Aesthetic Gingival Recontouring

Gingival aesthetics contribute to the overall visual assessment of a completed orthodontic case. Excessive gingival display, asymmetry of gingival contours, and disproportionate clinical crown heights or widths may influence the perceived balance and harmony of an otherwise well-aligned dentition. These features reflect variations in gingival anatomy and tooth–gingiva relationships rather than orthodontic tooth position alone.

In the maxillary anterior region, the position and contour of the gingival margins influence smile aesthetics and the perceived dimensions of the teeth. In many individuals, the gingival margins of the maxillary central incisors and canines are positioned at similar vertical levels, with the lateral incisors often exhibiting slightly more incisal gingival margins. The location of the gingival zenith and the symmetry of gingival contours across the midline contribute to visual balance. Variations from these patterns are common and may be influenced by tooth morphology, eruption patterns, lip dynamics, and periodontal anatomy.

Perception of excessive gingival display is subjective and influenced by lip mobility, smile dynamics, facial proportions, and individual esthetic preferences. While gingival display beyond a few millimeters is sometimes described as less desirable in esthetic literature, assessment must be individualized and contextual rather than based on fixed numerical thresholds.

Advances in soft-tissue management have expanded options for addressing gingival contour irregularities when clinically indicated. In selected cases, aesthetic gingival recontouring may be considered to refine gingival margins after orthodontic alignment has been completed and periodontal health has been established. Such procedures are typically limited to areas where gingival form significantly affects smile balance, most commonly within the maxillary anterior segment.

Decisions regarding gingival recontouring require careful evaluation of periodontal biotype, biological width considerations, tooth position, and long-term tissue stability. Coordination with a general dentist or periodontist may be appropriate to ensure that any soft-tissue modification is conservative, biologically sound, and aligned with the patient’s overall oral health and esthetic goals.

Reference

Graber L.W., Vanarsdall R.L., Vig K.W.L., Orthodontics: Current Principles and Techniques, 5th ed., 2011.