Gum Contouring and Frenectomy: Soft Tissue Procedures With a Diode Laser

One Device, Two Ways of Working

The diode laser used in dentistry produces light at a wavelength of roughly 810–980 nanometres. This wavelength is absorbed by haemoglobin and melanin in tissue, and almost not at all by hard tissues such as enamel and bone. The diode laser is therefore a soft tissue instrument.

The distinction that makes the rest of this article clear is this: the same device does two different jobs at two different power levels.

• Cutting (ablative) mode: At higher power, with a focused tip, it cuts and vaporises tissue. Gum contouring, frenectomy and treatment of pigmented gums are carried out in this mode.
• Biostimulation (photobiomodulation) mode: At low power, with an unfocused tip, light is applied without touching the tissue at all. There is no cutting, vaporisation or thermal damage. Aphthous ulcers, cold sores and support of wound healing are handled in this mode.

For the patient these are entirely different experiences. One requires local anaesthesia; the other usually does not. The cutting-mode procedures are covered first below, then the biostimulation applications.

What Is Gum Contouring (Gingivoplasty)?

Gum contouring means reshaping the margin and thickness of the gum to create an outline in harmony with the teeth. Two terms are used closely in the literature, but they do not describe the same thing:

• Gingivectomy: Removal of excess gum tissue. Quantity is the point.
• Gingivoplasty: Reshaping the form and contour of the gum. Form is the point.

In practice the two are often carried out together in the same session: the excess is removed first, then the margin is brought to a natural contour.

When Does It Come Into Question?

• An uneven gum line: Where the gum margins of neighbouring teeth sit at different heights, the teeth do not appear equal in length.
• Too much gum showing on smiling: Certain forms of what is commonly called a "gummy smile".
• Teeth that look short: Gum sitting further over the tooth than it should makes the tooth look short.
• Preparation before restorations: Where veneers, crowns or bonding is planned, the gum line may need reshaping first. White and pink aesthetics are planned together.
• Medication-related gum overgrowth: Some blood pressure, epilepsy and immune-regulating medicines can cause excessive gum growth. In such cases the prescribing physician is consulted first.

Not Every "Gummy Smile" Is Corrected by Cutting Gum

This is the most widely misunderstood part of the subject. There is no single cause for showing too much gum when smiling, and gum removal carried out without establishing the cause may not correct the appearance.

• Gum-related: The gum has not receded sufficiently from the tooth. This is the situation in which gingivoplasty works directly.
• Bone-level related: The bone beneath the gum sits too close to the tooth. If only gum is removed, the tissue returns to its former position within a short time. These cases require the bone level to be reshaped as well, and a diode laser does not cut bone; the procedure is planned surgically.
• Lip mobility: The upper lip rises more than usual on smiling. This has nothing to do with a gum procedure.
• Vertical excess of the upper jaw: A skeletal condition, assessed within orthodontics or jaw surgery.

Assessment is therefore made not by looking alone, but with periodontal measurements and radiographs where needed. For planning aimed at the smile as a whole, see the smile design page.

What Is a Frenectomy?

The frenum is a thin fold of connective tissue attaching the lip or tongue to the tissue covering the jaw bone. Everyone has one and it normally causes no problem. When the attachment sits lower than it should, or is thick or tight, function and tissue health can be affected. A frenectomy is the procedure that releases this band.

When Is It Needed?

• A gap between the front teeth (diastema): If the upper lip frenum extends between the two front teeth, the band can contribute to the gap reopening even after the teeth have been closed orthodontically. In such cases frenectomy is usually planned after orthodontic closure.
• Tongue tie (ankyloglossia): A short or forward-attached lingual frenum can restrict tongue movement. It may affect feeding in infants, and the production of certain sounds and oral cleaning later in life.
• Contribution to gum recession: A tight band attached to the gum margin pulls that margin down with every lip movement, which can advance gum recession.
• Denture stability: In people using removable dentures, a high attachment can lift the edge of the denture and disturb its seating.

An important point: a frenectomy on its own does not close the gap between the teeth. It releases the band; closing the gap is achieved by an orthodontic or restorative procedure.

Treatment of Pigmented (Dark) Gums

Gums appearing dark brown or close to black are usually the result of melanin deposition. This is not a disease; it relates to the individual's tissue characteristics and does no harm to health. Smoking can also increase melanin production.

Because the diode laser's wavelength is strongly absorbed by melanin, the pigment-containing surface epithelial layer can be selectively removed. Lighter epithelium forms in the area during healing.

Two points need to be stated honestly here. First, the colour can partly return over time. The melanin-producing cells are not entirely eliminated; repigmentation may be seen over months or years, and this varies between individuals. Second, repigmentation is more likely if smoking continues. The procedure is planned with this expectation in mind.

