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, or are painful and swollen, are reasons to see a dentist⁴ before any cosmetic plan. So is bad breath. Gingivitis, the early stage of gum disease, is reversible with improved self-care⁵. Damage from advanced gum disease (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 the disease is under control. More on this is on the gum disease 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 (spaces between the gum and the tooth) and any recession
• Photographs, and a scan or impressions if a wider plan is being made

A plan made from photographs alone is only a preliminary assessment; the plan is confirmed at the examination.

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. Your dentist will advise whether any of these means waiting, or not having the surgery. Bring a written list of your medicines. One hospital in London advises its gum-surgery patients to stop smoking. For patients who cannot stop completely, it advises not smoking 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. If you take one, also ask how any bleeding after surgery should be managed.

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 at once: 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. Before you decide, you can ask another dentist for a second opinion. Turkey's patient rights regulation gives you the right to ask for other doctors' opinions⁹.

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 months¹⁰. The averages were 2.91 mm at 12 months and 2.76 mm at 36 months¹⁰. The review's published summary 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 series¹¹. These describe a single patient or a small group of patients. It found no agreed definition of relapse, and a lack of studies on the effect beyond one year¹¹.
• Treatments other than surgery. When the upper lip is the cause, treatments other than surgery also exist. Ask your 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 gum was moved over the root, towards the crown of the tooth (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 cent¹². 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 cent¹². The studies were small and their results could not be pooled. These figures are the range seen in the studies, not your own chance. Several of the studies counted treated areas, not people. Over the years, the gum margin tended to recede again¹³.

A collagen material from an animal source can be used instead of tissue from the roof of your mouth (the palate). In a review of four trials, it meant shorter surgery, and less pain afterwards in three of the four trials¹⁴. But in studies of several receded teeth, complete root coverage was achieved more often with the patient's own tissue¹⁵. 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 3¹⁶. The same review reports that such a wound can take up to four weeks to heal completely¹⁶.

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 back¹⁷. Pain afterwards was lower with a laser¹⁷. In the individual trials, as that review reports them, recurrence ranged from 0 to 80 per cent¹⁷. It varied with the method, the trial and the time point. Follow-up was 15 months at most¹⁷. Another review found the lowest recurrence with freezing (cryosurgery)¹⁸, 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, where two teeth touch, was 5 mm or less from the bone, the gum filled the space almost every time¹⁹. At 6 mm it did so 56 per cent of the time¹⁹. At 7 mm or more, it did so 27 per cent of the time or less¹⁹. 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 more²⁰. But the authors found the evidence insufficient to make recommendations²⁰. 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)¹¹. For frenectomy, a review of 6 trials found pain scores lower with a diode laser on day 1 and day 7, not on day 3²¹. The certainty of that evidence was low to very low²¹. 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 time between them. Ask for these in writing before you agree to treatment.

Anaesthesia. The hospital in London mentioned above numbs the gum for gum surgery with a local anaesthetic injection, and its patients stay awake⁷. Ask which anaesthesia is planned for each step of your treatment. If sedation is suggested, ask what kind it is and why, and who will give it. Your written plan names the place where any sedation is given. A UK standard for dental sedation says adults need an escort for every form of sedation except inhalation sedation with nitrous oxide and oxygen²². Ask us whether the method planned for you needs an escort, and arrange in advance who will take you home. More is on the conscious sedation page.

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 weeks¹¹. If tissue was taken from the palate, that area can be sore too (see above).
• Swelling and bruising. After gum surgery, the hospital in London mentioned above lists possible bruising and swelling of the gums or the face near the treated teeth⁷. Swelling can take 2 to 3 days to appear, and up to 2 weeks to go down completely⁷.
• 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. After gum surgery, including crown lengthening, the same hospital tells its patients not to brush the area where they had surgery⁷. It advises 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 for written instructions on how to clean the treated area and when to brush it again, and follow them. 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 rinse with water⁴.
• 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.
• Stitches and follow-up. At the same hospital, stitches that do not dissolve are usually removed 1 to 2 weeks after surgery⁷. Ask which kind of stitches you will have, when the healing will be checked, and by whom. The check-ups belong in your written plan.

