Periodontal aspects of improvement in smile: A Narrative review
Periodontal aspects of improvement in smile: A Narrative review
Keywords:
Esthetic Dentistry, Gingival Recession, Gummy Smile, Periodontal Regeneration, Minimally Invasive Surgery
Abstract
A smile significantly influences social interactions, self-perception, and psychological well-being. Dental and periodontal esthetic issues—such as gingival recession, gummy smile, black triangles, midline diastema, tooth wear, discoloration, and fluorosis—can impair function and psychosocial health, causing speech difficulties, sensitivity, and reduced self-esteem. Modern esthetic dentistry addresses these challenges through multidisciplinary approaches, including digital technologies, minimally invasive techniques, regenerative therapies, lasers, and biomaterials. Procedures like coronally advanced flap with connective tissue graft, VISTA, platelet-rich fibrin application, laser-assisted surgery, digital-guided crown lengthening, and soft tissue grafting improve root coverage, interdental papilla reconstruction, gingival depigmentation, and overall esthetics. Nanoparticles and tissue engineering further support periodontal regeneration. Evidence indicates these techniques enhance clinical outcomes, esthetic appearance, function, patient satisfaction, and quality of life. Continued research and implementation of advanced interventions are vital for effective treatment planning and optimized patient-centered care.
References
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23. Chauca-Bajaña L, Vásquez González PS, Alban Guijarro MJ, Guim Martínez CA, Velásquez Ron B, Proaño Yela P, et al. Comparative Effectiveness of Tunneling vs. Coronally Advanced Flap Techniques for Root Coverage: A 6–12-Month Randomized Clinical Trial. Bioengineering (Basel). 2025 July 30;12(8):824. https://www.mdpi.com/2306-5354/12/8/824
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27. Hamadah O, Almahayni S, Ghazzawi R, Mounajjed R, Altayeb W, Khalil M. Effectiveness of laser-assisted gingivectomy compared to surgical methods: a systematic review. Explor Med. 2025 May 26;6:1001325. https://doi.org/10.37349/emed.2025.1001325
28. Yi Z, Miao X, Wang L, Zhang G, Wu Y. A customized subepithelial connective tissue graft for interdental papilla reconstruction and soft tissue augmentation. J Esthet Restor Dent. 2022 Apr;34(3):451–60. https://pubmed.ncbi.nlm.nih.gov/34964233/
29. Woo HN, Cho YJ, Tarafder S, Lee CH. The recent advances in scaffolds for integrated periodontal regeneration. Bioact Mater. 2021 Oct;6(10):3328–42. https://doi.org/10.1016/j.bioactmat.2021.03.012
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31. Ashokkumar L, Krishnakumar D, Ravindran DM, Jain S, Kumar D, SK B. Comparison of Various Minimally Invasive Techniques for the Management of Gingival Hyperpigmentation: A Case Report. Cureus. 16(11):e73870. https://pmc.ncbi.nlm.nih.gov/articles/PMC11652682/
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33. Alsaleh O, Baz NA, Salem A, Abed H, Almarghlani A. Assessing Platelet-Rich-Plasma in Gingival Depigmentation: A Split-Mouth Two Case Report Comparing Laser and Bur Ablation. Saudi J Oral Dent Res. 2025 Mar 25;10(03):167–73. https://doi.org/10.36348/sjodr.2025.v10i03.003
2. Afroz S, Rathi S, Rajput G, Rahman SA. Dental Esthetics and Its Impact on Psycho-Social Well-Being and Dental Self Confidence: A Campus Based Survey of North Indian University Students. J Indian Prosthodont Soc. 2013 Dec;13(4):455–60. https://pmc.ncbi.nlm.nih.gov/articles/PMC3792334/
3. Singh VP, Uppoor AS, Nayak DG, Shah D. Black triangle dilemma and its management in esthetic dentistry. Dent Res J (Isfahan). 2013;10(3):296–301. https://pmc.ncbi.nlm.nih.gov/articles/PMC3760350/
