Does your smile look tilted or too gummy?
A smile can run uphill because the teeth tilt or because the gum line above them does, and the two problems call for different corrections. Veneers placed on an uneven gum line reproduce the unevenness in a brighter shade. Send us a photo of your smile and we will tell you which one you have and what it would cost to correct.
- A call within two hours during office hours.
- A written cost from us, before you commit to anything.
- No obligation. Many patients take weeks to decide. That is normal.
What this case cost
$454/month
144 payments at 9.99% APR, on approved credit.
Total: $38,000 for the analysis, the gum lifting, the provisional phase and twenty porcelain veneers across both arches.
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Treatment Plan by Dr. Mehdizadeh
- Analysis of the bite to establish the function the design had to work inside.
- Smile design, which determined how much gum we needed to reposition and where.
- Gum lifting to level the tissue line across the upper arch.
- Six weeks of healing before anything was prepared.
- Provisional restorations, revised in the mouth until she was satisfied with them.
- Twenty porcelain veneers in e.max, ten upper and ten lower.
The Patient's Journey
This patient came in because her smile appeared tilted and because the upper teeth projected considerably further forward than they should. She wanted a smile that was harmonious and that complemented her face rather than attracting attention independently of it. The existing teeth had discoloration and irregular edges, and a considerable amount of gum tissue showed above them.
The photographs make the tilt easy to see in the frontal view and considerably harder to attribute. The upper edges do run uphill toward one side, but the tissue above them runs uphill by a similar amount, which is the distinction that decided how we approached the case.
Understanding the Challenge
A smile can appear tilted because the teeth themselves tilt, or because the gum line above them does; in her case it was the gum line. The teeth had erupted to different heights and the tissue had followed them, so the visible length of each individual tooth varied across the arch even where the biting edges were reasonably close to level.
That distinction matters because entirely different procedures correct the two problems, and the incorrect correction is expensive. Veneers placed on an uneven tissue line reproduce the unevenness. A veneer begins where the gum begins, so tissue sitting too low on one tooth produces a short restoration on that tooth, however carefully our ceramist makes it.
The second problem was the flare. The upper teeth projected forward and the existing contours were bulky, which made the whole anterior segment appear prominent rather than proportionate, particularly in the frontal photographs where the flare is most obvious. Correcting that meant reducing the prominence rather than increasing it, which is the opposite of what people usually assume a veneer treatment does.
Establish whether the tilt was in the teeth or in the tissue. Level the gum line before preparing anything. Reduce the prominence of the upper arch rather than increase it. Even the color across both arches. Keep the proportions in balance with her face.
How We Approached Treatment
Dr. Mehdizadeh analyzed the bite first, and the smile design followed from it. The design determined the extent of the gum lifting: until the design sets the finished proportions of every tooth, there is no way to measure how much tissue to reposition, or where. Lifting an approximate amount produces an approximate result.
He then performed the gum lifting and allowed six weeks for the tissue to heal and stabilize before any preparation began. Tissue repositioned surgically continues to mature for several weeks afterwards, and preparing teeth against a margin that has not finished stabilizing produces restorations whose edges become noticeable later.
We placed provisional restorations next, and she wore them while we revised them in the mouth until the shape and the proportions corresponded to what she wanted. That revision is the part of the process patients have most influence over, and it happens in acrylic, where alterations cost an appointment rather than a remake.
Our master ceramist reproduced the approved provisionals as twenty porcelain veneers in e.max, ten in the upper arch and ten in the lower, designing and making all twenty in our own laboratory. The finished contours are considerably less prominent than the teeth she arrived with, which is what reduces the projection rather than disguising it.
The Result After Ten Weeks
The smile line is level, the teeth sit in proportion to her facial features rather than ahead of them, and less gum displays because the gum lift repositioned the tissue, not because we lengthened the restorations downward to conceal it. Five appointments across ten weeks covered the analysis, the gum lifting and its healing period, the provisional phase and the final cementation of the restorations.
She needs no further treatment, but surgery repositioned her gum line, and hygiene maintains it. Routine cleanings and examinations are what hold the result, which makes them considerably less optional for her than for someone who has had no periodontal surgery.
Frequently Asked Questions About Gum Lifting and Full Mouth Veneers
How do you tell whether a tilted smile is the teeth or the gums?
By measuring the visible length of each tooth against the biting edge and the tissue line separately. Where the edges are close to level but the visible lengths differ across the arch, the variation is in the tissue. Here we assessed both before designing anything.
What is a gum lift?
Repositioning the gum line so the visible length of each tooth is proportionate and even across the arch. It is a surgical procedure carried out before restorative work, not a finishing touch afterwards.
Why was the smile designed before the gum lifting?
Because the design establishes the finished proportions of every tooth, and until those are known there is no way to say how much tissue has to move or where. Lifting an approximate amount produces an approximate result.
Why wait six weeks after the gum lifting?
Repositioned tissue continues to mature for several weeks. Preparing teeth against a margin that has not finished settling produces restorations whose edges become visible once it does.
Can veneers alone correct a tilted smile line?
Not where the tilt is in the tissue. A veneer begins where the gum begins, so a gum sitting too low on one tooth produces a short restoration on that tooth however carefully our ceramist makes it.
Do veneers always make teeth look bigger or stick out more?
No. The finished contour is a design decision. Here the upper teeth projected forward and were bulky, and we designed the restorations with less prominence than the teeth underneath them.
Why were the lower teeth treated as well?
Because people see the two arches together and read them as one set. Restoring only the upper teeth leaves a color and shape difference that becomes the most noticeable thing about the smile.
What is the provisional stage for?
It is where you have the most influence. We revise the provisionals in the mouth until you agree on the shape and proportions, and only then reproduce them in ceramic, so changes cost an appointment rather than a remake.
Is there anything left to do after treatment?
No further treatment, but surgery changed the gum position and hygiene maintains it. Regular cleanings and examinations are what hold the result, and they are not optional in the way they might be for someone who has had no periodontal surgery.
How much does a gum lift with full mouth veneers cost?
This case was $38,000, covering the analysis, the gum lifting, the provisional phase and twenty porcelain veneers across both arches. $454/month: 144 payments at 9.99% APR, on approved credit.