Laser for Aphthous Ulcers and Cold Sores: Application Without Cutting

In the applications in this section the laser cuts nothing at all. Light is applied at low power with an unfocused tip held near the tissue. The aim is to reduce pain and support healing.

Aphthous Ulcers (Recurrent Aphthous Stomatitis)

Aphthous ulcers are painful lesions of the oral soft tissue with a white-yellow base and a red halo. Studies show that low-power laser application markedly reduces pain immediately after treatment and shortens the time for the lesion to reduce in size. The application takes a few minutes and requires no anaesthesia.

That said, aphthous ulceration is a recurrent condition. The laser targets the lesion present at the time; it does not remove the person's tendency to develop ulcers. Where ulcers recur frequently, iron, B12 and folate deficiency and causes related to the digestive system are investigated separately.

Cold Sores (Herpes Labialis)

A cold sore arises when the herpes virus reactivates. Laser applied early, when tingling and tightness first begin, can help reduce pain and bring the crusting stage to completion sooner.

Here too the limit must be stated plainly: the laser does not clear the virus from the body. The herpes virus remains in the nerve ganglion and can reactivate under suitable conditions. The application is directed at the course of the episode. In widespread or frequently recurring lesions, and in people whose immune system is suppressed, drug treatment is assessed separately.

Biostimulation and Wound Healing

Photobiomodulation rests on low-power light acting at cell level. The light is absorbed by mitochondria within the cell; energy production (ATP) increases, fibroblast proliferation accelerates and inflammatory mediators are modulated. Tissue repair is thereby supported and the perception of pain decreases.

The main clinical uses are:

• Supporting healing of the site after surgery — following extraction, implant placement and gum surgery
• Reducing swelling and discomfort after a procedure
• Supporting healing of pressure sores caused by dentures
• Application in the same session immediately after a cutting-mode procedure

Biostimulation does not replace a treatment; it supports the treatment already in place. If infection is present, the infection itself is addressed separately.

How the Procedure Goes

For cutting-mode procedures the sequence is generally as follows. The area is assessed first and periodontal measurements are taken; where necessary the bone level is checked radiographically. Local anaesthesia is then applied — the laser does not replace anaesthesia, and the procedure is carried out under it. The tissue is then reshaped with the laser tip along the planned outline.

What the laser contributes at this stage is control of bleeding. Because small vessels are sealed by the heat during application, bleeding remains largely under control. This has two practical consequences: the dentist sees the working area clearly, which allows the margin to be shaped more precisely; and sutures are not needed in most cases, the site being left to heal on its own. As no sutures are placed, no suture-removal appointment is needed either.

In biostimulation applications there is no anaesthesia, no incision, and the tip does not touch the tissue. Most people feel a mild warmth.

What the Laser Provides — and What It Does Not

The differences the laser makes should be conveyed without exaggeration. Comparative studies give a consistent picture.

What it provides

• Control of bleeding during the procedure and a clear working field
• No need for sutures in most cases
• Less pain and lower need for analgesics in the first days afterwards
• Less swelling and usually a quick return to daily life
• Less vibration and pressure, since the tissue can be worked without contact

What it does not provide

• It does not remove the need for anaesthesia. Local anaesthesia is still required for cutting procedures.
• It does not work on hard tissue. Where bone needs reshaping, a diode laser is not sufficient.
• It does not change the final outcome. In frenectomy studies the long-term results of laser and scalpel have been found comparable. The difference lies largely in the procedure itself and the early healing period.
• It does not always mean faster closure. A site left without sutures closes by secondary intention; some studies report that epithelial closure can be slower than in a sutured scalpel site.
• It does not replace diagnosis. Which procedure is appropriate follows from the assessment, not from the device.

The Period After the Procedure

After cutting-mode procedures there may be tenderness and mild discomfort in the area for a few days. Warm, soft foods are preferred in the first days; very hot, spicy and acidic foods can irritate the site. Brushing is not abandoned, but the treated area is passed over gently with a soft-bristled brush for the period your dentist describes.

A whitish covering over the healing area is ordinary; it is not infection but a tissue layer formed during secondary healing, and it should not be picked at. Smoking delays healing and contributes to earlier return of colour after procedures on pigmented gums.

Increasing pain, bleeding that does not stop, marked swelling or fever call for contacting your dentist without delay.

How Assessment Is Made

None of these procedures begins with the procedure itself. Gum health, measurements, bone level, smoking and general medical condition are evaluated together. If active gum inflammation is present, gum treatment and dental cleaning are completed first; contouring is not carried out on inflamed tissue.

Information about the procedures carried out at our clinic is on the laser gum contouring and frenectomy page. You can arrange an appointment for assessment through the contact page.

This article is for general information purposes and does not replace a clinical examination. Which procedure is suitable for you, whether it can be carried out and the expected course can only be determined by your dentist after clinical and, where necessary, radiological evaluation.