Cosmetic Gum Contouring

People ask about gum contouring for several different concerns. Each can have more than one cause, and the cause decides what can help.

• Too much gum when you smile (a "gummy smile"). The cause can be gum that covers more of the teeth than usual, or an upper lip that is short or moves a lot. It can also be the position of the upper jaw, or a combination of these¹. Only the first is mainly a gum problem.
• Teeth that look short or square. The gum, and sometimes the bone under it, may sit further down the tooth than usual. This is where gum reshaping or aesthetic crown lengthening may be considered.
• An uneven gum line. Some teeth may have extra gum while others have receded. Extra gum can be reshaped; a receded area may need tissue added instead.
• Receded gums. Recession is common in adults and tends to increase with age³. Without signs of disease, monitoring the area³ is considered the proper approach; surgery may be considered in some cases.
• Dark patches on the gums. Natural (physiological) pigment in the gum can be removed for appearance. It can come back.
• Dark gaps between the teeth ("black triangles"). These appear where the gum no longer fills the space between two teeth. Treatment results are hard to predict.

The last three are covered in "Receded gums, dark patches and gaps between teeth".

Gum contouring is surgery on tissue that needs to be healthy first. Gums that bleed when you brush or eat hard foods are a reason to see a dentist⁴ before any cosmetic plan. So are painful, swollen gums and bad breath⁴. Gingivitis, the early stage of gum disease, is reversible with improved self-care⁵. Damage from periodontitis is irreversible, but the disease can be stabilised⁵. Its treatment follows steps, starting with oral hygiene and risk factors⁶. Cosmetic gum surgery is planned once the gums are healthy and stable. More on this is on the gum disease treatment page.

What the examination looks at

• How much gum shows when you smile and speak, and how far the upper lip lifts
• Where the gum sits on each tooth, and the length and width of the teeth
• Where the supporting bone lies under the gum, with X-rays if needed
• How thick the gum is, and whether enough would remain after reshaping
• Gum health: bleeding, gum pockets and any recession
• Photographs, and a scan or impressions if a wider plan is being made

A qualified dentist should examine you before your treatment plan and its cost are confirmed. A plan made from photographs alone is only a preliminary assessment.

Tell your dentist before treatment

If you take a blood thinner or any other regular medicine, have diabetes or heart disease, smoke, or are pregnant, tell your dentist before treatment. Bring a written list of your medicines. One hospital in London advises its gum-surgery patients to stop smoking. If they cannot stop completely, it advises stopping for at least 2 weeks after the surgery⁷ to help the gums heal. Do not stop or change⁸ your blood thinner for dental treatment unless your doctor or dentist tells you to.

Where it may be considered

• Adults with healthy gums whose gum covers more of the teeth than usual, so that the teeth look short
• An uneven gum line where the extra gum is on some of the teeth
• A planned step before veneers or crowns, where the gum level affects how they will look

Where another route comes first, or it may not help

• Active gum disease: treated first.
• A gummy smile caused mainly by the upper lip or the jaw: removing gum does not change the lip or the jaw. Other treatments are considered (see the techniques below).
• Receded gums: reshaping removes gum, so it does not treat recession. Without signs of disease, monitoring the area³ is considered the proper approach; if treatment is needed, it may mean adding tissue with a graft.
• Expectations the tissues cannot meet: gum and bone have limits. For example, the gum may not fill a gap between two teeth, whatever is done.
• A wish to finish the whole smile in one short trip: the gum margin can still move during the first three months of healing². This affects when veneers or crowns can be made.

Leaving the gums as they are is also an option. You can ask a dentist near your home for an independent opinion before you decide.

Which technique fits depends on the cause found at the examination. The studies cited here do not compare these treatments with each other directly. The figures come from published studies, not from our own records.

