuts the gingiva with the help of a scalpel. Although effective, this method may involve more bleeding during the procedure and a slightly longer recovery period. After resculpting, the doctor stitches the place with the help of sutures. In some cases, doctors may need to add gum tissue to secure the surrounding periodontal structures. It is done in a process called gum grafting.

Laser Gingivoplasty:

In this type, the gum tissue is reshaped using medical lasers like the Nd: YAG laser. Other types of lasers commonly used for gingivectomy and gingivoplasty procedures include carbon dioxide and erbium lasers. Studies show that the use of lasers in gingivectomy and gingivoplasty causes less pain and accelerates wound healing.⁵Abesi, F., & Derikvand, N. (2023). Efficacy of low-level laser therapy in wound healing and pain reduction after gingivectomy: a systematic review and meta-analysis. Journal of lasers in medical sciences, 14, e17.

Electrosurgical Gingivoplasty:

This method uses electrical current to remove and contour the gum tissue. It allows good control of bleeding, although care must be taken to prevent thermal damage to the surrounding tissues.⁶Bashetty, K., Nadig, G., & Kapoor, S. (2009). Electrosurgery in dentistry… Journal of Conservative Dentistry, 12(2), 72–76.

Rotary Instruments (Rotary Gingivoplasty):

High-speed dental burs or diamond-tipped rotary instruments can also be used for reshaping. This method is more technique-sensitive and requires skilled hands, but can deliver smooth results in specific cases.⁷POLLOCK, S. (1964). Gingivoplasty Technique Using Rotary Diamond Stones at Ultra Speed. Dental Clinics of North America, 8(1), 99-110. https://doi.org/10.1016/S0011-8532(22)02002-X

Recovery:

Gingivoplasty recovery time depends on the extent of the procedure and factors like the overall health of the patient. In general, patients can return to their normal routines within a few days. However, complete healing can take up to a few weeks.

During the first 24-48 hours after surgery, you might experience mild post-op swelling and pain. These issues can be easily managed with medications (OTC pain killers) and home remedies. The final results are apparent after full healing, i.e., after a few weeks.

Gingivoplasty Post-Op Care

• Use a cold sponge during the first 24-48 hours to reduce swelling and pain.
• Strictly follow your doctor’s instructions and take over-the-counter painkillers to alleviate pain. 
• Avoid strenuous activities and heavy exercises for the first few days. 
• Avoid smoking during the first week.
• Shift to a softer diet (like cheese, soup, yogurt, etc.) during the first week.  
• You can also use an antibiotic mouthwash (with your doctor’s permission) to minimize the risk of infection. 
• Do not miss your follow-up appointments because doctors need to monitor your gum recovery. 

Complications of Gingivoplasty

While gingivoplasty is generally a safe and well-tolerated procedure, like any surgical intervention, it carries some potential risks. Common complications include postoperative pain, swelling, and bleeding at the surgical site. In rare cases, infection may develop, especially if proper oral hygiene is not maintained. Over-contouring of the gingiva can also lead to sensitivity or aesthetic concerns. In some instances, there may be delayed healing or recurrence of gingival overgrowth, particularly if the underlying cause isn’t addressed. Proper technique and aftercare significantly reduce the likelihood of these complications.⁸Griffin, T. J., Cheung, W. S., Zavras, A. I., & Damoulis, P. D. (2006). Postoperative complications following gingival augmentation procedures. Journal of Periodontology, 77(12), 2070–2079. https://doi.org/10.1902/jop.2006.050296

Final Word

Gingivoplasty or gum contouring is a surgical procedure to resculpt abruptly shaped/grown gum. This minimal surgical procedure helps improve facial aesthetics in patients having a gummy smile or orthodontic treatment-induced gingival enlargement. Sometimes, doctors perform gingivoplasty in conjunction with gingivectomy to correct periodontal defects. The procedure is done under LA and lasts only for a couple of hours. A periodontist cuts the gingiva with a laser or scalpel and recontours the soft tissue before reattaching it with sutures. Recovery is fast, and full recovery is attained within a few weeks. The periodontal surgery improves aesthetics and, therefore, boosts self-confidence in patients.

Refrences

• 1
  Storrer, C. L. M., Valverde, F. K. B., Santos, F. R., & Deliberador, T. M. (2014). Treatment of gummy smile: Gingival recontouring with the containment of the elevator muscle of the upper lip and wing of nose. A surgical innovation technique. Journal of Indian Society of Periodontology, 18(5), 656-660.
• 2
  Huang, X., Zhu, W., Zhang, X., & Fu, Y. (2022). Modified gingivoplasty for hereditary gingival fibromatosis: two case reports. BMC oral health, 22(1), 523.
• 3
  Pinto, A. S., Alves, L. S., do Amaral Zenkner, J. E., Zanatta, F. B., & Maltz, M. (2017). Gingival enlargement in orthodontic patients: Effect of treatment duration. American journal of orthodontics and dentofacial orthopedics, 152(4), 477-482.
• 4
  Shirbhate, U., Bajaj, P., Solanki, D., Dare, S., & Sarangi, S. (2023). Management of orthodontic-induced gingival enlargement: a case report. Cureus, 15(10).
• 5
  Abesi, F., & Derikvand, N. (2023). Efficacy of low-level laser therapy in wound healing and pain reduction after gingivectomy: a systematic review and meta-analysis. Journal of lasers in medical sciences, 14, e17.
• 6
  Bashetty, K., Nadig, G., & Kapoor, S. (2009). Electrosurgery in dentistry… Journal of Conservative Dentistry, 12(2), 72–76.
• 7
  POLLOCK, S. (1964). Gingivoplasty Technique Using Rotary Diamond Stones at Ultra Speed. Dental Clinics of North America, 8(1), 99-110. https://doi.org/10.1016/S0011-8532(22)02002-X
• 8
  Griffin, T. J., Cheung, W. S., Zavras, A. I., & Damoulis, P. D. (2006). Postoperative complications following gingival augmentation procedures. Journal of Periodontology, 77(12), 2070–2079. https://doi.org/10.1902/jop.2006.050296