CDEN0210

I 21 case report _ gummy smiles I cosmeticdentistry 2_2010 It should be noted that placement of porcelain on the molar teeth to increase vertical height is extremely conservative because the porcelain lies on top of the existing teeth. Even if the available biological width is sig- nificant, correcting the bite allows the dentist to removelessgumtissueduringthegingivectomy. A frenectomy can also be performed, when appropriate, to remove a small portion of the lip frenulum with a diode laser. This allows the lip to move down slightly over the previously exposed gums and can also reduce the amount of gum tissue that must be removed during the gin- givectomy. _Case I A 27-year-old female presented with 13 mm VI, requesting that her gummy smile be cor- rected or reduced. The average VI is 17 to 21 mm. Therefore, her VI would be aesthetically pleasing if increased by a minimum of 4 mm, reducing the gum-to-teeth ratio. The patient’s teeth were out of proportion, with the length-to-width ratio of the central incisors almost identical, rather than the aes- thetically pleasing length-to-width ratio of 75 to 80 per cent. Her gums were inflamed and in poor condition. Therefore, she was first referred to a hygienist for cleaning, root planing, deep scaling and debriding (Figs. 1a & b). At physiological rest, the K7 Evaluation System calculated that the patient’s VI was increased to 17 mm before any gum tissue was removed. The gum-to-teeth ratio had already been increased significantly. The Golden Propor- tion equations were also utilised. The patient’s golden VI was calculated at 16.7 mm, and the orthotic gave her a VI of 17 mm (Fig. 2). It was determined that the patient would have an even greater aesthetic result by further increasing the gum-to-teeth ratio. Sounding determined that 2 mm of gum tissue could be removed safely, so an additional 2 mm was burned away utilising a diode laser. The diode laser immediately cauterises the tissue and causes less bleeding and less post-operative stress for the patient than other gingivectomy methods. As demonstrated in Figure 3, gum tissue had been removed from three teeth, showing the additional vertical length com- pared to the remaining teeth. The healing process following the diode laser gingivectomy is approximately two weeks. Sounding indicated that a gingivectomy alone would have allowed for the removal of no Fig. 8 Fig. 10Fig. 9