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PLASTIC SURGERY OF THE SMILE

Sophie Gordon spoke with Beverly Hills Periodontist Sharyar Baradaran, DDS, MS, on how to achieve a gorgeous smile with cosmetic procedures that promote symmetry and balance of the gum tissue.

Reprinted from Anti-Aging & Cosmetic Surgery Magazine with Permission.

Many people consider the teeth are the most important element of a sensational smile. Not so –– the gum or gingival tissue is just as important, if not more so, when it comes to a beautiful smile as well as overall dental health. Now, with advances in periodontics, a specialty of cosmetic dentistry, the pretty pink gum tissue can be corrected to appear in aesthetic harmony with the beautiful white teeth.

This area of expertise deals with treatment of the gum and bone supporting the teeth and is becoming known as "periodontal plastic surgery", or "plastic surgery of the smile." Just as cosmetic plastic surgery has progressed in leaps and bounds over the last few years, so has periodontal surgery. Dentists have been practicing periodontal procedures for almost thirty-five years. Recently they have perfected newer, better, and more gentle techniques to obtain ideal results with minimum impact on the patient.

Why is the gum tissue so important to the smile as well as the health of the mouth? The size, shape, integrity and health of gum tissue greatly influence the aesthetic appearance of the size and shape of the teeth. Like a frame around a masterpiece painting, it can either enhance or detract from the painting.

Too much gum tissue can lead to short looking teeth, while too little gum tissue can lead to exposure of root surfaces and long looking teeth. Uneven or asymmetrical gum tissue results in uneven and asymmetrical looking teeth. Without the proper shape, thickness and amount of gum tissue, the teeth will never look pleasing to the eye and the overall smile will suffer. Without healthy beautiful gum tissue, no restorative dental treatment like bonding, veneers or crowns can make a smile gorgeous. Every patient must start with healthy gingival tissue that frames the teeth.

Anatomically, the gum is a blanket of soft tissue that protects the underlying bone. Its primary function is to act as a protective layer for the teeth, the roots of the teeth, and the bone that supports the teeth. "A minimum of gum tissue is necessary to avoid vulnerability to chronic redness, sometimes bleeding and progressive periodontal disease," says Dr. Baradaran, a dentist in Beverly Hills who specializes in periodontics.

"We've developed delicate techniques for gum tissue grafting that are superior and more easily tolerated by the patient in addition to obtaining better results," says Dr. Baradaran. "The technique is a routine and painless procedure and patients are able to go about their lives normally and with very few restrictions. Some of the work is done under a microscope using very high magnification. Incisions are less invasive, more precise, often smaller, and sometimes not even visible to the patient.

Gum disease can occur when patients are ineffective in their daily hygienic care of flossing and brushing, or when they do not make regular visits to their dentists. We all produce bacteria in our mouth twenty-four hours a day. Plaque is the primary harbor for bacteria and likes to hide in small dark spaces. Flossing is critically important in the fight against harmful bacteria.

Sometimes gum diseases such as gingivitis or periodontitis can cause gum loss or recession, which may lead to the need for gum tissue surgery, replacement or augmentation. In other cases, brushing too hard and poorly fitted crowns and discrepancy in tissue position can also ruin the appearance of the gums, detracting from an otherwise attractive smile. "Sometimes, simple asymmetry of one gum area in a patient's smile can throw it off completely," says Dr. Baradaran. "Altering this small area can enhance the true beauty of that person's smile."

Dr. Baradaran also states that excessive gum tissue that can be seen while smiling is one of the most common problems he encounters. Having a "gummy smile" is one of the more unaesthetic blemishes to one's smile, which can easily be corrected with proper planning by a surgeon with an artistic eye. A surgical method is used to lift and shape the gums to recreate balance between the amount of tooth, gum tissue and lip tissue displayed during a smile. Correcting it is easy and painless, and patients can see immediate results while in the office. The plastic surgeon develops rejuvenation by balancing and harmonizing the facial structures and features of the entire face. The periodontal plastic surgeon does the same with the elements of the smile.

Gum recession can occur for numerous reasons. Therefore, it is paramount in many instances that a team effort between the restorative dentist and periodontist be established. The periodontist can create a proper healthy environment for the indicated restorative dentistry.

Gum recession around a crown is another problem dentists run into quite often and can be easily fixed by tissue grafting or tissue lifting. This usually occurs when a crown is placed on a tooth while the gum tissue is still inflamed and swollen, before the gum tissue has had an opportunity to heal and shrink. "Problems can occur if the crown was placed when the gum was not in a healthy state," says Dr. Baradaran. It is therefore imperative for the restorative dentist to establish optimal tissue health before placing a crown or any other dental restoration.

Once the gum tissue has receded from the edge of the crown, the only solution is either to remake the crown, or perform a gingival grafting procedure, which would then recover the root. "In this situation we would perform a tissue graft where we take a small section of gum tissue from the palate (the roof of the mouth) and add it to the area that is missing," Dr. Baradaran explains. "Because tissue comes from the patient, there is no rejection factor and the success rate is extremely high -- nearly 100%. Gum tissue will blend and grow and attach to the adjacent gum tissue, thereby recreating what the patient had before."

When considering periodontal treatment for health or periodontal plastic surgery for optimal aesthetics of the smile, the first visit to Dr. Baradaran's office is usually for a consultation, where a detailed analysis is performed including photographs and x-rays. At this time the entire mouth is evaluated and decisions are made on what treatment options should be considered in order to achieve optimal health.

If surgery is indicated, it normally takes place with local anesthesia while the patient is awake, but the area being worked on is completely numb. It usually takes about one to two hours, after which the patient can go home. For those patients who prefer not to think about the treatment, there is the option of undergoing light IV (intravenous) sedation so that although they are still awake, they feel as if they have experienced a relaxing nap during the procedure.

Periodontal treatment is applicable to the general population and is not age–dependent. "The youngest patient we've had has been seven years old and the eldest over eighty," notes Dr. Baradaran. "These treatments are not meant only for movie stars but also the person standing in the elevator next to you." Included in the wonderful cosmetic dental treatments available are the disciplines of orthodontics, restorative dentistry and periodontics. As such, a "team approach" to comprehensive cosmetic dentistry and facial aesthetics is mandatory.

When you critique your own smile, look at the gum tissue, as well as the teeth, to determine whether it is the teeth, the gums or both that might be out of balance. Ask your dentist what can be done to improve both. Feel comfortable in obtaining multiple opinions to get your questions answered, After all, it's your health and your smile!