Marlon A. Moldez, DMD, MS, MSc, PhD
Gingival aesthetics play a large role in the visual assessment of a finished orthodontic case. Excessive gingival display, uneven gingival contours, and disproportionate crown heights and widths as a result of less than ideal gingival anatomy significantly diminish the aesthetic value of even the most perfectly aligned teeth.
Ideally, the gingival margins of the upper anterior teeth are positioned at or very near the inferior border of the upper lip in full smile. Display of gingival tissue in excess of 2 mm is generally considered to be undesirable. Additionally, the position, contour, and bulk of the gingiva on the crowns of the teeth often determine the perception of tooth length and width, with uneven gingival contours causing some teeth to appear too short while others appear too tall. The gingival margins of the upper central incisors and upper cuspids should be approximately level with each other and slightly superior to the gingival margins of the upper lateral incisors. The gingival zeniths of the upper lateral incisors should typically coincide with their long axis centers, and gingival symmetry should exist from one side to the other
With the advent of diode laser many clinicians are choosing to include optimization of gingival aesthetics as part of comprehensive orthodontic treatment. As a rule, aesthetic gingival recontouring is most beneficial in the upper arch from cuspid to cuspid.
Graber, LW et. al., Orthodontics: Current Principles and Techniques, 5th ed, 2011).