Dental Tribune UK Edition, October 4-10, 2010, No.24 Vol.4

W ith the esthetic zone being absolutely critical to a patient’s external appearance and in- ner emotions, orchestrating a bioesthetic result is mandatory. Too often, this is complicated when esthetic desires infringe on the health of the periodon- tal complex. This is often true when biologic width violations have occurred iatrogenically. Many factors may contribute to these failures; the two main culprits being intracrevicular margin location and overcon- toured restorations. Not only is plaque accumulation problem- atic, but the supracrestal fibres also become interrupted, caus- ing the tissues to become fur- ther inflamed and esthetically unmanageable. Kois’ landmark study defined the total dentogin- gival complex (DGC) as clini- cally predictable at 3mm on the direct facial aspect, and at 3mm- 5mm interproximally when measured from the free gingival margin to the osseous crest. It is critical anteriorally that the gingival margin mimics the osseous scallop while maintain- ing the DGC.1 Further compli- cating these complex situations is the degree of inflammation in the soft tissue, affecting the clin- ical development of health and esthetic symmetry. Dental lasers have evolved considerably as an adjunctive and alternative treatment to safely, conservatively, and reli- ably decrease bacterial levels and improve the hard and soft tissue contours. An ideal result Often the patient is frustrated with his or her previous poor cosmetic results. However, to improve the periodontal frame- work in order to create an ideal result, they must be referred to yet another doctor. Even more challenging is the extended healing time created by reflec- tive mucoperiosteal surgery. This not only affects the chro- nology of final restorative care, but also delays the patient’s ul- timate satisfaction and happi- ness for a minimum of two to three months. Fortunately, dental lasers have evolved considerably as an adjunctive and alternative treat- ment to safely, conservatively, and reliably decrease bacterial levels and improve the hard and soft tissue contours. Studies of Er: YSGG lasers by Rizoiu and others have shown that thermal coagulative results, as well as bony ablation charac- teristics are similar to a dental bur.2 From a patient-friendly standpoint, less need for sutur- ing and shorter healing times improves case acceptance for doing ideal dentistry. In selected cases, such as the one presented in this article, minimally inva- sive laser procedures, with pre- cise restorative planning and technique, can satisfy esthetic and functional parameters. Fur- thermore, patients can enjoy op- timal results more comfortably and efficiently. A conservative strategy was devised that would allow us to correct the problems and causes in a “multi-tasking” manner. Case Presentation A 38-year-old female patient presented for correction of what she termed her “tilted smile” (Fig 1). Given that she was start- ing a new sales career, she also wanted to make her teeth bright- er and her smile much broader. The patient shared her frus- tration about previous dental consultations that had focused solely on orthodontic or surgi- cal solutions without consider- ing a more practical approach that would fit her busy life. Her smile analysis estab- Smile enhancement with laser tech- nology – predicatble and esthetic Dr Hugh Flax details the fundamental importance of the esthetic zone to a patient’s external appearance and inner emotions Fig 1: Visualizing the entire oral-facial composition helps to diagnose less harmo- nious features of the smile. Figure 2: Close-up photography is essential to planning perio-restorative care. Figure 3: A mounted diagnostic wax-up is a critical roadmap to planning a realistic result. Figure 4: Outlining the desired gingival margins, prior to anesthesia, communicates a blueprint to the patient and restorative team. Figure 5: A stick-bite helps to verify that incisal and gingival planes will be parallel. Figure 6: The tissues are treated in a very nontraumatic manner with the Waterlase. Figure 7: To modify the bone, a very tight up-and-down movement is performed, using the black mark as a reference follow- ing the gingival scallop. ‘Not only is plaque accumulation problematic, but the supracrestal fibres also become interrupted, causing the tissues to become further inflamed and esthetically unmanageable’ October 4-10, 201026 United Kingdom EditionClinical