• Gum reshaping (gingivectomy) and aesthetic crown lengthening. When gum covers more of the teeth than usual, the gum is reshaped, together with the supporting bone where needed. If bone is to be reshaped, ask how much would be removed, and how much support would remain for the tooth and its neighbours. A randomised trial compared the conventional technique with a computer-guided one, which uses a surgical guide planned on a computer and then printed. It included 16 people with thick gums whose gum covered more of the teeth than usual (altered passive eruption). In both groups, the visible length of their teeth rose from about 7.1 mm to 8.46 mm at 6 months¹. It did not change significantly between months 3 and 6¹. The trial was small and followed people for 6 months only.
• Lip repositioning surgery. This may be considered when an upper lip that lifts high is the main cause. Surgery inside the upper lip aims to limit how far it lifts. In a review of 13 studies, the gum on show was reduced by an average of 3.06 mm at 6 months⁹. The averages were 2.91 mm at 12 months and 2.76 mm at 36 months⁹. The review's abstract does not say how many studies the 36-month figure rests on. Another review, of 38 studies, found that most were case reports or case series¹⁰. It found no agreed definition of relapse, and a lack of studies on the effect beyond one year¹⁰.
• Treatments other than surgery. When the upper lip is the cause, treatments other than surgery also exist. Ask your own dentist or doctor about them.
• Orthodontics or other treatments. When the cause lies in the position of the teeth or the jaw, these are considered instead of gum surgery.
• A gum graft for a receded area, and removal of dark pigment: see the next section.
• Leaving the gums as they are. For a purely cosmetic concern this is an option, and the decision is yours.

Receded gums: adding tissue, not removing it

Where the gum line is uneven because the gum has receded, a gum graft can cover part of the exposed root. This is periodontal surgery; more is on the periodontal surgery page. Studies followed single receded areas, without loss of gum or bone between the teeth, for at least 5 years. In some, the surgeon moved the gum over the root (a coronally advanced flap). In others, a graft of the patient's own tissue was added under it. With the flap alone, complete root coverage rates ranged from 33 to 60 per cent¹¹. This range leaves out one flap-only group with unusually poor results. With the graft added, the rates were 66.7 to 88.2 per cent¹¹. The studies were small and could not be pooled, so these are ranges, not a personal chance. Several of the studies counted treated areas, not people. Over the years, the gum margin tended to recede again¹².

A collagen material from an animal source can be used instead of tissue from your palate. In a review of four trials, it meant shorter surgery, and less pain afterwards in three of the four trials¹³. But in studies of several receded teeth, complete root coverage was achieved more often with the patient's own tissue¹⁴. Sometimes tissue is taken from the palate and the wound is left to heal open. In a review of 68 studies of this, pain was most pronounced in the first three days, typically peaking on day 3¹⁵. The same review reports that such a wound can take up to four weeks to heal completely¹⁵.

Dark patches of gum

Natural (physiological) dark pigment can be removed with a scalpel, a laser or other methods. Your dentist first examines the area to check whether the pigment looks natural. A dark patch that is new or changing is not a cosmetic matter: have it checked by a dentist before any cosmetic treatment. In a review of 25 controlled trials, laser and scalpel did not differ significantly in removing the pigment or in how often it came back¹⁶. Pain afterwards was lower with a laser¹⁶. In the individual trials, as that review reports them, recurrence ranged from 0 to 80 per cent¹⁶. It varied with the method, the trial and the time point. Follow-up was 15 months at most¹⁶. Another review found the lowest recurrence with freezing (cryosurgery)¹⁷, but it rested mainly on case reports. The controlled trials above found no significant difference between laser and scalpel. So no method has been shown to keep the pigment away better than the others, and no one can promise that it will not return.

Gaps between the teeth ("black triangles")

A 1992 study looked at 288 sites in 30 patients with natural teeth. When the contact point between two teeth was 5 mm or less from the bone, the gum filled the space almost every time¹⁸. At 6 mm it did so 56 per cent of the time¹⁸. At 7 mm or more, it did so 27 per cent of the time or less¹⁸. A 2024 review of 45 studies looked at hyaluronic acid injections, grafts, orthodontics and a concentrate made from the patient's own blood (platelet-rich fibrin). These seemed to improve the result at 3 months or more¹⁹. But the authors found the evidence insufficient to make recommendations¹⁹. No one can promise that the gap will close completely.

Laser or scalpel?

For removing pigment, the review above found similar results, with less pain after a laser. Some lip repositioning techniques include cutting the small fold of tissue between the upper lip and the gum (labial frenectomy)¹⁰. For frenectomy, a review of 6 trials found pain scores lower with a diode laser on day 1 and day 7, not on day 3²⁰. The certainty of that evidence was low to very low²⁰. The reviews cited here do not compare laser and scalpel for reshaping the gum line itself. Ask your dentist which instrument they plan to use, and why.

