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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 10  |  Issue : 1  |  Page : 16-18

Laser-assisted cosmetic dentistry


1 Oral and Maxillofacial Surgeon, Axiss Dental Pvt, Ltd., Bengaluru, Karnataka, India
2 Dental Surgeon, Axiss Dental Pvt, Ltd., Bengaluru, Karnataka, India

Date of Web Publication23-Jun-2016

Correspondence Address:
Rubina Khatoon
Dental Surgeon, Axiss Dental Pvt, Ltd., Bengaluru - 560 066, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.184602

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  Abstract 

A 30-year old female patient had reported with compromised aesthetics in the region of 21. On clinical examination, it was observed that the tooth (21) was discolored and supra-erupted. Also, the gingival margin level was severely affected. On radiographic examination it was found that the tooth was endodontically treated before. Laser gingivectomy was carried out to maintain the level and flow of gingival margin, and a metal free zirconia crown was given resulting highly promising dental outcome.

Keywords: Cosmetic dentistry, crown lengthening, diode laser


How to cite this article:
Gupta S, Khatoon R. Laser-assisted cosmetic dentistry. J Dent Lasers 2016;10:16-8

How to cite this URL:
Gupta S, Khatoon R. Laser-assisted cosmetic dentistry. J Dent Lasers [serial online] 2016 [cited 2020 Apr 4];10:16-8. Available from: http://www.jdentlasers.org/text.asp?2016/10/1/16/184602


  Introduction Top


The beautiful and pleasant appearance of the frontal maxillary area of the mouth creates great impact on the improvement of physical appearance of the patient and therefore their self-confidence. Simply reproducing lost tooth structure is not sufficient. Modern standards highlight the significance to avoid procedures which lead to esthetic compromise since the aim is providing patients with enhanced esthetics whenever promising. [1],[2]

Among the most recurrently used techniques of achieving expectable, effective esthetic restoration of the smile is crown lengthening. Surgical procedure is involved in crown lengthening done by a dentist for exposing larger amount of tooth structure for the goal of consequently restoring the tooth by cosmetic surgery. Such treatment may be done on the whole gingival line, a single tooth, or multiple teeth for achieving a pleasant appealingly attractive smile. The purpose of the procedure is to enable a perfect gingival architecture once done in the anterior maxillary region. This entails re-contouring of the soft and hard tissue for preventing biologic width violation. [2],[3] Meanwhile maintaining a healthy periodontium remains the prerequisite of a functional and a successful restoration, it is necessary not to impede the normal functioning or arrangement of the biological width. [4] Since the biological width seems to establish a continual feature in the human periodontium, it was recommended as an unaltered therapeutic parameter. [4] Clinical observations are indicative of the impingement of the biological width resulting in efforts of the gingival tissue for re-establishing its original dimension through bone suction or, in the existence of a thick alveolar crest, chronic gingival inflammation. [2],[5] After procedures of crown lengthening and healing, time needed for achieving them is an important factor of consideration in the predictability of gingival line levels.

The two signs for crown lengthening procedures of anterior maxillary are:

  1. For increasing the amount of clinical crown's labial exposure
  2. For increasing the amount of tooth exposed greater to the bone for preventing impingement of restoring on the biological width.



  Laser-assisted Crown Lengthening Top


Critical to any crown lengthening procedure's longstanding success - whether achieved either by traditional means or by laser, and whether entailing modification of soft tissue alone or in combination with osseous surgery - is preserving biological width. [6] For accomplishing this goal, it is essential to take into consideration the attached gingiva's width and the location of the fundamental alveolar crest for defining properly, the surgical method for esthetic crown lengthening. Measuring the extent of attached gingival determines the relationship between the anatomic crown and the attached gingival. For determining the location of anatomical landmarks, that will specify whether there is normal gingival width, or gingival excess, and alveolar crest's location in association with the cementoenamel junction (CEJ), their measurement, is required. Alveolar crest's transgingival sounding decides its relationship to mucogingival junction, gingival crest, and CEJ. The surgical treatments of correcting defects are built on the values of such parameters. The lasers' ability to perform hard- and soft-tissue crown lengthening was defined in many published reports [Figure 1] and [Figure 2]. [7],[8],[9],[10] Diode lasers use for bony and gingival recontouring has an important impact on the manner crown lengthening done. As the laser cuts merely at the end of the tip, the user gets efficient control of hard- and soft-tissue resection. While using conventional rotary instruments in performing osseous resection, always, there will be the risk that their rotation impairs adjacent root surfaces. Moreover, as the surgical laser would is less upsetting, less chance of bony damage is there because of frictional heat that is always possible while using rotary instrumentation without appropriate irrigation. Such slightly invasive technology leads to less postoperative uneasiness and earlier healing of the patient. [10]
Figure 1: Initial profile

