Gum treatment and gum contouring in Turkey

Gum disease treatment: gingivitis or periodontitis?

Gum disease is not one condition but two stages of the same process. Both start with plaque, the soft bacterial film that builds up along the gum line every day.

Most adults have gingivitis at some point. Only some develop periodontitis, depending on genetics, smoking, diabetes, stress and how long the inflammation is left. Periodontitis is now classified in stages I to IV by severity and grades A to C by how fast it progresses, which helps to decide how intensive treatment and maintenance should be.

Signs and risk factors

Periodontitis rarely hurts until it is advanced. Signs to take seriously:

• bleeding when brushing, flossing or eating an apple
• persistent bad breath or a metallic taste
• gums pulling back so that teeth look longer
• gaps appearing between front teeth, or teeth that have moved or feel loose
• pus at the gum line or recurring gum abscesses

The main risk factors are smoking, which also hides bleeding and so masks the disease, diabetes that is not well controlled, a family history of early tooth loss, and crowded teeth or old restorations that are hard to clean.

Pocket depths and the periodontal assessment

Between a tooth and its gum there is a small groove. In health it measures about 1 to 3 mm. When periodontitis destroys the attachment, the groove deepens into a pocket where bacteria live beyond the reach of a toothbrush.

At the first appointment in Istanbul the dentist measures six points around every tooth, records bleeding, mobility and recession, and relates this to the bone level on the 3D CBCT scan. This chart is the baseline against which every later check is compared.

Deep cleaning: scaling and root planing

What happens

Under local anaesthetic, ultrasonic and hand instruments remove hardened tartar and the bacterial film from the root surfaces inside each pocket. The roots are left smooth and clean so the gum can tighten around them again. We usually treat one half of the mouth per session, in two appointments on consecutive days, or the whole mouth within 24 hours in suitable cases.

How it feels

With anaesthetic the cleaning itself is usually comfortable. Afterwards gums are tender for a day or two and teeth may be sensitive to cold for a few weeks. As swelling settles, the gum shrinks slightly, which is a sign of healing rather than damage.

Adjuncts and surgery

In most cases careful cleaning plus good home care is the treatment. Laser-assisted disinfection can support it in deep pockets, and antibiotics are reserved for aggressive or advanced forms because they add little in routine cases. If pockets of 6 mm or more remain at re-evaluation, flap surgery may be discussed to reach and reshape those areas, sometimes with regenerative materials in suitable bone defects.

Why gums must be healthy before implants and veneers

Implants. The bacteria that cause periodontitis can colonise implants too. Inflammation around an implant, called peri-implantitis, can cause bone loss and, in the worst case, loss of the implant. Studies show a higher rate of peri-implantitis in patients with a history of untreated periodontitis. Treating the gums first, and keeping them stable, is one of the most effective ways to protect dental implants.

Veneers and crowns. A veneer or crown margin is placed at or just below the gum line. If that gum is swollen and bleeding, impressions are inaccurate, bonding is contaminated, and once the inflammation settles the gum can recede and expose a dark line. Can you have veneers in Turkey with gum disease? Not safely while it is active. The gum disease is treated first; mild gingivitis can often be settled in the same trip, while periodontitis may need a few weeks of healing before final veneers or crowns are made.

Gum contouring and the gummy smile

A smile is often described as gummy when more than about 3 to 4 mm of gum shows above the upper teeth. Contouring only helps when the cause is the gum itself, so the first step is working out why.

Gingivectomy or crown lengthening?

If there is enough distance between the gum margin and the bone, excess gum can simply be removed with a scalpel or laser (gingivectomy). If the bone sits too close to the new margin, the gum tends to grow back, so a small amount of bone is also reshaped (aesthetic crown lengthening). The CBCT and probing tell us which one you need.

Contouring is planned together with a digital smile design and, where veneers or crowns follow, before they are prepared. The gum is then given time to stabilise, typically several weeks and longer after bone reshaping, before the final margins are set. Our Hollywood smile page shows how this fits into a full smile design.

Receding gums and grafting

Gum recession exposes the root, which can be sensitive and more prone to decay, and makes teeth look long. Causes include thin gum, aggressive brushing, periodontitis and tooth position. Recession that is stable and not bothering you often needs nothing more than gentler brushing. When it is progressing, sensitive or aesthetically important, a connective tissue graft from the palate or a collagen substitute can cover the root partly or fully and thicken the gum. Full coverage cannot be guaranteed and depends on how much bone remains between the teeth.

Your stay in Istanbul and the part done at home

Be aware that periodontal treatment has a built-in waiting period. Pockets are properly reassessed after around 6 to 12 weeks, and that check usually happens with your dentist or hygienist at home. If you are coming back for implants or veneers, we combine it with your second trip. Read how it works for the full process.

Who it is not suitable for, and the alternatives

• Heavy smokers can be treated, but results are clearly worse; we will recommend stopping or cutting down before implants.
• Uncontrolled diabetes should be brought under control with your doctor first, as it slows healing.
• Teeth with very advanced bone loss may not be worth keeping. Extraction and a planned replacement, such as implants or a bridge, can be more predictable.
• A gummy smile caused by the lip or jaw is not solved by contouring. Alternatives include lip procedures or orthodontic and jaw surgery assessment at home.
• If you cannot commit to maintenance, periodontal treatment will not hold. In that case it is better to know before planning implants.

For many people with gingivitis only, a thorough professional cleaning and better daily routine with their dentist at home is all that is needed.

Maintenance: what decides the long-term result

Treatment brings the inflammation under control; maintenance keeps it there. Studies of treated periodontitis patients show that those who attend regular supportive care lose far fewer teeth than those who do not. In practice this means:

• professional cleaning and pocket checks every three to six months, depending on your risk
• brushing along the gum line twice a day, ideally with an electric toothbrush
• interdental brushes in the right sizes once a day, which reach where floss often cannot
• not smoking, and keeping blood sugar well controlled if you have diabetes

We give you a written maintenance plan that your dentist or hygienist at home can follow.

What shapes your treatment plan and quote

The plan depends on the stage of disease and how many areas are affected, whether deep cleaning is enough or residual pockets need further care, how many teeth are contoured and whether bone reshaping is required, and whether grafting is part of the plan. Gum treatment is often combined with other work in the same trip, and your written quote lists each item separately. Current starting prices are on the dental costs in Turkey page.

Healthy gums come before any cosmetic work. See how a healthy gum line changes a smile in Miley Cyrus's veneers transformation, or compare all our dental treatments.