Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-12-14, 09:49:38 | version 1.38.0
39 39 2_2016 laser laser_case report case report I width.7 Inordertoaccomplishthisgoal,itisnecessary to consider the width of the attached gingiva and the location of the underlying alveolar crest to properly define the surgical approach for aesthetic crown lengthening.Assessingtheextentofattachedgingiva ascertainstherelationshipbetweentheattachedgin- givaandtheanatomiccrown. In order to determine the location of anatomical landmarks,whichwillindicatewhetherthereisgingi- val excess or normal gingival width, and the location ofthealveolarcrestinrelationtothecemento-enamel junction (CEJ), their measurement is required. Trans- gingival sounding of the alveolar crest determines its relationship to the gingival crest, the CEJ and the mucogingival junction. The surgical treatments to correct defects are based on the values of these pa- rameters. The ability of lasers to perform soft- and hard-tis- sue crown lengthening has been described in several published reports.8–11 The use of the Er:YAG laser for gingival and bony recontouring has a significant im- pactonthewaycrownlengtheningisperformed.Since thelasercutsonlyattheendofthetip,theuserhasef- fectivecontrolofsoftandhardtissueresection.When using traditional rotary instruments to perform os- seousresection,thereisalwaystheriskthattheirrota- tion will damage adjacent root surfaces. Additionally, since the surgical laser wound is less traumatic, there is less chance of bony damage due to frictional heat, which is always possible when using rotary instru- mentation without proper irrigation. This minimally invasivetechnologyresultsinlesspost-operativedis- comfortandquickerhealingofthepatient.12 _Case presentation A38-year-oldfemalepatientwasreferredforcom- prehensive dental treatment. The clinical evaluation revealedalonglistofproblems.Inaddition,numerous teethhadundergonerootcanaltreatmentthatwould require endodontic retreatment. One of the patient’s desires was to improve the appearance of her smile. The examination was completed and the appropriate diagnostic information was collected, including peri- odontal and occlusal evaluations. Study models were obtainedandmountedwithafacebowandcentricre- lationbiterecords. Problemsidentified 1.Activegeneralchronicperiodontitis 2.Insufficientendodontictreatmentofteeth#44and 45 3.Insufficientfillingsinteeth#18,17,12,11,21,22,23, 24,25,26,38,37,33,43–,44,45 4.Tooth#27wastobeextracted 5.Missingteeth:#16,14,28,36,35,34,46 6.Missingteethtobereplaced:#16,14,34,35and36 7.Pooraesthetics:Gummysmile Step-by-step treatment plan Initialtherapy 1.Conventional and Er:YAG laser-assisted treatment ofthemildtomoderateperiodontitis 2.Endodontictreatmentandfilling 3.Toothextraction Basiccorrectivetherapy 1.Implants 2.Er:YAG-assisted crown lengthening in the anterior maxillary region (teeth #13–23) in order to correct thegummysmile Correctivetherapy 1.Prosthesesintheretro-canineregions 2.Aestheticprosthesesintheanteriormaxillaryregion (teeth#13–23) Recall First, the treatment for correction of the gummy smile was planned. The treatment planning process was initiated by evaluating the position of the maxil- laryteeth.Thephotographsshowahighsmilelineand theaffectedoutlineoftheincisalline(Figs.1&2).The alignmentoftheteethfromtheocclusalviewdemon- stratestheproblemswithteeth#13,12and22(Fig.3). The occlusal plane of the left posterior teeth re- quired correction in order to allow sufficient interoc- clusaldistancetorestorethemandibularleftposterior region with two implants in regions #36 and 34 for supportingasmallposteriorbridge.Therefore,thepro- cedurebeganwithtrimmingoftheincisaledgeofthe central and lateral incisors. Once the position of the maxillaryocclusalplanehadbeendecided,theposition of the cervical or gingival line was evaluated. Since Figs. 5–8_Measuring and marking the mid-facial length of the antici- pated clinical crown and the length of the biologic crown with Chu’s Aes- thetic Gauges. I 17 laser 1_2015 Fig. 4b Fig. 5 Fig. 6 Fig. 7