Gingivectomy (gum trimming): when is it needed, and how does it heal?

The word gingivectomy means 'cutting away the gum'. Bringing the edge into a natural shape after the excess tissue has been removed is called gingivoplasty; the two procedures are usually done together. The aim is to bring the gum down to the level it should be on the tooth and to create an edge that can be kept clean.

The most common reason is gum overgrowth. Some blood pressure medicines, the epilepsy medicine phenytoin and the organ transplant medicine ciclosporin can make the gums grow; growth caused by plaque build-up during treatment with braces is also common. MSD Manuals writes that if there is excess gum after plaque cleaning and adjustment of the medicine, it can be trimmed away. The order matters here: first cleaning and dealing with the cause, then surgery for the excess tissue that remains.

The second area of use is false pockets. When the gum grows, a deep pocket can be measured even without bone loss; this pocket comes from the gum thickening upwards. Gingivectomy removes this excess tissue and so does away with the pocket. In true periodontal pockets where there is bone loss, however, the problem is not an excess of gum but the loss of the support underneath; for these pockets, flap surgery or regenerative methods are considered.

The third area of use is aesthetics. There are several reasons why too much gum shows when you smile: the gum over the tooth not having drawn back to its normal level in adulthood, the upper jaw having developed too much vertically, or too much lip movement. Gingivectomy is the solution only in the first case, and only if the bone level is suitable. When the excess comes from the jaw, orthodontics or jaw surgery come into it; one systematic review reports that in vertical excess of the upper jaw, jaw surgery gives a lasting result.

There is a natural soft tissue attachment distance between the gum and the bone. According to the international classification work, when the edge of a filling or crown is placed into this attachment zone, inflammation and gum recession can be seen. This review does not measure regrowth; the conclusion drawn in clinical practice is this: if the bone is very close to the edge of the tooth, trimming the gum alone is not enough, as the gum may grow to re-establish this distance. In that case, crown lengthening surgery, in which the bone is also corrected, is done.

Gingivectomy is usually a limited procedure done in a single session with local anaesthetic. The real difficulty is not the procedure itself but doing it in the right case. In a wrongly chosen case, the result either recurs or ends with gum recession and root sensitivity.

The decision is made with an examination, pocket measurements and often an X-ray. The list below gives a rough direction.

The sequence below is a general framework; the details vary with the dentist's method and the case.

1. 1

   Finding the cause

   It is established whether the growth comes from a medicine, from plaque, from braces or from a developmental condition. Say which medicines you take and since when.

2. 2

   Cleaning beforehand

   Plaque and tartar are cleaned off, and care at home is improved. Part of the swelling caused by inflammation goes down at this stage; the amount of tissue to be removed surgically becomes smaller.

3. 3

   Measurements and, if needed, X-rays

   Pocket depth and bone level are assessed. If the bone is very close to the edge of the tooth, the plan turns to crown lengthening. In aesthetic cases, the length of the teeth and the smile line are also measured.

4. 4

   Numbing and trimming

   The area is numbed with local anaesthetic. The excess tissue is removed with a scalpel, a laser or electrosurgery, and the edge is shaped. If needed, the tissue removed is sent for pathology examination.

5. 5

   Protecting the wound

   If a scalpel was used, a protective dressing (periodontal pack) may be placed over the surface. With a laser there is less bleeding, so it is often not needed.

6. 6

   Check-up and maintenance

   Healing is checked. For growth caused by medicines or plaque, a regular maintenance interval is set; if a recurrence is noticed early, further surgery may not be needed.

These options are chosen according to the cause of the growth and the bone level.

Gingivectomy is a minor surgical procedure; its risks are usually limited. The real problems come from choosing the wrong case.

The sequence below is a general framework; timings vary with how extensive the trimming is and with the method.

1. The day of the procedure

   Do not eat until the numbness wears off, and take care not to bite your cheek or lip. Take the painkiller your dentist recommends.

2. The first few days

   Pain and tenderness are most noticeable during this period. Choose lukewarm and soft foods; very hot, spicy and hard foods irritate the wound surface. If a protective dressing has been placed, do not remove it.

3. The first weeks

   The wound surface gradually closes over. Clean the trimmed area as your dentist has shown you; plaque builds up on a wound surface that is not cleaned, and healing is delayed. Over time the gum margin takes on its mature pink appearance.

4. Check-up

   Your dentist checks the healing and the level of the gum margin. In aesthetic cases, the final appearance is assessed after the tissue has matured.

5. In the long term

   For growth caused by medicines or plaque, regular maintenance and cleaning at home are the main way to prevent recurrence.

The scope of a gingivectomy varies from case to case. The determining factors:

The area and the number of teeth

Shaping limited to a single tooth and removing widespread growth across both jaws are not the same procedure.

The method used

Scalpel, laser or electrosurgery; the method changes the length of the procedure and the materials needed.

Whether the bone needs correcting

If crown lengthening is needed, the procedure becomes more extensive surgery.

Treatment beforehand and pathology

The cleaning sessions beforehand and sending the tissue removed for examination are separate items.