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Cosmetic Dentist Troy Michigan MI Implants
Michigan Comprehensive Rehabilitation
Troy Solutions for Excessive Bone
Ara Nazarian, DDS
Maxillectomy Procedure
1857 East Big Beaver Rd
Michigan Dental Center
Troy MI 48083
(248) 457-0500
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Troy Gummy Smile Treatment Alternatives

Jawbone Modification vs Gum Tissue Contouring

Gummy Smile Diagnosis and Treatment Basics

The appearance of a gummy smile is usually related to certain conditions that are related to the existence of too much gum tissue on one or both arches of teeth. Although common with children, it becomes more "noteworthy" with older patients.

In some cases, too much gum tissue can create the appearance of "juvenille teeth". Primary, or baby teeth that don't become replaced with Secondary teeth also retain their gummy appearance.

Maxillary excess
Juvenille Appearance
Common orthodontic treatments that involve the use of conventional metal braces can cause hyperplasia (overgrowth of gum tissue) that is caused by certain bacteria conditions.

For a large percentage of adults who simply have too much gum tissue that "frame" their healthy teeth, the most popular treatments for creating an ideal cosmetic change are porcelain veneers (or crowns) coupled with gingival shaping or contouring.

Some patients need only the gum reshaping treatment. These treatments produce a very dramatic result.

Gummy Smiles caused by Too Much Bone

Patients who have an oversized maxilla (in height) can also have the appearance of a gummy smile. A broad smile typically shows gum tissue that is too far above the upper teeth. Lip Repositioning can be performed that positions the upper lip into it's most attractive postion.

Excess Vertical
Poor Occlusion
An upper jaw with an excess of bone height is most commonly a genetic, or developmental event.

Unopposed Super Erupted Teeth

Excess bone growth can also occur due to super eruptions of a long span of teeth, often due to malocclusion where the upper teeth close down in front of or behind the lower teeth.

The adjacent photo reveals how an untreated occlusal problem actually caused the upper anterior arch of teeth to drop down. Attempts to correct this condition with crowns were unsuccessful.

Proper Diagnostics Reveals Treatment Need

Although the patient had the outward appearance of a common gummy smile, the dynamics underlying the condition were not as apparent. Dr. Nazarian's routine use of cone beam 3D ctscans IMMEDIATELY revealed the underlying cause.

Excess Vertical
Ctscan Bone Levels
The close up photo of the patient's retracted smile reflects the amount of excess height in her bony ridge (bone tissue that natural teeth are anchored in).

The yellow line shows the present level while the black line reflects where the bone level "should be".

The patient's previous restorations including multiple crowns and a 3 unit bridge were all failing, due to advanced gum disease.

The next photo in this treatment series reveals the unusual combination of too much bone growth while revealing bone loss at nearly every tooth root.... due to advanced disease.

Excess Vertical
Bone Growth plus Bone Loss

Treatment Solution

Simply extracting the teeth and providing a teeth replacement choice of a porcelain bridge or cosmetic denture would not be sufficient for re-creating the bite and smile behavior she once had many many years ago.

Rather, the bony ridge needed a "reduction surgery" (maxillectomy) to establish a foundation of level bone that would form the basis of her dental reconstruction.

The patient's teeth were removed quickly with special non invasive instruments and protocols, which was completed in a matter of minutes.

Extractions + Leveling + Tissue Grafts
Ready for Suturing
Formulations of grafting materials to fill in the extractions sites (socket grafts) and to create a uniform height and width to the entire bony ridge was completed, using the technical data derived from the ctscans.

The adjacent photo in the treatment series shows the desired uniformity obtained before suturing was performed.

Maxillectomy in One Appointment

The entire treatment was completed in one appointment.

Extractions, bone leveling, socket grafting and leveling grafts, incorporating both bone and soft tissue regeneration products and final suturing prepared the patient for a custom Immediate Denture.

Given today's technologies, no patient should be expected to be toothless during any type of treatment.

Precise Implant Selection - Placement
Eliminates Errors

Dental Implant Surgery

After several weeks of healing (average time is about 2-4 months) the custom ctscan-based surgical guides are used to place the dental implants throughout the newly modified bony ridge.

The surgical guides assure the correct placement of each and every dental implant, some of which are especially selected to take the best advantage of bone tissue conditions (proper centering, depth and avoidance of critical nerve tissues).

Dr. Nazarian avoids the use of "one size fits all" types of implants. Precision diagnostics and the use of advanced technologies is the most effective means for providing fail safe dentistry.

Dental Implants Placed
Dental Implant Placements

Final Osseointegration and Healing

Healing caps are placed on the implants which promote optimal healing and thorough integration of the implants within the new bony ridge.

The patient continues to use the immediate denture that was fabricated earlier.

In approximately 8 weeks the implants are fitted with the custom abutments that will be used to attach the new porcelain bridge.

Dental Implants Placed
New Non Removable Porcelain Teeth

Great Bite with a "Correct" Smile Line

Nine strategically placed dental implants provided the foundation for creating 14 new replacement teeth in the upper jaw.

Issues with vertical dimension (bite height) and occlusion have been totally resolved.

Final Treatment Outcome

The patient was thrilled with the outcome. She became tearful when she viewed her new smile for the first time.

Dental Implants Placed
Look Great.... Feel Great
Her husband commented he had little idea of how bad her tissue conditions were before treatment.

With proper daily care and routine checkups the patient can expect to own her new smile for a lifetime.


Call our office at (248) 457-0500 to schedule a consultation or use our on-line Consult Request to get treatment details of the maxillectomy procedure.

Patients who have specific questions about information on this page or other concerns about unusual bone conditions are invited to contact Dr. Nazarian directly with our Ask The Dentist form. Dr. Nazarian will respond to you directly with the answers or information you are seeking.

MI Reconstructive Implant Dentistry
Ara Nazarian, D.D.S.
1857 East Big Beaver Road
Troy MI 48083
(248) 457-0500 - Fax: (248) 457-0501
Serving Oakland County areas of Birmingham Bloomfield Hills Clawson and Southfield