The outline below is general. Your written plan should state the technique, the teeth involved, the number of appointments and the days they need. Ask for these in writing before you book.

Anaesthesia. At the hospital in London mentioned above, gum surgery is done with a local anaesthetic injection that numbs the gum, and you stay awake⁷. Ask which anaesthesia is planned for each step. If sedation is offered, ask what kind it is, why, where it is given and who gives it. A UK national standard covers conscious sedation in dentistry. For adults, it says that every form of sedation other than inhalation sedation requires an escort²¹. It also says that if an escort cannot be assured, treatment under sedation must not be provided. Ask us before you book whether the method planned for you needs an escort, and how this works if you are travelling alone.

How long it takes. In the trial described above, the operating time was about 45 minutes on average with the computer-guided technique, and 54 minutes with the conventional one¹. Your dentist tells you how long your own appointment is likely to take.

• Pain. In the crown-lengthening trial, pain was scored from 0 to 10. On the first day it averaged about 4 in the computer-guided group and 5 in the conventional group¹. The trial found no significant difference in pain between the two groups¹. Pain had largely gone by two weeks¹. Studies of lip repositioning that reported pain describe mild pain during the first three weeks¹⁰. If tissue was taken from the palate, that area can be sore too (see above).
• The gum line keeps settling. In studies of crown lengthening before a crown, the gum margin may grow back over the tooth (rebound), mostly in the first three months². The final gum line is judged after healing, not on the day of surgery.
• Cleaning and eating. Follow the written instructions on when and how to clean the treated area. After gum surgery, including crown lengthening, the hospital in London mentioned above tells patients not to brush the area where they had surgery⁷. It tells them to use an antiseptic mouthwash 2 or 3 times a day for 2 to 3 weeks⁷. It also advises a soft diet for a week⁷. Ask your dentist when you can brush the treated area again. Keep up your daily care in the rest of your mouth. Brush twice a day with a fluoride toothpaste; afterwards, spit the toothpaste out and do not rinse⁴.
• Stitches and the wound check. At the hospital in London, stitches that do not dissolve are usually removed 1 to 2 weeks after surgery⁷, at a review appointment. Ask before you book which kind of stitches you will have, and who will check the wound if you fly home before then.
• Before veneers or crowns. How long to wait after crown lengthening before the final crown or veneer is a gap in the research². Ask how long your dentist will wait, and why.
• Follow-up. Ask who checks the healing. If you are treated in Antalya, agree this before treatment. The later checks can be with your own dentist at home, if they accept that, or on a return visit.

Bleeding that does not stop, or pain and swelling that keep getting worse, are not normal. See "When to contact the clinic or a dentist" below.

Risks and limitations

• The gum can grow back part of the way. After crown lengthening, the gum margin may grow back over the tooth (rebound), mostly in the first three months². This evidence comes from few studies with a high risk of bias², and gives no figure for how much.
• Short follow-up. The randomised trial of aesthetic crown lengthening followed 16 people for 6 months¹. The studies cited on this page do not show how the result looks years later.
• Exposed roots and sensitivity. An exposed root surface is frequently associated with sensitivity and a poorer appearance³. Ask before surgery about the chance of sensitivity, of the root surface showing, and of the appearance changing over time.
• Pain, swelling, bleeding and infection. These can follow any surgery on the gums. A hospital in Cambridge lists the risks of gum grafts in a patient leaflet. They include bleeding, infection, swelling, an uneven gum line and the need for further surgery²². At a palate donor site, bleeding, burning, altered sensation and changes in eating¹⁵ have also been reported.
• Longer-looking teeth and larger gaps. After gum surgery, your teeth may look longer and the spaces between them larger⁷. This depends on how much gum was reshaped. In cosmetic contouring, longer teeth are the aim; larger gaps are not.
• Uncertain results after lip surgery. There is no agreed definition of relapse, and little research beyond one year¹⁰.
• Pigment can return after it has been removed, and gaps between teeth may remain after treatment (see above).
• The result may differ from the design. A photograph or digital design is a visualisation, not a promise. The real result depends on your gums, bone and teeth.

Benefits

• Where extra gum is the cause, reshaping it can show more of each tooth¹.
• Planning the gum line together with any veneers or crowns aims to avoid conflicting procedures.

