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ePaper created 2016-12-14, 09:49:38 | version 1.38.0
40 2_2016 laser 40 laser_case report I case report Fig. 9_Osseous reshaping of the alveolar crest line. Fig. 10_Reshaping was performed using the LiteTouch Er:YAG laser straight handpiece. Fig. 11_The mucoperiosteal flap was repositioned and sutured with 6-0 silk sutures, paying particular attention to primary closure of the flap. Fig. 12_Four weeks post-operatively, the final prosthetic reconstruction took place and included crowns on the central and lateral incisors and veneers on the canines. therewasanasymmetricalgingivallinewithahighlip line,thatis,agummysmile(Figs.1&4),crownlength- ening was planned in order to improve several prob- lems with the patient’s smile. Since it had been estab- lished that crown lengthening using an erbium laser wouldbethebesttreatmentoptionforthepatient,the extentofcrownlengtheningtobeperformedwasde- terminedbyevaluatingthepatient’sphotographsand atemplatemadefromthediagnosticwax-uponstone models of the patient’s mouth. The measuring and positioning of the gingival line and bone level were doneusingChu’sCrownLengtheningGaugewiththe Biologic Periogauge tip (Hu-Friedy), which is de- signedtomeasurethemid-faciallengthoftheantic- ipated restored clinical crown and the length of the biologic crown (i.e. from the bone crest to the incisal edge) simultaneously during surgical crown length- ening (Fig. 5).13 Measurements can be performed directly on the patient’steeth.Afterdiscussingthetreatmentoptions, thedecisionwasmadetoperformcrownlengthening surgery with an open technique and osseous reshap- ing. After three to four weeks, the final prosthetic re- constructionwouldbedone. _Treatment Beforeinitiatinganyclinicaltreatment,afullsetof radiographs were taken to determine whether the bone level was at or below the CEJ. Study models and a diagnostic wax-up were then prepared. The proce- durebeganbymeasuringandmarkingthemid-facial lengthoftheanticipatedclinicalcrownandthelength of the biologic crown with Chu’s Aesthetic Gauges (Hu-Friedy;Figs.5-8). Performinganexternalbevelgingivectomy Once the new free gingival line location had been created,thefirststepintheprocessafterlocalanaes- thesia was to perform the Er:YAG laser-assisted gingivectomy with the LiteTouch laser (2,940nm; Syneron Dental Lasers) using the straight handpiece. Withthetipalmostparalleltotherootsurface,thesoft tissuewascutinasweepingmotionfrommesialtodis- tal to the level just coronal to the marked points, fol- lowedbyslopingofthe90-degreegingivaledgemade duringthefirstcut. Recontouringthebone After administering anaesthetic, an incision was made with the laser at the buccal and palatal sides of teeth#13–23andaverticalincisionwasnotrequired. A full-thickness mucoperiosteal flap was then re- flected.Theosseousreshapingofthealveolarcrestline (Fig. 9) was performed using the LiteTouch straight handpiece (Fig. 10). The buccal and palatal flaps were lifted and the area was explored for any soft tissue around the neck of the teeth. The soft tissue was ab- lated using the laser. Vaporisation of soft/granulation tissue (if any) after raising a flap can be achieved effi- cientlywiththeEr:YAGlaserandthereisoftennoneed for hand instruments. The bone was recontoured in a sweeping motion, with the tip moving laterally from mesialtodistalfollowingtheCEJ.Themucoperiosteal flap was repositioned and sutured with 6-0 silk su- tures,payingparticularattentiontoprimaryclosureof theflap(Fig.11). The laser operating parameters employed for the varioussurgicalstageswereasfollows: –Flapaccess:wavelengthof2,940nm(Er:YAG),600µ sapphiretip,softtissuemode,contactmode,100mJ perpulseat30Hz,andtotalpowerof3W. –Soft tissue removal: wavelength of 2,940nm (Er:YAG),1,300µsapphiretip,softtissuemode,non- contact mode, 200mJ per pulse at 20Hz, and total powerof4W. –Bone surgery: wavelength of 2,940nm (Er:YAG), 1,300µsapphiretip,hardtissuemode,non-contact. 18 I laser 1_2015 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12