- Biological width- gums find a height is proportional to the height of the underlying tooth supporting bone around the color of each tooth.
- Tissue & bone biotype: each person has their own unique gum types or thickness: thick vs thin and bone type thick vs thin.
- Excess tooth supporting bone under or near the gingival height of contour
- bony tori out pocking or bump of bone
- Bony ridges called bony exostosis common on the sides near cheeks. If this tooth supporting bone is not properly shaped, it will greatly increase the cosmetic failure of cosmetic gum surgeries.
- Tooth to tooth alignment: high or low, front to back, and side to side, distance (roots too close or crowding), and root angulation will effect interdental papilla height, volume and contour. In turn the shape of the interdental papilla and underlying tooth supporting bone or lack there of will have an effect on the level and shape of the gum height on the facial surface of teeth roots.
- Each individual tooth root position, rotation, and angulation of as it relates to cervical emergence from the gums & underlying tooth supporting bone
- gums find a height that is proportional to the contour & position of the tooth root emergence from the gums Facial /lingual positions
- Type of tooth ie canines vs lateral incisors each have uniquely different anatomical root form & height of contour near the gums. This is another reason why canine substitution is a poor esthetic solution for missing lateral incisors.
- Tooth movement after gum treatment either by a dentist or as a result of a patients unique function or parafunctional habits.
- Gum overgrowth from inflammation caused by traumatic bite
- Adjacent height of gum tissues on all sides including the palatal tissue (roof of mouth).
- Benign or malignant lesion in the gums or bone
- Gum overgrowth from inflammation caused by poor oral hygiene, gum disease
- Gum overgrowth from inflammation caused by oral appliances like braces
- Gum overgrowth caused by oral infections, teeth, gum or bone infections & bad dentistry
- Gum overgrowth exasperated by smoking
- Medical conditions induce gum overgrowth
- Hormonal imbalances
- Pregnancy
- Leukemia
- Medications induced gum overgrowth
- Calcium-channel blockers
- Immunosuppressants
Risk factors which may effect the gum tissue height or contour
- Existence of dental implants or the surgical addition of dental implants
- Bony defects hidden under the gum tissues dehisence and fenestrations
- Exposed roots, gum recession
- Existing poorly contoured old bad dentistry