If veneers or crowns are also planned, gum contouring can be planned together with them, as part of a smile makeover. The order matters: gum disease is treated first, the gum line is set, and the restorations are made to fit it.

The gum margin can still move during the first three months². So ask these questions before you agree to anything.

1. Will the gum contouring and the veneers or crowns be done on the same trip, or on separate trips?
2. If on the same trip, how will the restorations allow for the gum settling afterwards?
3. Who checks the gum line once it has settled, and who decides whether anything needs adjusting?
4. Can you have the gum contouring alone, and decide on the rest later?

Ask for the whole written plan, with every step, before you agree to the first one. After the examination in Antalya, you can still decide not to go ahead. You can say no, or ask to stop, at any stage.

Your treatment is provided by our clinic in Antalya, Turkey, and carried out there by the clinic's dentists.

Periodontology, the branch of dentistry that deals with the gums, is one of the nine dental specialties set by law in Turkey²³. In Turkey, only a dentist who holds a certificate in that specialty²³, issued and registered by the Ministry of Health²⁴, may use its title.

Ask who will assess your gums and plan the gum line, and who will carry out the surgery. Ask what their titles are, where they qualified, and whether any of them holds a Ministry-registered specialty certificate in periodontology. Ask for the answers in writing.

The surgery itself happens in Antalya, but healing continues after you fly home. The gum margin can still move during the first three months², so the check of the settled gum line usually happens once you are home. Agree how this will work before treatment starts.

What can be done in Antalya

• Examination and planning. Gum health, the cause of the concern and the technique are established.
• Gum treatment, if needed. For gum disease, deep cleaning may take more than one appointment. Its re-assessment usually comes later; see the gum disease treatment page.
• The procedure. The technique in your plan, if the clinic carries it out. Ask which of these techniques the clinic itself performs, and which it would refer elsewhere.
• The early wound check, if it falls before you fly. Otherwise, agree who will check the wound and remove any stitches near your home (see "Before you fly home" below).

What usually continues at home

• Checking the settled gum line. Plan it with your own dentist at home, or plan a return visit to Antalya.
• Veneers or crowns that wait for healing. Ask whether they need a second trip.
• Regular check-ups. The UK's NICE guideline on dental recall says check-up intervals should be set for each person according to their risk²⁵ and discussed with them. Agree yours with your dentist at home.

What to agree in writing before you start

Before you book, you receive a written preliminary plan with the appointments and how many days they need. It is based on what you send, such as photographs and any recent X-rays from your own dentist, and it is not a diagnosis. The examination confirms or changes it, and with it the days and the cost.

Ask for the plan to answer these questions:

1. What is the cause of my concern, and which technique is planned for which teeth?
2. Which steps happen in Antalya, and which are expected to continue at home?
3. Will the stitches dissolve? If not, when is the wound check, and will it be before I fly?
4. If veneers or crowns follow, on which trip, and how long after the gum surgery?
5. Who checks the gum line once it has settled, and what happens if it has grown back?
6. Which records will I take home for my own dentist?
7. What is included if the result needs adjusting, and who pays for any extra trip?

You can also ask a dentist near your home for an independent opinion before you decide. Ask which treatment you need, and what having it where you live would involve. After the examination in Antalya, you can still decide not to go ahead. You can say no, or ask to stop, at any stage.

Flying. We have found no guidance that sets a waiting time before flying after gum contouring specifically. A 2023 narrative review of flying after dental treatment suggests waiting about a week after most dental interventions²⁶. This assumes there is no pain, swelling or bleeding where you were treated. The authors note that the research is limited and comes mainly from military aviation. They call their intervals a starting point for the dentist's decision. Ask your dentist when you can fly.

Your own dentist

Talk to your own dentist before you go. They need to know the plan if they are to check the healing. Ask them before you travel whether they will see you after the treatment, and what that will cost. If they will not, agree the follow-up with the clinic in writing. If you do not have a regular dentist, find one before you travel.

Your records

Ask the clinic for a written record of the treatment to take back to your own dentist. It should say which teeth were treated and with which technique, whether bone was reshaped, and where any graft tissue came from. Ask for the photographs taken before treatment and copies of any X-rays too. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging²⁷.