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Figure 2: Preoperative intraoral

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For a comprehensive dental treatment, a 33-year-old female patient was referred. The patient wanted an improvement in the appearance of her smile. The examination was over and the proper diagnostic information was gathered, entailing occlusal and periodontal evaluations.

Problems identified

  • Root canal treated tooth as referred in 21
  • Low gingival margin as detailed in 21
  • Tooth's supraeruption as referred in 21
  • Discolored tooth as detailed in 21.


Treatment

Before initiation of any clinical treatment, a complete set of radiographs was taken for determining whether bone level was below or at the CEJ. A diagnostic wax-up and study models were prepared.

After creating the new free gingival location, in the process, the first step after local anesthesia was the performance of laser-assisted gingivectomy with biolase diode laser making use of the straight handpiece. Having the tip nearly parallel to the root surface, in a sweeping motion, the soft tissue was cut from mesial to distal to the level coronal to marked points, trailed by sloping of 90° gingival edge made in the first cut [Figure 3] and [Figure 4].
Figure 3: Postcrown lengthening

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Figure 4: Postzirconia crown placement

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Following are the operating parameters:

940 nm, 2 W in contact mode.

Post-operative instructions

The patient was given painkillers if needed. The patient was instructed to rinse with 0.2% chlorhexidine thrice a day, to be used for 2 weeks starting the next day.

The ultimate prosthetic reconstruction occurred 4 weeks postoperatively and comprised crowns on the central. The duration of recall period was a week and a month for professional cleaning and checkup. [9]


  Conclusion Top


It can be concluded from diode laser-assisted crown lengthening procedure's case report and presentation that biolase laser with the straight handpiece could be used as an adjunct device. It has proved to be very effective and safe. Its use for the procedure offers a number of advantages since the diode laser 940 nm EPIC cuts soft-tissue cleaner with good hemostasis, providing the best comfort for the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
The glossary of prosthodontic terms. J Prosthet Dent 2005;94:10-92.  Back to cited text no. 1
    
2.
Lee EA. Laser-assisted gingival tissue procedures in esthetic dentistry. Pract Proced Aesthet Dent 2006;18:2-6.  Back to cited text no. 2
    
3.
Coluzzi DJ. Lasers in dentistry: The future is here. Contemp Esthetics 2006;10:14-7.  Back to cited text no. 3
    
4.
Pick RM. Using lasers in clinical dental practice. J Am Dent Assoc 1993;124:37-4.  Back to cited text no. 4
    
5.
Magid KS, Strauss RA. Laser use for esthetic soft tissue modification. Dent Clin North Am 2007;51:525-45,xi.  Back to cited text no. 5
    
6.
Ganji KK, Patil VA, John J. A comparative evaluation for biologic width following surgical crown lengthening using gingivectomy and ostectomy procedure. Int J Dent 2012;2012:479241.  Back to cited text no. 6
    
7.
van As G. Osseous recontouring with the Er: YAG laser to obtain ideal biologic width. J Can Dent Assoc 2005;71:53-5.  Back to cited text no. 7
    
8.
van As G. Uncovering the tooth: The diode laser to uncover teeth, brackets and implants. Dent Today 2012;31:168.  Back to cited text no. 8
    
9.
Hernández RM, González GM. Periodontal plastic surgery performed in clinically short crowns for prosthetic rehabilitation. Rev Odontol Mex 2013;17:236-42.  Back to cited text no. 9
    
10.
Rosenberg ES, Cho SC, Garber DA. Crown lengthening revisited. Compend Contin Educ Dent 1999;20:527-32, 534, 536-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Laser-assisted C...
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