CDE0111

14 I I case report _ dental lasers _As aesthetics are absolutely critical to a pa- tient’s external appearance and inner emotions, orchestrating a bio-aesthetic result is mandatory. Toooften,thisiscomplicatedwhenaestheticdesires infringe on the health of the periodontal complex. This is often true when biologic width violations have occurred iatrogenically. Many factors may contribute to these failures; the two main culprits are intra-crevicular margin location and over-contoured restorations. Not only is plaque accumulation problematic, but the supra- crestal fibres also become interrupted, causing the tissues to become further inflamed and aestheti- cally unmanageable. Kois’ landmark study defined the total dento-gingival complex (DGC) as clinically predictable at 3 mm on the direct facial aspect and at 3 to 5 mm inter-proximally when measured from the free gingival margin to the osseous crest. It is critical anteriorly that the gingival margin mimics the osseous scallop while maintaining the DGC.1 Further complicating these complex situa- tions is the degree of inflammation in the soft tis- sue, affecting the clinical development of health and aesthetic symmetry. _An ideal result Often, the patient is frustrated with his/her pre- vious poor cosmetic results. However, to improve the periodontal framework 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 reflective mucoperiosteal surgery.Thisnotonlyaffectsthechronologyoffinal restorative care, but also delays the patient’s ulti- mate satisfaction and happiness for a minimum of two to three months. Fortunately,dentallasershaveevolvedconsider- ably as an adjunctive and alternative treatment to safely,conservativelyandreliablydecreasebacterial levels and improve the hard and soft-tissue con- tours.StudiesofEr:YSGGlasersbyRizoiuandothers have shown that thermal coagulative results and bony ablation characteristics are similar to those resulting from use of a dental bur.2 From a patient- friendly standpoint, less need for suturing and shorter healing times improve case acceptance for doing ideal dentistry. In selected cases, such as the onepresentedinthisarticle,minimallyinvasivelaser procedures, with precise restorative planning and technique, can satisfy aesthetic and functional pa- rameters. Furthermore, patients can enjoy optimal resultsmorecomfortablyandwithinashortertime. Forthiscase,aconservativestrategywasdevised that would allow us to correct the problems and causes by completing multiple task simultaneously. _Case presentation A 38-year-old female patient presented for cor- rectionofwhatshetermedher“tiltedsmile”(Fig.1). Given that she was starting a new sales career, she alsowantedtomakeherteethbrighterandhersmile much broader. The patient shared her frustration cosmeticdentistry 1_2011 Laser-assisted cosmetic dentistry—Acase report Author_ Dr Hugh Flax, USA Fig. 1_Visualising the entire oral-facial composition helps to diagnose less harmonious features of the smile. Fig. 2_Close-up photography is essential to planning periodontal-restorative care. Fig. 3_A mounted diagnostic wax-up is a critical guide for planning a realistic result. Fig. 4_Outlining the desired gingival margins prior to anaesthesia communicates a blueprint to the patient and restorative team. Fig. 1 Fig. 3 Fig. 4Fig. 2