4. Manjula WS, Sukumar MR, Kishorekumar S, Gnanashanmugam K, Mahalakshmi K. Smile: A review. J Pharm Bioallied Sci. 2015 Apr;7(Suppl 1):S271–5. https://pmc.ncbi.nlm.nih.gov/articles/PMC4439690/
5. Sharma Y, Jain A, Tangade P, Singh V. Impact of Dental Esthetics and Oral Health Status on Psychological Well Being and Dental Self Confidence in University Students. International Journal of Medical Science and Dental Health. 2025 July 30;11(07):146–54. https://www.ijmsdh.org/index.php/ijmsdh/article/view/435
6. Patel M, Guni A, Nibali L, Garcia-Sanchez R. Interdental papilla reconstruction: a systematic review. Clin Oral Investig. 2024;28(1):101. https://pmc.ncbi.nlm.nih.gov/articles/PMC10794407/
7. Bennani V, Ibrahim H, Al-Harthi L, Lyons KM. The periodontal restorative interface: esthetic considerations. Periodontol 2000. 2017 June;74(1):74–101. https://onlinelibrary.wiley.com/doi/abs/10.1111/prd.12191
8. Mari R, Nath AR, Peter MR, Vyloppillil R, Balakrishnan B, Suresh R. Periodontal Approaches to Esthetic Dentistry: A Review on Current Trends. J Contemp Dent Pract. 2022 Feb 1;23(2):251–67. https://pubmed.ncbi.nlm.nih.gov/35748458/
9. Sweta VSA, Muthu J, Pratebha B, Kumar RS. Long term efficacy of root coverage techniques. IJPI. 2021 July 28;6(2):79–87. https://ijpi.in/article-details/14394
10. Yadav VS, Gumber B, Makker K, Gupta V, Tewari N, Khanduja P, et al. Global prevalence of gingival recession: A systematic review and meta-analysis. Oral Dis. 2023 Nov;29(8):2993–3002. https://onlinelibrary.wiley.com/doi/10.1111/odi.14289
11. Venugopal A, Manzano P, Ahmed F, Vaiid N, Bowman SJ. Gummy smiles: Etiologies, diagnoses & formulating a clinically effective treatment protocol. Seminars in Orthodontics. 2024 Dec 1;30(5):482–501. https://doi.org/10.1053/j.sodo.2023.11.014
12. Brito ML de, Silva Junior MLS, Carvalho BWL, Silva EMC da, Lira ADLS de. Prevalence and factors associated with gummy smile in adolescents: a cross-sectional analysis. Braz J Oral Sci. 2023;22:e230408. https://doi.org/10.20396/bjos.v22i00.8670408
13. Al-Zazai HSA, Al-Haddad K, Al-Harazi G, Al-Sharabi MG, Rasheed AM, Rajhi KI, et al. Prevalence and Etiology of Maxillary Midline Diastema among University Students, Hodeidah Governorate, Yemen: A Cross-sectional Study. J Contemp Dent Pract. 2024 Oct 1;25(10):968–75. https://pubmed.ncbi.nlm.nih.gov/39873259/
14. Hasan HS, Al Azzawi AM, Kolemen A. Pattern of distribution and etiologies of Midline diastema among Kurdistan-region Population. J Clin Exp Dent. 2020 Oct 1;12(10):e938–43. https://pmc.ncbi.nlm.nih.gov/articles/PMC7600205/
15. Goyal K, Sharma M, Nayak SU, Kundra R, Bhumra A, Shenoy R. The Prevalence of Tooth Wear in Adult Population and its Impact on Quality of Life: A Cross-sectional Study. World Journal of Dentistry. 2023 May;14(5):425–8.https://doi.org/10.5005/jp-journals-10015-2236
16. Gbadebo SO, Ajayi DM. Self Reported Tooth Discolorations Among Patients Seen at Dental Center University College Hospital Ibadan. J West Afr Coll Surg. 2015;5(3):66–77. https://pmc.ncbi.nlm.nih.gov/articles/PMC5036264/
17. Niazi FC, Pepper T. Dental Fluorosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Oct 8]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK585039/
18. Mittal HC, Bajpai R, Singh RK, Sardana D, Mohanty U. Prevalence of Dental Fluorosis in India: A Systematic Review and Meta-Analysis. J Public Health Dent. 2025 July 31; https://pubmed.ncbi.nlm.nih.gov/40741788/
19. Kathuria M. The Psychological Impact of Dental Aesthetics on Self-Esteem. IJSR. 2025 Mar 27;14(3):1330–2. https://dx.doi.org/10.21275/MR25326085129