Health service and insurance where you live

What a health service or an insurer covers after treatment abroad differs from country to country. Before you travel, ask the health service or your insurer where you live what they would cover. Ask in particular about a check of the healing, an adjustment of the gum line and any complication. Tell your travel insurer about your plans too. Before you book, ask whether anything linked to the treatment is covered, such as a complication or an extra trip.

These are the questions we suggest you ask before treatment abroad, with what this page can answer today and what to ask for in writing.

1. Who will carry out my treatment, and what are their qualifications? The treatment is provided by our clinic in Antalya, Turkey. Ask for the name of the dentist who will examine and treat you. Ask where they qualified and what their title is (see "Who carries out the treatment?").
2. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate²⁷ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes²⁸, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of your treatment. A dentist in private practice in Turkey must also register with the provincial or regional dental chamber²⁹ within a month of starting. Ask for the treating dentist's own registration details as well. More is on our page about dental treatment abroad.
3. Will someone explain the treatment in my language? Ask who will explain the plan, the consent form and the aftercare instructions to you in English, and whether you get them in writing.
4. How often have you done this treatment, and what are your success and complication rates? The figures on this page come from published studies, not from the clinic's own results. Ask how often the clinic carries out gum contouring, whether it keeps its own figures, and how they were collected.
5. Is the work guaranteed, and for how long? The gum margin can grow back part of the way, and removed pigment can return. This page makes no guarantee. Ask what the clinic's written terms cover, for example an adjustment if the gum line grows back.
6. What happens if I am not happy with the result? For gum contouring, the result is judged once the gum has settled, often after you are home. Ask who would judge it, and ask for the clinic's answer in writing.
7. What aftercare do you provide, and who can I contact after the treatment? Your written plan should say who checks the healing, whom to contact, how, and in which language.
8. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you commit.
9. What happens if the examination shows that the planned treatment is not the right one for me? Ask in advance what you pay for the examination, and what happens to anything you have already paid.
10. Do you have a complaints system, and can I see a copy? Ask for it before treatment. A complaint goes to the clinic first. If it is not resolved there, you can apply to the provincial health directorate's Patient Rights Board³⁰, which does not assess allegations of medical error. The dental chamber can also open disciplinary proceedings²⁹ against a dentist. Turkish regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided²⁷.
11. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre²⁷. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.

Think twice before booking any treatment abroad if you see any of these signs. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare. Apply them to this clinic too.

Some tenderness and a little bleeding in the first days after gum surgery can be expected. If bleeding does not stop, press firmly on the area with gauze for at least 30 minutes⁷. Contact the clinic, or your own dentist if you are home, if:

• Bleeding still does not stop after that
• Pain or swelling keeps getting worse instead of easing
• You have a fever

If you cannot reach either, see a dentist where you are.

Emergencies. The following need urgent medical help³¹. Do not wait for a dental appointment or for the clinic's reply. Go to the nearest emergency department or call the emergency number where you are (112 if you are in Turkey).

• Swelling that makes it hard to breathe, speak or swallow
• Swelling of the eye or the neck³², a painful eye, or sudden problems with your eyesight
• A lot of swelling inside the mouth
• Finding it hard to open your mouth

Before you fly home

Make sure you have a written record of what was done to which teeth, and written care instructions. Know how to clean the treated area and whom to ask about it. Know when the gum line will be checked, and by whom. Know whether your stitches dissolve; if they do not, know who will remove them and when.

Once you are home

If a problem comes up that is not urgent, write to the clinic and send photographs. For anything that needs someone to look in your mouth, see your own dentist or a dentist near your home. In the emergencies above, do not wait for a reply.

This page does not give prices. Your treatment plan and its cost are confirmed after the examination. The main factors that shape them are:

• The cause of the concern, which decides the technique
• The technique itself: gum reshaping, crown lengthening with bone reshaping, a graft or lip surgery
• How many teeth are involved
• Whether gum disease needs treating first
• Whether veneers or crowns follow, and how many trips the plan needs
• X-rays, and the checks after healing, and whether these take place in Antalya or with a dentist near your home

Ask for the plan in writing, showing what is included and which procedures will be assessed separately. Ask too who pays for further treatment and extra travel if there is a complication.

If you are comparing with a plan from a practice near your home, compare what each one includes, item by item.