A patient from England: treating a gummy smile in stages, because patience is part of the treatment
A patient living in England whose gummy smile had been treated with laser gingivectomy only, followed by crowns; the gums became inflamed and the case deteriorated. We restarted from the foundation: surgical crown lengthening with bone removal, implants and provisionals, then, about a year and a half later, final crowns with vertical preparation.
A patient living in England
She came to me in 2024 with a gummy smile. A previous dentist had tried to lengthen her teeth with laser gingivectomy only, then placed crowns.
When gum tissue is removed without addressing the bone underneath, it grows back. Combined with crown margins placed deep under the gum, inflammation set in and the case deteriorated.
Going one step back
Instead of only replacing the crowns, we treated the cause:
- Surgical crown lengthening: bone removal and proper soft-tissue management.
- Implants for the missing teeth, and root canal treatment for some teeth.
- Provisional crowns, and the patient travelled back.
About a year and a half later she returned. We replaced the anterior crowns and converted the preparations from horizontal to vertical, which is more conservative.
The result
It was not only the crowns that changed: the smile line, tooth proportions and gingival display changed, and the bite improved markedly, from a deep bite towards a more normal one. The lower anterior teeth and premolars will be completed later.
The idea: patience
With patients who live abroad, we are often tempted to rush: remove, cut and deliver quickly because they are travelling. That is rarely what is best for them.
What is best is to stage the treatment and coordinate the patient's time with ours, so every phase gets what it needs.
Clinical details for dentists
1 Before: inflamed gingiva around crowns with deep subgingival margins after laser-only gingivectomy 
2 Surgical crown lengthening with bone removal, sutured 3 After: new anterior crowns on vertical preparations; new smile line and gingival display
Case summary
Adult female living abroad (UK). Gummy smile and relatively deep bite. Previous treatment: laser gingivectomy only, then crowns with margins placed deep subgingivally. Presentation: marked gingival inflammation around the crowns and missing teeth.
Diagnosis
Soft-tissue removal without addressing the bone led to tissue rebound; deep margins encroaching on the supracrestal tissue attachment caused chronic inflammation.
Treatment
- Phase 1 (2024): surgical crown lengthening with osseous resection and soft-tissue management; implant placement; root canal treatment where needed; provisional restorations.
- Phase 2 (about 1.5 years later): removal of the old crowns, core build-ups, conversion from horizontal to vertical preparation, new anterior crowns.
- Pending: lower anterior teeth and premolars.
Treated as one plan
Gummy smile, smile line, deep bite, soft tissue, bone, implants, endodontics, prosthetic design and occlusion were addressed as one comprehensive treatment plan rather than as separate procedures.
Laboratory
Abdelhalim Faris: vertical preparation and characterization.
Take-home message
If you came to place an implant, don't look at the implant alone. If you came to make crowns, don't look at the crowns alone. And with patients who travel, stage the treatment instead of rushing it.
Book a Consultation
Leave your details and our team will contact you to arrange your visit — whether you live in Egypt or are travelling in for treatment.
