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ePaper created 2016-01-08, 09:25:11 | version 1.38.0
I case report Fig. 9_Immediate image after gingivectomy in the upper arch. Fig. 10_Two-weeks post-operative image and healing of gingival tissue in the upper arch. Fig. 11_Immediate image after gingivectomy in the lower arch, following the same procedure. Fig. 12_Two-weeks post-operative image and healing of gingival tissue in the lower arch. 16 I laser4_2015 Thegingivalarchitectureintheupperarchwasnot evenandgumhyperplasiawasnotedatareas#21–22 and#22–23,owingtochronicinsufficientplaquere- moval and possibly to the PFM crown placement on tooth #22. Moreover, study of the casts showed that in order to attain an optimal length-width ratio of 62–80%, crown lengthening should take place prior to diastema closure. Normally, the gingival margin is 1mmcoronallytothecemento-enameljunction.The above-mentionedproblemscanbesolvedbyremov- ing the excessive gingiva via precisely planned inci- sions. When crown lengthening is planned to in- creasethetoothlength,thebiologicalwidthneedsto be considered and not encroached upon, as this may lead to periodontal breakdown. Therefore, periodontal measurements of the sul- cusdepthwererecordedandinaccordancewiththe preferredtoothdimensions,toothwidth,heightand their ratio was recorded prior to surgery (Table 1). Ideal ratio would be 0,8–0,9. Once the appropriate proportion was determined, the outlines were marked on the gingiva with a waterproof marker (Fig. 7). Since the clinical crown was measured to be shorter than the anatomical crown, approximately 2mm of gingiva were calculated to be removed (Fig.8).Thegingivaltissuewasofathickbiotypeand hadadequateattachedgingiva.Gingivalrecontour- ing was performed with the following parameters. Average output power was set to 2,5W, with a pulse durationof700µsec(S-Mode)andapulserepetition rate of 50Hz using an MZ5 tip under minimal water spray (Air: 10%—Water: 10%). Gum hyperplasia ar- eas were treated first and a scalloped excision pat- tern was followed (Fig. 9). As a final step, a pleasing gingival symmetry was created and the gingiva was allowed to heel for two weeks before the next treat- ment phase (Fig. 10). The patient reported slight bleedingatthenextdayfollowingthegingivaltreat- ment, but no pain or soreness. Gingivectomy in the lower jaw (Fig. 11) was performed at the next appointment, together with bleaching of the upper teeth, and was allowed to heal for two weeks (Fig. 12). _Er,Cr:YSGG assisted teeth bleaching Inordertoachievethebestclinicalresultswithout harmingdentaltissues,itiscrucialtofollowthepro- cedure carefully and take all safety measures. Before starting the first session, the patient was also in- formedthattheresultoftheprocedureisnotperma- nent and is dependent on the age of the patient and the use of tobacco and extrinsic staining by deposi- tionoftanninsfoundincoffee,redwine,teaandcola beverages. The average duration expectancy is three to four years for non-smokers. The patient was in- structed that if teeth sensitivity or pain was felt dur- Fig. 11 Fig. 12 Fig. 9 Fig. 10