20. Almedlej R, Aldosary R, Barakah R, Alkhalifah A, Adlan A, AlSaffan AD, et al. Dental esthetic and the likelihood of finding a job in Saudi Arabia. A cross-sectional study. J Family Med Prim Care. 2020 Jan 28;9(1):276–81. https://pmc.ncbi.nlm.nih.gov/articles/PMC7014893/
21. Domínguez-Rosales KE, Fernández-de Castro LA, Bojórquez-Armenta HA, Silva-Benítez E de L, Garzón-Trinidad JA, Herrera L, et al. Esthetic Crown Lengthening with Digital Workflow: Case Report and Bibliographic Review. JDHOR. 2025 July 6;6:1–12. https://doi.org/10.46889/JDHOR.2025.6220
22. Cairo F. Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontol 2000. 2017 Oct;75(1):296–316. https://pubmed.ncbi.nlm.nih.gov/28758301/
23. Chauca-Bajaña L, Vásquez González PS, Alban Guijarro MJ, Guim Martínez CA, Velásquez Ron B, Proaño Yela P, et al. Comparative Effectiveness of Tunneling vs. Coronally Advanced Flap Techniques for Root Coverage: A 6–12-Month Randomized Clinical Trial. Bioengineering (Basel). 2025 July 30;12(8):824. https://www.mdpi.com/2306-5354/12/8/824
24. Mangal S, Kaushal S, Lal N. Innovative Approaches to Enhance Preservation Over Invasion in Minimally Invasive Periodontal Surgery: A Narrative Review. Cureus. 2025 Aug;17(8):e89707. https://pubmed.ncbi.nlm.nih.gov/40932989/
25. Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB. Int J Periodontics Restorative Dent. 2011;31(6):653–60. https://pubmed.ncbi.nlm.nih.gov/22140667/
26. Neophytou C, Dorda M, Balouri A, Dimitriadou P, Neofytou AM, Batas L. The Role of Platelet-Rich Fibrin (PRF) in Periodontal Plastic Surgery: A Contemporary Review of Evidence-Based Applications. IJCMCR [Internet]. 2025 [cited 2025 Oct 12];55(1). Available from: https://ijclinmedcasereports.com/ijcmcr-ra-id-01355/
27. Hamadah O, Almahayni S, Ghazzawi R, Mounajjed R, Altayeb W, Khalil M. Effectiveness of laser-assisted gingivectomy compared to surgical methods: a systematic review. Explor Med. 2025 May 26;6:1001325. https://doi.org/10.37349/emed.2025.1001325
28. Yi Z, Miao X, Wang L, Zhang G, Wu Y. A customized subepithelial connective tissue graft for interdental papilla reconstruction and soft tissue augmentation. J Esthet Restor Dent. 2022 Apr;34(3):451–60. https://pubmed.ncbi.nlm.nih.gov/34964233/
29. Woo HN, Cho YJ, Tarafder S, Lee CH. The recent advances in scaffolds for integrated periodontal regeneration. Bioact Mater. 2021 Oct;6(10):3328–42. https://doi.org/10.1016/j.bioactmat.2021.03.012
30. Nasiri K, Masoumi SM, Amini S, Goudarzi M, Tafreshi SM, Bagheri A, et al. Recent advances in metal nanoparticles to treat periodontitis. J Nanobiotechnol. 2023 Aug 21;21(1):283. https://doi.org/10.1186/s12951-023-02042-7
31. Ashokkumar L, Krishnakumar D, Ravindran DM, Jain S, Kumar D, SK B. Comparison of Various Minimally Invasive Techniques for the Management of Gingival Hyperpigmentation: A Case Report. Cureus. 16(11):e73870. https://pmc.ncbi.nlm.nih.gov/articles/PMC11652682/
32. Alasmari DS. An insight into gingival depigmentation techniques: The pros and cons. Int J Health Sci (Qassim). 2018;12(5):84–9. https://pmc.ncbi.nlm.nih.gov/articles/PMC6124824/
33. Alsaleh O, Baz NA, Salem A, Abed H, Almarghlani A. Assessing Platelet-Rich-Plasma in Gingival Depigmentation: A Split-Mouth Two Case Report Comparing Laser and Bur Ablation. Saudi J Oral Dent Res. 2025 Mar 25;10(03):167–73. https://doi.org/10.36348/sjodr.2025.v10i03.003
Published
2026-03-01
How to Cite
Dr. Sumit Nagaraj Ede, Dr. Mukhtar Un Nisar Andrabi, Patil, D. S., & Dr.Faiza Javed. (2026). Periodontal aspects of improvement in smile: A Narrative review. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 12(1). https://doi.org/10.21276/ujds.2026.12.1.25
Section
Review Article
