Opinion Needed, Gum Contouring/Crown Lengthening Post Braces

[ClarityTeeth]

I got my braces off about two and half weeks ago. I had worn them for approx. 13 months to fix (mainly) upper and lower spacing, including a rather large diastema between my two front teeth. This was my second go 'round in braces. I had them as a pre-teen/teen and didn't wear my retainer. Several years later, my teeth had shifted to their near original position.

Now that I have my braces off, I went to a periodontist per my orthodontist's referral. The periodontist said that I didn't need a frenectomy (frenum not that low) nor a fiberotomy - that each procedure could be a 50 percent hit or miss. He also said that gum contouring might be of some cosmetic benefit but that it was not necessary to maintain my outcome. He added that orthos have no conclusive evidence that fiberotomies sustain positive outcomes more than consistent retainer wear alone.

When I reported these opinions to my orthodontist during a follow-up appointment, he seemed aggitated. He thought I should probably get all three procedures done, but definitely the gum contouring more than anything. I have some areas where my gums appear to have "bubbled up," or thickened, where there were once considerable spaces. The ortho says that if this is not addressed through gum contouring/crown lengthening, that the pressure exerted by the gums might push my teeth apart.

After visiting my normal dentist for a cleaning, he said he thought it would eventually lessen on its own.

I'd like a completely unbiased opinion from someone who doesn't stand to benefit directly financially or score points for passing along referrals to friends. If I wear my retainer 24/7 for a year, then nightly thereafter, do I NEED to get any - or all - of these procedures done? Will gum contouring actually do anything to help my teeth stay in position?

[rsprouse]

So there are a lot of important details that you left out that are needed for a true and unbiased opinion.

First off, was the frenectomy recommended by your orthodontist or your periodontist? What is the reason? Do you have a diastema that won't close due to a frenum? Most frenectomy's are very simple (<Snip> You're done!!), but I wouldn't do one without a good reason.

Regarding a fiberotomy, the literature is mixed on whether or not it is beneficial after taking into account all of the risks. Personally it makes little sense to me. The principle is to sever the attachment fibers around the tooth so that they grow back fresh in a way that prevents relapse. But when you move a tooth the fibers repair themselves so it seems like a redundant procedure. I personally recommend a retainer (permanent or removable) to prevent relapse. But I am not familiar with your case so your best bet is to trust your treating ortho, dentist and/or periodontist.

Sounds like you have a pseudo-pocket due to excess tissue. Do the contours of your gum bother you? Did your dentist or periodontist probe deep pockets that you would not be able to clean? I have seen some very impressive results from contouring tissue and it is not a big deal. But if you are happy with your results and there is no clinical reason to do the procedure then don't feel obligated to do it.

Good Luck,
Rory

[2hOtT2HaNdLe01]

Clarity Teeth- I have your same problem. My main reason for braces was to close multiple spaces in my upper and lower arches, including a larger diastema between my two front teeth. As the spaces began to close, my gums started to "bunch up" around the teeth. My orthodontist told me to brush my gums, I did that, and it worked- just barely. Then during my cleaning at the dentist, my hygienist told me i needed to floss, so I began flossing on a regular basis- still did not help. Then I talked to my best friend's father, who is a dentist/orthodontist and he recommended a gingivectomy. I was really excited because this was just the answer I was looking for. So maybe you can try talking to your orthodontist or dentist about getting that. I hope everything works out for you. Good Luck!

[ClarityTeeth]

Thanks for the responses.

I have decided to go ahead and get the gum contouring/crown lengthening procedure done. It is scheduled for next week. I do have a question for the doc(s). One of the main reasons I am deciding to go forth with it is because when I got my braces off, my orthodontist said that since my gum tissue is so thick, he was "still getting some bounce" off my teeth when he palpated them with his finger, for example. He thinks that my gum tissue, if left alone, could actually promote my teeth shifting.

I do notice that when I take my retainer off for 45 minutes or more, my center top space reopens slightly but returns to closure when I put my retainer back on. Could the excessive gum tissue in that space be making that occur? Or could it simply be that braces didn't offer me "perfection," so I'll need to consider bonding for a further cosmetic alternative?

I am not a candidate for an fixed retainer. The orthodonist said I would knock it off when biting down - not enough space.