Gingivectomy

Gingivectomy is surgery to remove excess or overgrown gum tissue (gingiva). Periodontists (gum specialists) use it to treat some forms of periodontal (gum) disease. Gingivectomy (pronounced “jin-juh-VEK-tuh-mee”) is also a common cosmetic dentistry procedure used to fix a “gummy smile.” This is when excess gum tissue makes your teeth look short or “boxy.”

This procedure may be right for you if you have:

• Gingivitis (early-stage gum disease)
• Periodontitis (a bacterial infection that causes your gums to swell)
• A “gummy smile” that makes your teeth look too short
• Periodontal pockets (areas where your gums have pulled away from your teeth)
• Tooth malposition (the position of your tooth results in excess gum tissue)
• Overgrown gum tissue caused by braces or other orthodontic appliances
• Extra gum tissue caused by certain medicines (like amlodipine for high blood pressure or cyclosporine as an immunosuppressant)

Types of gingivectomy

There are two main types:

• Traditional gingivectomy: A surgeon uses a scalpel to remove excess gum tissue. In some cases, they may need to remove a small amount of underlying bone. They may use stitches to close incisions and slow bleeding.
• Laser gingivectomy: A surgeon uses a handheld laser to remove excess gum tissue. As lasers also seal gum tissue, you may not need stitches.

What happens during gingivectomy surgery?

Here are the steps you can expect during the procedure. Your surgeon will:

1. Administer anesthesia. You’ll get local anesthesia to numb your gums. Your surgeon may give you sedatives to help you relax.
2. Remove excess gum tissue. Using a scalpel or laser, your surgeon will remove any excess or overgrown gum tissue.
3. Reshape your gums. Your surgeon will reshape your remaining gums. This ensures that your gums are proportionate to your teeth.
4. Reshape bone. In some instances, your surgeon may need to reshape the underlying bone. To do this, they’ll need to make small incisions along your gum line.
5. Stitch the site. Your surgeon will use stitches to close the incisions and slow bleeding. (They may skip this step with laser gingivectomy.)
6. Dress the wound. Your surgeon may place soft putty over the surgical area to protect it. This dressing usually falls out on its own. If not, your surgeon will remove it at your first follow-up appointment.

In most cases, it takes between 30 and 60 minutes to complete a gingivectomy procedure. If you need surgery on several teeth, it may take a little longer.

Gingivectomy recovery

You’ll be able to go home the same day as the procedure. If you get sedatives, you’ll need someone you trust to drive you.

Your surgeon will give you a list of instructions to care for yourself during recovery. They may tell you to:

• Keep the surgical site clean. While you’ll want to avoid brushing too hard, you’ll still need to clean the surgical area. Brush gently and rinse with an antibacterial mouthwash. Brush and floss all other teeth normally.
• Take all medications as directed. Your surgeon may prescribe antibiotics or pain medication. Be sure to take these exactly as they tell you.
• Use an ice pack. Place a cold compress on your outer jaw to help reduce swelling and inflammation.
• Stick with soft foods. You can eat after surgery, but start with liquids or soft foods. After a few days, introduce more solid foods, like yogurt, mashed potatoes, cooked veggies and scrambled eggs. Avoid hard, crunchy foods for at least one week.
• Avoid touching the surgical area. Though it may be tempting, don’t touch the surgical area with your fingers or tongue. This can disturb the healing process.

On average, it takes about one week for your gums to heal following gingivectomy.

How can I manage pain following a gingivectomy?

You can expect to have some soreness and mild discomfort after surgery. Most people can manage pain with over-the-counter pain relievers, like acetaminophen or ibuprofen. You may also have:

• Bruising
• Swelling
• Teeth sensitivity

These side effects should fade within three to four days.

When can I go back to work or school?

Most people can return to work or school in a day or two. But keep activity light. If your job requires physical labor, you may want to stay home for at least three days.

Be sure you avoid strenuous exercise or heavy lifting for at least 48 hours. An elevated heart rate could cause more pain, bleeding and swelling.

When should I call my healthcare provider?

Call your surgeon right away if you’ve recently had a gingivectomy and develop:

• A fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius)
• Bleeding that won’t stop
• Pus or drainage coming out of the surgical site
• Pain that doesn’t get better with medication

What are the risks of a gingivectomy?

It’s possible to develop complications like:

• Infection at the surgical site
• Severe pain that doesn’t improve with medication
• Abscess
• Nerve damage
• Sepsis (a complication of infection)

Any surgery carries risks. But it’s important to know that gingivectomy is considered a safe procedure. Complications are very rare.

Do I need a gingivectomy with braces?

Most people with braces don’t need gingivectomy. But some people develop swollen and puffy gums after they get braces. Usually, you can prevent this with improved brushing and flossing at home. If not, you may need a gingivectomy. Your orthodontist can tell you if you’d benefit from this procedure.

Do gums grow back after gingivectomy?

No, gingivectomy results are usually permanent when a periodontist correctly diagnoses your condition and performs the procedure. Poor hygiene, smoking and not going to your dentist regularly can cause your gums to regrow.

What makes gingivectomy different from other gum procedures?

Gingivoplasty and crown lengthening share some similarities with gingivectomy. But these three procedures have different purposes:

• Gingivectomy is the removal of excess or overgrown gum tissue.
• Gingivoplasty is the reshaping of your gum line.
• Crown lengthening involves contouring and reshaping the bone underneath your gums. Your dentist may recommend crown lengthening when your tooth is too short to hold a crown or when a cavity or filling sits below your gum line.

Periodontists may perform these as standalone treatments or in combination with one another.