A gingivectomy is a common periodontal procedure involving the precise removal of excess or overgrown gum tissue, often called gum contouring. While wearing braces, a gingivectomy is frequently possible and often becomes a necessary component of the overall treatment plan. This procedure restores gum health, improves access for cleaning, or enhances the final aesthetic outcome of the smile.
Understanding Gum Tissue Changes During Braces
The presence of fixed orthodontic appliances significantly increases the risk of gingival enlargement, also known as gingival hyperplasia. This tissue overgrowth is primarily an inflammatory response to the accumulation of plaque and bacteria around the brackets and archwires. Braces create a mechanical obstruction, making it challenging to maintain the meticulous oral hygiene required to prevent inflammation.
The constant irritation and difficulty in plaque control lead to a chronic inflammatory state that stimulates gum cells to proliferate. Hormonal fluctuations, common in adolescents, can further exaggerate this reaction. In some instances, a reaction to metal ions, such as nickel, released from the appliances may also contribute to the overgrowth. This excessive tissue can become red, swollen, and prone to bleeding, sometimes interfering with tooth movement or the placement of new brackets.
Timing the Gingivectomy While Wearing Braces
A gingivectomy is often performed during the middle or later stages of orthodontic treatment, rather than waiting until the braces are removed. The timing depends on the goal: addressing a health concern or an aesthetic issue. If the overgrown tissue is severe enough to impede proper oral hygiene or interfere with tooth movement, the procedure is done mid-treatment to prevent worsening periodontal conditions.
The orthodontist and a periodontist must coordinate closely to determine the precise timing and extent of the tissue removal. If a laser is used, the procedure is often quick and performed with minimal discomfort using only local anesthesia. To gain clear access to the gum line, the orthodontist may need to temporarily remove the archwire connecting the brackets, though the brackets remain bonded to the teeth.
Performing the procedure before the braces are removed eliminates tissue pockets that harbor bacteria, allowing teeth to finish moving into their correct positions. This also ensures the final gum line is properly contoured and symmetrical for the finished smile. Reshaping the gums while the braces are still on ensures the final tooth-to-gum ratio is ideal when the appliances are removed.
Maintaining Results and Healing With Brackets
The healing process after a gingivectomy is generally rapid, often taking about one week for the gums to recover significantly. Patients typically experience mild soreness managed effectively with over-the-counter pain relievers. Post-operative care emphasizes a soft, cool diet for the first few days to protect the surgical site from irritation.
Preventing the overgrowth from recurring requires immediate and meticulous attention to oral hygiene, even with the brackets in place. Patients should resume gentle brushing with a soft-bristled brush within a day or two, being careful around the newly contoured gum tissue. Rinsing with a prescribed antimicrobial mouthwash for about one week is often recommended to minimize the bacterial load during the initial healing phase. Specialized tools, such as interdental brushes and water flossers, are invaluable for navigating the wires and brackets to keep the gum line clean and prevent a return of the inflammatory tissue response.