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Gingival contours/levels in the anterior

In this section, I have summarized some of the points from a lecture about the appears of the soft tissue in the maxillary anterior region.

  • In regards to gingival contours in the maxillary anterior the 2 centrals are even, the laterals drop down, and the canines rise back up is traditional way of thinking.
  • Symmetry is more important that a specific millimeter marking.
  • Patients may or may not want to spend the extra time and expense to idealize gingival margins if the margin does not show in a natural smile.
  • Study showed that non-dentists don’t particularly have concerns about gingival contour differences between central incisors at up to 1mm. 5mm is where they started to notice a lower quality of esthetics.  However, non-dentists did not notice the actual tooth height compared to adjacent teeth until it reached 2mm difference.
  • Smile line and patient considerations/expectations play a large role in the decision making process.
  • When you want to move the tissue apically or coronally, you can intrude/extrude tooth, add root coverage, or crown lengthen.
  • When trying to get tissue to follow tooth during ortho movement, there is a limitation as to how quickly the tooth can be moved. 5mm per month would be safe.  However, in certain cases, tissue may not follow tooth.
  • It is possible to do periodontal surgery to reposition and plasty tissue in order to reduce, move, and possibly eliminate amalgam tattoos.