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Video: Gum Lift and Porcelain Veneers

Gum Lift and Porcelain Veneers - Patient Story

The existing composite veneers and past gum lift 15 years ago have served well.

High gummy smile with general dark gum discolourations is a concern for this patient.

Treatment: Smile rejuvenation with improvement in level of tooth display using gum lift and construction of maxilla (upper arch) using porcelain veneers to improve: tooth shape, colour, display, arch form and shape to complement facial aesthetics of this lovely patient.

patient before gum lift and procelain veneers

Patient before

This study will show:

  1. Complexity of treatment. Hence a specialist intervention is required as precise outcome is critical in this complex smile outline
  2. Treatment outcome
  3. Patient’s assessment - refer to the video provided

Initial Presentation

Patient had restoration work completed in the practice some 15 years ago. However with time the restorations required revisiting.

Past smoker, stopped now for 2 years.

Now we have a unique opportunity to improve on the diagnosis and design of proposed treatment plan: The difficulty here is the gum pigmentation that is present with the proposed tooth length using combination of gum lift and porcelain veneers. Therefore the direct diagnostic composite mock-up is critical in formulating how we design these restorations for an optimal aesthetic outcome.

patient before gum lift and procelain veneers

Initial presentation

Chief concerns: improving the aesthetic appearance of her smile:

  1. To improve the the gummy smile, narrow upper arch shape and smile line as well as tooth colour.
  2. This lovely socilite patient wants to smile, understanding the complexity and the precison of the work required.

Diagnosis: Unacceptable tooth an gum display, assymetry and narrow upper arch: creating an aesthetic disturbance.

Diagnosis and patient centred treatment planning

Once we have determined their needs and expectations and when the patient is ready, we begin to restore their teeth to optimal function and aesthetics.

Diagnostic Mock Up

Diagnostic: mock-up and assessment. Finalise degree of gum and tooth showing during smile and speech dynamics, maxillary arch form and smile width.

We tested the diagnostic mock up for patient acceptance that guided the final desired aesthetic outcome.

close-up diagnostic mock-up

Diagnostic mock-up

Our Aim: to improve the aesthetics of upper arch: Gum level, tooth shape, display, tooth colour, length, symmetry and smile line in general along the upper arch involving 12 maxillary teeth porcelain veneers.

This was accomplished with minimal discomfort to the patient and using no tooth intervention. No provisional veneers were required, since the existing composite veneers placed by myself 15 years ago and required no tooth intervention. Therefore, the tooth enamel is intact and helped in gum healing process following gum lift.

assessing the diagnostic mock-up

Patient guiding the diagnostic mock-up

Treatment

Following a discussion of all risks and treatment modalities with our patient that included:

  1. No treatment: this is not an option as the restorations are failing and affecting aesthetics
  2. Repair existing restorations and gum lift: this is a temporary measure and not accepted by the patient
  3. Gum lift & porcelain veneers: best long-term solution: accepted by the patient

Gum lift and 12 porcelain veneers to complete the high smile line: molar to molar. No tooth intervention.

diagnosis of gum lift

Gum level diagnostics

Procedure & Results

  1. Diagnostic: mock-up and assessment. Finalise degree of gum and tooth showing during smile and speech dynamics, maxillary arch form and smile width
  2. Removal of existing composite veneers and gum lift
  3. Impressions for porcelain veneers
  4. Issue the porcelain veneers

The work was completed in two visits. In general it takes about 3-4 weeks from diagnosis to final outcomes.

gum recontouring gum lift

Gum lift

I would prefer 3 weeks for gum healing. Is best not to rush biology and allow optimal healing.

We tested the diagnostic mock up for patient acceptance that guided the final desired aesthetic outcome. Note how we designed the final porcelain veneers and tooth emergence for that natural look to create symmetry and balance.

gum recontouring gum lift

Gum Lift & porcelain veneers

Creating balance and complementing on facial aesthetics: confidence. Note how all compositional elements of teeth gums lips and face are in concert together. The aesthetic effect should establish harmony and balance between dentition and surrounding soft tissues.

Final treatment outcome: we have restored aesthetics, symmetry and harmony. Complemented our lovely patient’s facial aesthetics. We have a confident and happy patient. Hence the term: dentofacial rejuvenation.

Thank you for taking the time to explore this patient's story. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.

Dr. Sarkis Nalbandian
Registered Specialist
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)

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