Gum Lift + Veneers After Invisalign

The Patient's Journey

This patient came to us with concerns that many people share but few discuss openly: a gummy smile that made her self-conscious, and teeth that had been worn down over years of grinding. She had already completed Invisalign treatment, which straightened her teeth but couldn't address the excess gingival display or the damage from bruxism. To complicate matters, she was also missing a tooth in the upper right quadrant.

Her goal was clear: she wanted a natural result. Not the overly white, uniform look that screams "dental work," but something age-appropriate that would simply look like her—only better. This is the kind of request that separates cosmetic dentistry from true facially-driven digital smile design. Anyone can make teeth whiter. Creating a result that looks like it was always meant to be there requires a different approach entirely.

"I wanted people to notice my smile, not my dental work."

Understanding the Challenges

A gummy smile can have several causes, but in this case we were dealing with altered passive eruption—a condition where the gum tissue covers more of the tooth crown than it should. The teeth themselves were of normal length; they were simply hidden beneath excess tissue. Combined with the wear from bruxism, which had shortened her teeth further, the result was a smile that showed more gum than tooth.

Many patients assume a "gum lift" is a simple laser procedure. In cases like this, that assumption would lead to disappointment. Laser-only gingivectomy addresses soft tissue but ignores the underlying bone architecture. Without addressing the bone, the gum tissue simply grows back. For a predictable, lasting result, we needed to perform true aesthetic crown lengthening—a surgical procedure that recontours both the soft tissue and the bone beneath it.

The Treatment Approach

The sequence of treatment matters enormously in cases like this. Everything begins with the facially-driven digital smile design—a detailed plan that maps out exactly where the gum line should sit, how the teeth should be shaped, and how all the elements will work together. This design becomes the blueprint for every subsequent procedure.

With the design established, we performed the crown lengthening procedure. This involved carefully excising the excess gum tissue according to the planned gum line, then recontouring the underlying bone to support this new tissue position. There's an important technical consideration here: the higher you raise the gum line, the thicker the remaining tissue tends to become. A thick, bulky gum line doesn't look natural. To address this, we also reduced the gingival thickness from the facial aspect. This refinement not only creates a more delicate, natural-appearing gum line but also results in healthier, pinker tissue.

After allowing six weeks for the gingival tissues to heal and mature, we placed the implant in the upper right. The implant position was determined by our facially-driven digital smile design—ensuring it would support a restoration that matched seamlessly with the adjacent veneers. Once the implant integrated with the bone, we moved forward with temporization and finally the definitive porcelain restorations.

• Facially-driven digital smile design to establish ideal tooth and gingival proportions
• Aesthetic crown lengthening with osseous recontouring
• Buccal gingival reduction for natural tissue thickness
• Six-week healing period before implant placement
• Implant placement guided by final facially-driven digital smile design
• Provisional restorations to verify aesthetics and function
• Final porcelain veneers with natural characterization

The Artistry of Natural Results

When a patient asks for something "natural," they're really asking for something invisible—dental work that doesn't announce itself. This requires attention to details that most people never consciously notice but would immediately sense if they were wrong: subtle color gradations from the gum line to the incisal edge, surface texture that catches light the way natural enamel does, proportions that relate harmoniously to the patient's facial features.

The final result achieves exactly what she asked for. Her teeth appear longer and more prominent because the gum tissue now sits where it should. The wear from bruxism has been corrected with porcelain that restores proper tooth proportions. The missing tooth has been replaced with an implant-supported crown that blends invisibly with her natural teeth and veneers. And through it all, there's nothing that reads as "dental work"—just a healthy, balanced smile.

"The goal isn't perfection. The goal is harmony."

Beyond the Technical

Crown lengthening is, in my view, one of the most underutilized procedures in general practice—let alone in aesthetic dentistry. When performed correctly, it transforms the entire framework of a smile. Combined with well-executed veneers and implant work, it enables results that simply aren't achievable through any single procedure alone.

This case represents what comprehensive facially-driven digital smile design can accomplish: multiple procedures, carefully sequenced and precisely executed, all in service of a single goal. Not a collection of dental treatments, but a cohesive transformation that looks like it was always meant to be.