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ePaper created 2016-01-08, 09:25:11 | version 1.38.0
case report I bracketsweredebondedandthatshemaintainedno proper hygiene. Additionally, it was made clear that it is contra-indicated to further continue with the orthodontictreatment,astheriskofrootabsorption was high due to the long-time activation of the brackets. Clinical examination revealed poor oral hygiene, gums hyperplasia, visible discoloration around the bracketsduetosmoking,cariesontherightupperca- nineandaPFMcrownontheleftlateralincisor(Figs. 2–6).Milddemineralisationaroundthebracketswas also noted after they were removed. It was also ob- servedthattheteeth’scentralmid-linedidnotcorre- spondwiththefacialmid-line(Fig.1).Clinicalandra- diographic examination showed no problem at the posterior teeth. Accordingtoourfindings,respectingthepatient’s wishesandtakinginconsiderationherfinanciallim- itations,theaestheticrehabilitationshouldincludea multidisciplinary approach. It was decided to per- form the following treatment plan: –Gingivectomy on upper and lower gum line –Bleaching on upper and lower arch –Diastema closure between teeth #11–21, #11–12 and #21–22 Inordertoallowpropersofttissuehealingandfol- lowing the guidelines for adhesive restorations per- formed after bleaching, a two-week interval was scheduledbetweeneachappointment.Thedeminer- alisationaroundthebracketswasdecidedtobehan- dled with fluoride gel application. _Gingivectomy PeriodontalplasticsurgeryintroducedbyMillerin 1993,includessurgicalproceduresperformedtocor- rect or eliminate anatomic, developmental or trau- maticdeformitiesofthegingivaoralveolarmucosa.1 It is often combined with aesthetic rehabilitation of the smile with conservative composite restorations or with veneers. The goal is to eliminate the peri- odontal pockets by excision of the excessive soft tissue. Fig. 4_Initial frontal view of the lower teeth. Fig. 5_Right side initial view. Fig. 6_Left side initial view. Fig. 7_The pattern of gingivectomy was designed on the gingival tissue. Fig. 8_Periodontal sulcus depth was checked prior to surgery. Table 1_Central and lateral incisors dimensions. I 15laser4_2015 Fig. 6 Fig. 8Fig. 7 Fig. 4 Fig. 5 Tooth Number 12 11 21 22 Width 7 9 9 7 Height 7,5 9 8 8 Width:Height Ratio 0,93 1 1,125 0,87 Tooth Number 12112122 Width 7997 Height 7,5988 Width:Height Ratio 0,9311,1250,87