You’re certainly right; they are some of the options, both fairly aggressive in nature and not conservative. Lowering the lip has certain effects and if you already have nice-sized teeth or proportionate teeth; to reduce the gum or raise the gum for the sake of reducing the gummy smile can throw out the balance and make you look quite toothy. A newer and more conservative option, however not long-term, is the use of Botox. Botox can be used to reduce the ability of the levator muscle around the lips so that upon smiling this does not lift, and reduces the appearance of the gum by keeping the lip in a static motion. This is only temporary, and last three to four months, but it is a nice conservative option that is worth trying.
I’m assuming your implants here have failed, which means the actual thread or the screw that is in the jawbone has not integrated with the jawbone. The only procedure that can be done is to let that area heal, thoroughly reassess it, and then replace the implants. Look at the options of different implant types, whether you need grafting, and get an assessment as to why it failed, “Was this because of the operator skill? Was it because of your medical condition? Were instructions not followed? Are you a smoker?” There are several reasons why implants can fail, this is based on the assumption that the whole implant failed and we’re not talking about just the crown component.
If you were referring to the initial healing post-surgery, generally if it was a carefully performed procedure, like any other surgical procedure, you would feel a little bit uncomfortable or be aware in the first week. The mouth is a quick healer and until the stitches start to fall off, dissolve or are removed; it is at this point that your mouth starts to feel normal. If the implants or the screws are carefully threaded into the jawbone, there’s generally no feeling that you have anything in your jawbone. Most of this sensation comes from peeling back the gum during the dental procedure and the minor swelling that might occur after the surgery.
The key to achieving the ideal aesthetics in your case is to get the proportions of the adjacent teeth right. You’re correct in that reducing one part of the tooth to bond to another would allow and give you more flexibility in getting an aesthetically desirable result. Bonding the front six teeth would be the ideal way. Pre-planning and measuring your existing teeth would allow a more aesthetic result, but improve it based on what you have. The equivalent can be done with porcelain veneers, where if the teeth are reduced accordingly and the final restorations are designed well, this would achieve a better and more symmetrical smile.
That can be one of the options; one consideration is to what extent these teeth need to be filed down to provide a nice natural aesthetic and congruent smile. If the ‘eye’ teeth are sticking out a lot or protruding, then you would have to reduce a substantial amount of tooth structure to place a veneer so you have to weigh up the long-term benefits of doing this. Ideally in these cases, even a mild or short course of orthodontics to get the position of the teeth or improve the position of the teeth prior to any porcelain or aesthetic work, can reduce the amount of tooth structure that has to be grounded off the existing teeth. In your case, the canines are quite protrusive and the laterals are quite in. There’s going to be a big difference in the thickness, whether it’s bonding or porcelain, that’s placed on there. By getting these teeth in better alignment, you will reduce the size of the material that has to be placed on there. CEREC could be quite an ideal choice but it is dependent on how skilled the CEREC user is. The more skilled a CEREC user is, the better the outcome is in designing the final set of restorations or veneers in this case.
