A gingivectomy is a common periodontal procedure involving the surgical removal of excess gum tissue, known as the gingiva. The goal of this procedure is to reshape the gum line, which can be done to treat gum disease, improve oral hygiene access, or enhance the appearance of the smile. For patients undergoing orthodontic treatment, this reshaping becomes necessary when gums swell or overgrow, leading to a disproportionate look or making effective cleaning difficult. Defining the gum line is often a final step in achieving a balanced, healthy-looking smile once the teeth have been properly aligned.
Reasons for Gum Overgrowth During Orthodontic Treatment
The presence of orthodontic hardware, such as brackets and wires, creates numerous small surfaces where plaque and bacteria can easily accumulate. This buildup often leads to gingivitis, an inflammatory response that causes gums to become red, swollen, and puffy. The constant irritation from this inflammation is the primary cause of excess gum tissue, medically termed gingival hyperplasia or enlargement, during treatment. Difficulty cleaning around the appliances exacerbates the problem, and hormonal fluctuations, common in adolescents, can also make the gum tissue more sensitive and prone to swelling. While improved oral hygiene is the first defense, the physical irritation combined with inflammation can sometimes cause significant gum overgrowth that will not resolve with brushing and flossing alone.
Performing a Gingivectomy While Wearing Braces
Yes, a gingivectomy can be successfully performed while a patient is still wearing their braces. The presence of the orthodontic brackets and wires does not prevent the gum specialist from accessing or reshaping the gum tissue. Performing the procedure while braces are in place can sometimes be beneficial, as it may be necessary to correct severe overgrowth that is interfering with treatment progress or oral hygiene. Coordination between the orthodontist and the periodontist is necessary to determine the optimal timing for the procedure. The gingivectomy may be performed mid-treatment to allow for better bracket placement, or more commonly, closer to the end of the orthodontic process for final aesthetic contouring.
Methods and Steps of the Procedure
Procedure Steps
The gingivectomy procedure typically begins with the administration of a local anesthetic to ensure the patient is comfortable throughout the process. Once the area is completely numb, the specialist removes the excess gum tissue to expose the full height of the tooth crown. The amount of tissue removed is precisely calculated to achieve an ideal, balanced gum line in relation to the newly positioned teeth.
Removal Techniques
Several techniques are available for the removal and contouring of the tissue. Traditional methods involve the use of a specialized surgical scalpel or electrosurgery, which uses a high-frequency electrical current to cut and cauterize the tissue simultaneously. A popular and often preferred modern method is the laser gingivectomy, which utilizes a diode laser to remove the tissue with minimal bleeding and discomfort. The laser’s precision allows for very accurate contouring and often results in a faster initial recovery due to the immediate sealing of blood vessels. Regardless of the tool used, the final step involves carefully shaping the remaining gum tissue to create a natural and symmetrical scallop around the teeth.
Recovery and Timeline for Orthodontic Adjustment
Post-Procedure Care
The recovery period following a gingivectomy is generally swift, with most patients experiencing a significant reduction in discomfort within the first few days. The first 24 to 48 hours require the most care, with mild swelling and tenderness being a normal part of the healing process. Patients are advised to use a cold compress on the outside of the face and adhere to a diet of soft, non-spicy foods to protect the surgical site.
Hygiene and Adjustment Timeline
Maintaining oral hygiene around the existing braces requires extra attention during recovery. Patients should avoid brushing the surgical site directly for the first few days, instead using gentle rinsing with warm salt water or a prescribed antimicrobial mouthwash. Brushing with a soft-bristled toothbrush can usually resume gently on the treated area within a day or two, being careful not to dislodge the healing tissue. The gums typically achieve initial healing within one to two weeks, but the tissue may continue to firm up and remodel for several weeks beyond that. Orthodontic adjustments, such as wire changes or increased pressure on the teeth, are typically delayed until the periodontist confirms the surgical site has sufficiently healed, which is usually a period of a few weeks.