A newly aligned smile following orthodontic treatment can sometimes be accompanied by concerns about the appearance of the gums. This often manifests as a receding gumline, where tooth roots appear longer, or as dark, triangular spaces between the teeth near the gumline, known as “black triangles.” Many people wonder if the soft tissue around their teeth will naturally restore itself to its previous height after the braces are removed.
The Limits of Gum Tissue Regeneration
The direct answer to whether gum tissue will grow back to cover an exposed root surface is no. The tissue surrounding the teeth, known as the gingiva, has a limited capacity for true regeneration, which is the complete recovery of both structure and function. While the epithelial layer of the gums is constantly renewed, the underlying connective tissue does not readily rebuild to cover a previously exposed root surface once recession occurs.
A key factor governing gum height is the level of the underlying alveolar bone that supports the tooth. Gum tissue almost always follows the contour of the bone beneath it. If bone loss has occurred, the gum tissue cannot regenerate past that lower bone level. Recovery from inflammation is possible, where swollen tissue shrinks back to a healthy state, but this is a reduction in swelling, not a regrowth of lost tissue.
Primary Causes of Gum Changes During Orthodontic Treatment
The visual changes in gum appearance during or after braces are linked to mechanical and biological factors. A significant cause is inflammation resulting from poor oral hygiene while wearing the appliances. Brackets and wires create more surfaces for plaque and bacteria to accumulate, and the resulting gingivitis causes gum tissue to swell and then recede as the inflammation is controlled.
Another factor involves the controlled movement of the teeth, especially when teeth are moved outward toward the lip or cheek. If a tooth is pushed beyond the limit of the surrounding alveolar bone, the bone on that side can resorb. Since the gum tissue relies on the bone for support, it collapses with the lost bone, creating recession. This is more common in individuals who have naturally thinner gum tissue, known as a thin biotype.
The appearance of “black triangles” is a specific change often revealed by tooth alignment. These gaps form when the interdental papilla, the triangular gum tissue between teeth, does not completely fill the space under the contact point. When teeth are straightened, the wider parts are brought together, but the narrower parts near the gumline may leave a space the papilla cannot fill. This issue often results from the natural triangular shape of the teeth or pre-existing bone loss hidden by previous crowding.
Clinical Strategies for Addressing Persistent Gum Recession
When natural recovery does not occur, professional strategies can address persistent gum recession and aesthetic issues like black triangles. The first step post-braces is maintaining excellent oral hygiene to ensure any remaining inflammation resolves completely. This recovery from swelling can sometimes improve the appearance of the gumline in mild cases.
For the cosmetic concern of black triangles, dentists often use dental bonding. This involves applying tooth-colored composite resin to the sides of the teeth. This procedure slightly widens the teeth at the gumline, closing the triangular space and providing an immediate aesthetic improvement.
Surgical Options
Soft tissue grafting, commonly known as a gum graft, is the most predictable method for restoring lost gum tissue and preventing further recession. This procedure involves taking a small amount of tissue from another area of the mouth, often the palate, or using a donor source to cover the exposed root surface. Specialized techniques, such as the Pinhole Surgical Technique which involves minimal incisions, are also available for restoring lost gum tissue.