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16 I I case report _ dental lasers region. No tissue necrosis or significant bleeding occurred as a result of using the laser’s relatively lower settings. All areas were ‘sounded’ using a periodontal probe (Fig. 6). Atthefacialmargins,osseoussculpting required great precision in order to main- tain a 3 mm DGC. A specially tapered T-4 tip (400 µm in diameter) was used at a 25 % higher wattage of 2.5 W. Prior to usage, the tip was measured and marked to 3 mm in order to maintain controlled adjustments within the gingival sulcus during periodontal probing movement of thetip(Fig.7).Theresectionwassmoothed with a 7/8 curette (Fig. 8). Using low-level laser therapy at a setting of 0.25 W, a decrease in the release of inflammatory histamine and increased fibroblasts for junctional epithelial growth was achieved by ‘frosting’ the outer epithelium and in- jectionsites(Fig.9).Thepatientwasplaced on a vigorous home-care regimen (Oxygel, Oxyfresh) and closely monitored for a month, while occlusal therapy and bleaching procedures were performed. Four weeks after surgery, the tissues had healed andrestorativecarecouldbeinitiated.Thepatient’s teeth were prepared for veneers and a crown with mild soft-tissue reshaping in order to make ad- justments to our previous treatment. After taking impressionsandbiteregistrations,prototypeprovi- sionals (Luxatemp Plus, Zenith DMG) were fabri- catedusingthe‘shrink-wrap’technique.Thepatient was sent home with the same home-care regimen as mentioned previously and instructed to ‘test- drive’ her new smile for aesthetics and function. Shereturnedinaweekfortheprototype’socclusion, colour and morphology to be perfected. Photo- graphs and models were sent to the laboratory, providing a final blueprint for the porcelain resto- rations (Fig. 10). _Satisfied patient Four weeks later, the provisionals and cement were carefully removed from the teeth. All restora- tions were tried in individually and as a group to verifyfitandaesthetics.Afterthepatient’senthusi- astic approval, the porcelain was bonded using the two-by-two technique and isolation. Margins were smoothed and polished and occlusion balanced with the T-scan. A protective night-time appliance was created to bring longevity to the rehabilitation. Ourverysatisfiedpatientsaidthatwehadexceeded her expectations (Figs. 11 & 12). A hard- or soft-tissue laser is a wonderful ad- junctive tool for cosmetic and restorative dentistry. The case discussed here demonstrates that this type of laser technology gives dentists the ability to make significant hard- and soft-tissue changes while being minimally invasive. These changes not only improve the final aesthetic outcome of the case, but also provide the physiological functional parameters required for successful dentistry. _Acknowledgments I would like to thank my office team and labora- torytechnician,MrWaynePayne(PayneDentalLab), forcontinuallyenhancingthelivesofmanypatients such as the one presented here. I am also thankful to my family, who allow me to contribute to the education of other dentists and their teams._ Editorial note: This article is reprinted with permission fromthe Journal of Cosmetic Dentistry,©2010American Academy of Cosmetic Dentistry (Tel.: +1 608 222 8583; Fax:+16082229540;www.aacd.com).Allrightsreserved. Alistofreferencesisavailablefromthepublisher. cosmeticdentistry 1_2011 Fig. 11_The great improvement in aesthetics boosted the patient’s self-confidence and pride in her dental hygiene. Fig. 12_Ideal proportions and emergence profiles will create long-term healthy tissues and bio-aesthetics. DrHughFlaxhasbeenan AccreditedMemberofthe AmericanAcademyofCosmetic Dentistry(AACD)since1997. HeservedasCo-chairofthe AACD’sConferenceAdvisory Committeeforthe2003and 2008AnnualScientificSessions. HeservedontheAACDBoardofDirectors,serveson theeditorialboardoftheJournalofCosmeticDentistry andchairtheAACD’sDisasterReliefFundin2005and 2006.DrFlaxisalsoamemberoftheAmericanDental Association,AcademyofGeneralDentistry,Academyof LaserDentistry,L.D.PankeyAlumniAssociationandPierre FauchardAcademy.HeisaFellowoftheInternational AcademyforDentalFacialEsthetics.DrFlaxpractises fulltimeinAtlanta,USA,focusingonfunctionaland aestheticconditionsandadvancedlaserdentistry. cosmeticdentistry _about the author Fig. 11 Fig. 12