Esthetic Crown Lengthening case

Patient Presentation

24 year old Hispanic female
Dental student at the University of Pennsylvania School of Dental Medicine
No medications, no known drug allergies
Medical history non-contributory
Chief complaint of “I don’t like my gummy smile”

This patient “S.A.” presented with a chief complaint of “I don’t like my gummy smile.” There are several different causes of excessive gingival display, often called a “gummy smile,” of which vertical maxillary excess and altered (delayed) passive eruption are the most common. After a thorough evaluation, this patient was diagnosed with altered passive eruption, a condition that results from the failure of the gums and bone around teeth to recess, not allowing for full exposure during development.

Clinical Findings

Before picture of a “Gummy Smile”

Short clinical crowns
Excessive gingival display
Flat osseous profile in the anterior maxilla
Diastema between #11 and 21
High smile line

As you can appreciate from the photo above, this patient exhibited an excessive display of gingiva, short/square clinical crowns as well as a very flat appearance of the gums.

Diagnosis

Plaque induced gingivitis
Altered passive eruption (Type 1B)

Treatment Plan

Initial therapy (scaling and oral hygiene instruction)
Re-evaluation (3-4 weeks following)
Clinical crown lengthening #16-26
3 month maintenance

Given that this patient has a wide smile showing all the way back to her molars, we decided to plan for clinical crown lengthening from teeth #16-26. As we always do prior to these types of procedures, bone sounding at 6 points per tooth was done to determine her “personalized” biologic width at all sites scheduled to be crown lengthened. This patient’s values were in the 5mm range, not the typical 3mm seen in many. This personalized value will guide us in both hard and soft tissue removal to expose the correct amount of tooth accurately.