Dental Tribune Middle East & Africa Edition

DENTALTRIBUNE Middle East & Africa Edition Media CME 7 ing the surgical template to de- lineate the desired tooth contours (Fig. 10). The papillae were left intact and no sutures were required. Healing four weeks after the gin- givectomy revealed a harmo- nious gingival drape (Fig. 11). Final prosthetics Placement of final veneers on teeth #4 through #13 occurred three months post-gingivectomy (Fig. 12). An occlusal bite guard was deliv- ered to protect the restorations. In order to correct lip line asymmetry and further diminish gingival display, neuromus- cu- lar lip correction (lowering) with BTX-A was reconsidered, but the patient did not pursue treatment. Six years after veneer place- ment,thepatientremainedsatis- fied with the functional and es- thetic result achieved solely through peri- odontal surgery and prosthetic rehabilitation (Figs. 13, 14). Postoperative instructions After each surgical proce- dure, the patient was instructed to take 600 mg of ibuprofen every 4–6 hours, hydrocodone 7.5 mg/acetaminophen 750 mg every 4–6 hours as needed for pain and 100 mg of doxycycline a day for 10 days. The patient was instructed not to brush at or near the surgi- cal site but instead to rinse with 0.12 percent chlorhexidine or warm saline twice daily. The pa- tient was also directed not to chew in the affected area for at least two weeks. Suture removal occurred at 10 to 14 days post-surgery. CT References 1. Kokich VO, Kokich VG, Kiyak HA. Percep- tions of dental professionals and laypersons to altered dental es- thetics: asymmetric and symmetric situations. Am J Orthod Dentofa- cial Orthop 2006;130(2):141–51. 2. Coslet JG, Vanarsdall R, Weisgold A. Diag- nosis and classification of delayed pas- sive eruption of the den- togingival junction in the adult. Alpha Omegan 1977;70(3):24–8. 3. Garber DA, Salama MA. The aesthetic smile: diagno- sisandtreatment.Periodontol 2000 1996;11:18–28. 4. Polo M. Botulinum toxin type A (Botox) for the neuro- muscular correction of ex- ces- sive gingival display on smiling (gummysmile). Am J Orthod Dento- facial Orthop 2008;133(2):195–203. 5. Sonick M. Esthetic crown length- ening for maxillary anterior teeth. Compend Contin Educ Dent 1997;18(8):807–12, 14–6, 18–9; quiz 20. Periodontal surgeon: Michael Sonick, DMD Restorative dentist: Stephen Rothenberg, DMD Dr. Michael Sonick is a full-time practicing peri- odontist and implant sur- geoninFairfield,Conn.He isontheeditorialboardsof many journals and is co- editor of the textbook, Im- plant Site Development. He is currently a guest lec- turer at New York Univer- sity School of Dentistry and is director of Sonick Seminars, in Fairfield, Conn. Fig. 7: Sling sutures in place after osseous reshaping. Note the similarity in gingival height and morphology between pre-surgical and post-surgical views. Fig. 8: Healing 10 days after first stage crown lengthen- ing. The periodontal level still approximates the initial presentation. Fig. 9: Healing six weeks after first stage of crown lengthening. Fig. 10a: Frontal view immediately after second stage gin- givectomy. Fig. 10b: Positional relationship between the lip and gingival margin immediately after second stage gingivec- tomy. Fig. 11a: Frontal view four weeks after second stage gingivectomy. Fig. 11b: Positional relationship between the lip and gingival margin four weeks after second stage gingivectomy. Fig. 12a: Frontal view of final veneers (#4 through #13) three months after gingivectomy. Fig. 12d: Left lateral view of final veneers (#9 through #13) three months after gingivectomy. Fig. 12b: Central view of final veneers (#6 through #11) three months after gingivectomy. Fig. 12c: Right lateral view of final veneers (#4 through #8) three months after gingi- vectomy. Fig. 13a: Smile pre-treatment. Fig. 13b: Smile six years post-treatment. Fig. 14: Facial view six years post-treatment. After Before About the authors Dental Tribune Middle East & Africa in collaboration with CAPP introduce to the market the new project mCME - Self Instruction Program. mCME gives you the opportunity to have a quick and easy way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is interna- tional, drawn from the upper ech- elon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. How can professionals enroll? They can either sign up for a one- year (10 exercises) by subscrip- tion for the magazine for one year ($65)orpay($20)perarticle.After the payment, participants will re- ceive their membership number and will be able to attend to the program. How to earn CME credits? Once the reader attends the dis- tance-learning program, he/she can earn credits in three easy steps: 1. Read the articles. 2. Take the exercises 3. Fill in the Questionnaire and Submit the answers by Fax (+971 4 36868883) or Email :info@cappmea.com After submission of the answers, (name and membership number must be included for processing) they will receive the Certificate with unique ID Number within 48 to 72hours. Articles and Questionnaires will be available in the website after the publication. www.cappmea.com MEDIA CME Self-Instruc- tion Program