Straight Teeth, and One Gum Sitting Higher Than the Rest

Quick answer: When one gum margin sits out of line, the usual instinct is to trim the gum. Often the gum is exactly where it should be and the tooth is in the wrong vertical position — in which case cutting the gum makes things worse, and moving the tooth is the answer.

The call

The teeth were straight. That part had worked. What she could not stop looking at was the gum above her right lateral incisor, sitting a good 2mm higher than its twin on the other side.

Tamar, 22, from RBS Bet, had finished orthodontic treatment eight months earlier. She had come asking for gum contouring, having seen it described online.

What we found

The gum margin on the upper right lateral incisor sat 2mm higher than the margin on the left lateral. Everything else was even and the midline was correct.

The examination that decides this takes about five minutes and is almost always skipped.

Crown height. The right lateral measured 9.8mm from gum margin to biting edge. The left measured 7.6mm. So the right-hand tooth was displaying more of itself, not less — the opposite of what you would expect if the gum were simply overgrown on the left.

Probing. The distance from the gum margin down to the bone was normal on both sides, about 3mm. That is the critical measurement. Where a gum is genuinely excessive, that distance is greater and there is spare tissue to remove. Here there was none.

Biting edge position. The right lateral's edge sat level with its neighbours — but its whole tooth sat higher in the bone, gum and all.

That is a vertical position problem, not a gum problem. The tooth had been slightly over-intruded during orthodontic treatment, and the gum and bone had followed it up, as they do. The gum was in the correct relationship to its own tooth; the tooth was in the wrong place.

Why cutting the gum would have failed. Removing gum where there is no excess means cutting into the attachment. The tissue either grows back within months, or it does not and you have exposed root surface and a tooth that now looks too long, with a thin biological seal that inflames chronically. Either way, worse than before, and not reversible.

What we did

Sent her back to her orthodontist, with the measurements written down and photographs.

That is a less satisfying answer than doing something ourselves, and it was the right one. The correction needed was 1.5 to 2mm of extrusion — bringing the tooth down, letting the gum and bone come with it, and then adjusting the biting edge slightly to compensate.

Four months of limited orthodontic treatment with a fixed appliance on the upper front teeth only.

Then a small amount of composite added to the biting edge of that lateral, because extruding a tooth brings its edge down as well and the edge needed shortening or the crown lengthening — we chose to reshape rather than grind, which meant a minor addition to the neighbouring tooth to balance.

Then, finally, about 0.5mm of gum recontouring on one tooth to refine the result. A minor finishing step, done once the position was right, rather than the whole treatment.

The outcome

Gum margins level within about 0.5mm, which reads as symmetrical. Stable at two years, with a bonded retainer in place.

Had we contoured on the day she asked, she would have had a longer-looking tooth, an exposed margin and the same asymmetry from a different direction.

What to do if this happens to you

1. Ask for crown heights to be measured on both sides. Numbers, not impressions.
2. Ask how far it is from gum margin to bone. That determines whether there is any spare tissue.
3. Ask whether the tooth or the gum is out of position. They need opposite treatments.
4. Go back to your orthodontist if the problem appeared during or after treatment.
5. Be cautious about gum contouring offered without measurement. It is irreversible.
6. Judge the final result at six weeks, after tissue has settled.

Uneven gum line bothering you? Ramat Beit Shemesh Urgent Dental Care measures before recommending surgery. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.