Bleeding that does not stop, or pain and swelling that keep getting worse, are not normal. See "When to contact us 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.
• Sensitivity and exposed roots. After gum surgery, teeth might become sensitive to hot, cold or sweet foods or drinks⁷. Exposed root surfaces are 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 in its leaflet on gum grafts. They include bleeding, infection, swelling, an uneven gum line and the need for further surgery²³. At a palate donor site, bleeding, burning, altered sensation and changes in eating¹⁶ 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 year¹¹. Ask your dentist which other risks apply to lip surgery.
• 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 design plan. The order matters: gum disease is treated first, the gum line is set, and the veneers or crowns 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 veneers or crowns be made soon after the gum contouring, or only once the gum has settled?
2. If soon after, how will the veneers or crowns 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, you can still decide not to go ahead. You can say no, or ask to stop, at any stage. Turkey's patient rights regulation gives you the right to refuse treatment or ask for it to be stopped⁹; the possible consequences are explained to you.

At our clinic, gum contouring is carried out by our dentists. In Turkey, a dentist does not have to be a specialist to treat the gums. Turkish Law No. 1219 authorises every dentist²⁴ to diagnose and treat the teeth, the gums and the tissues of the mouth and jaw. It ties the specialist title to a specialist certificate²⁴, issued and registered by the Ministry of Health²⁵. Periodontology, the branch of dentistry that deals with the gums, is one of the nine dental specialties set by law²⁴.

You have the right to be told, on request, who is treating you, and their role and title⁹. The Turkish Dental Association's website has a search of registered dentists by name and province²⁶. Ask who will assess your gums and plan the gum line, and who will carry out the surgery. Ask whether any of them holds a specialist certificate in periodontology. Ask too which of the techniques on this page our clinic carries out itself, and which it would refer elsewhere.

Turkey's patient rights regulation sets out what you must be told before treatment. It includes who will carry out the treatment, where and how, the other options with their benefits and risks, and the possible complications⁹. Ask for your plan in writing as well. It should answer these questions:

1. What is the cause of my concern, and which technique is planned for which teeth?
2. Will only the gum be reshaped, or the bone as well?
3. If veneers or crowns follow, when, and how long after the gum surgery?
4. When will the gum line be checked once it has settled, and what happens if it has grown back?
5. What does the plan include if the result needs adjusting?

In private dental clinics, you are asked to sign a consent form for every treatment²⁷. The form is signed in two copies, and one copy is given to you⁹. Ask for your copy.

These clinics also record the diagnosis, the treatment and any X-rays in detail, with tooth numbers²⁷. You can look at your records and get a copy⁹. For gum contouring, ask for a record that shows which teeth were treated, and how. It should also say whether bone was reshaped, and where any graft tissue came from. Ask for copies of any X-rays too, and ask whether you can also have copies of the photographs taken before treatment. A dentist who treats you later can then see what was done.

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 a finger and a piece of gauze for at least 30 minutes⁷. Contact us, or your dentist, if:

• Bleeding does not stop after you have pressed on the area⁷
• Pain or swelling keeps getting worse instead of easing
• You have a fever

If bleeding does not stop and you cannot reach us or your dentist, go to a hospital emergency department⁷.

Emergencies. The following need urgent medical help²⁸. Do not wait for a dental appointment or for our reply. Go to a hospital emergency department or call 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling of the eye or the neck²⁹, a painful eye, or sudden problems with your eyesight
• A lot of swelling inside the mouth
• Finding it hard to open your mouth

This page does not give prices. Your treatment plan is prepared for you after the examination. The main factors that shape the plan 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
• X-rays, and the checks after healing

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