Achieving maxillary anterior esthetics is dependent on a multitude of factors including tooth position, clinical crown form and gingival harmony. Surgical modification is often required to improve the position of the gingival crest while providing appropriate biologic width and ideal tooth display. Many courses in esthetic dentistry suggest gingivectomy procedures for a gummy smile. However, this can be problematic in that the coronally positioned gingival crest associated with the gummy smile issometimes associated with a similarly positioned alveolar crest. Traditional methods for osseous resection have involved elevation of a mucoperiosteal flap. This report describes an alternative procedure using minimally invasive techniques for esthetic enhancement.
A 39 YOM presented with the desire for “a better smile.” An orthodontic diagnosis of class II division I malocclusion was applied. In addition a periodontal diagnosis of type 1 delayed passive eruption subgroup A was noted. With complete orthodontic therapy the desired tooth position was achieved and most critically the position of the CEJ’s were leveled. The relationship of the CEJ to the osseous crest was confirmed under local anesthesia for Teeth #6 through 11. Laser recontouring was employed to create the desired clinical crown form. The required biologic width of 3mm was accomplished via ostectomy for Teeth #7, 8, 10 and 11 using a sulcular approach
without flap elevation. Follow-up visits were performed at 2 and 6 weeks postoperatively to ensure the result. The patient reported
that only a single dose of ibuprofen was utilized for pain management during this period. We welcome your comments, questions and feedback on the surgical methods utilized in this case. If you have similar cases you would like to discuss, please feel free to contact our office.
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