CDE0111

I 15 case report _ dental lasers I cosmeticdentistry 1_2011 about previous dental consultations that had fo- cused solely on orthodontic or surgical solutions withoutconsideringamorepracticalapproachthat would suit her busy lifestyle. Her smile analysis established a collapse of the bicuspids in the buccal corridor. Furthermore, the axial inclinations, irregular gingival margins and incisaledgescreatedadownwardtilttothepatient’s right owing to tooth positioning. Close-up imaging demonstrated healthy gingival tissues, as well as a right central incisor weakened by a large composite (Fig. 2). _Findings A full clinical examination with radiographs and mounted models revealed the following: _biomechanically, the majority of her teeth re- mained strong despite previous dental care; _periodontally, soft and hard tissues were healthy; _occlusally, load testing was normal (after muscle relaxation)andtherewasobviousCR-COanterior- vertical slide due to premature contact at tooth #30; _aesthetically, the width-to-length ratio of the upper centrals was 1:2, far from the ideal range of 0.75:1.0, and tooth shade was VITA A2. _Treatment plan Given the patient’s previous history and her desire for minimally invasive dental care, a conser- vative strategy was devised that would allow us to correct the problems and causes by conducting multiple tasks simultaneously: _muscle and bite therapy with a Tanner appliance, followed by careful equilibration aided by the T-scan (Tekscan System); _3-D wax-up on a Stratos articulator (Ivoclar Viva- dent; Fig. 3); _home bleaching of the lower teeth with Opales- cence 15 % (Ultradent); _‘closed flap’ periodontal modification with the Waterlase Er,Cr:YSGG (Biolase), while the first three items were being accomplished (the combi- nation of these four steps was a tremendous time saverandallowedustomonitorprogresscarefully on a weekly basis); and _definitive restorative care with porcelain veneers and a crown on tooth #8. _Treatment Fortheinitialclosedperiodontallift,theEr,Cr:YSGG laser was used in three modes (gingival sculpting, osseous recontouring, and bio-stimulation). Prior to anaesthesia, the desired framework was planned and outlined using a fine marker (Fig. 4). Further- more, a stick-bite was used, not only to establish an ideal incisal plane, but also to align the gingival margins properly (Fig. 5). With the settings at 2.0 W, 20 pulses per second, 20 % air and 20 % water, a G-6 tip (600 µm in diameter) was used to shape the labial gingival Fig. 5_A stick-bite helps to verify that incisal and gingival planes will be parallel. Fig. 6_The tissues are treated atraumatically with the Waterlase. Fig. 7_Using the black mark as a reference following the gingival scallop, a very tight up-and-down movement is performed to modify the bone. Fig. 8_A curette helps clean and smooth the sulcus of any debris. Fig. 9_A ‘laser bandage’ is placed along the treated area to improve the healing time and decrease the patient’s discomfort. Note the immediate improvement of the geometric progression of gingival embrasures. Fig. 10_Detailed information helps the laboratory to translate clinical results to the porcelain restorations. Fig. 9 Fig. 10Fig. 8 Fig. 6 Fig. 7Fig. 5