Aesthetic periodontics

Boota Singh Ubhi considers the potential of surgical crown lengthening.

When approaching periodontology, we often think about the health of the gingiva and the treatment or management of disease. Whilst this is the priority, it is also often necessary to consider aesthetics too. The soft tissue is integral to the appearance and function of the teeth, so optimising every aspect of it is beneficial in achieving the best possible outcomes for patients.

Soft tissue impact on treatment
The soft tissue fulfils several roles within the mouth, including protection of the tooth roots and/or dental implants, prevention of infection and improving smile aesthetics.

When assessing the gingiva either visually or with a periodontal probe, it is commonly characterised according to its biotype. Typically, it is referred to as ‘thick’ or ‘thin’ – more specifically ‘scalloped and thin’ or ‘flat and thick’ – which relate to gingival thicknesses of ≥1mm or <1.0mm respectively.

It has been proposed that gingival biotype is one of the main factors influencing the success of root coverage procedures or restorative dental treatments. Patients with a thinner gingiva are more likely to experience recession following non-surgical periodontal therapy and mucogingival problems as a result of orthodontic treatment. Tissue biotype can also affect site preparation and surgical outcomes with regards to dental implant planning and placement. All of these have the potential to impact final aesthetics, so careful consideration should be given to minimising potential soft tissue complications when working with thinner biotypes.