Laser Assisted Cosmetic Dentistry

DR SAURABH WHITEFIELD-1

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 aesthetic compromise, since the aim is providing patients with enhanced aesthetics whenever promising(1,2).

Among the most recurrently used techniques of achieving expectable effective aesthetic restoration of the smile is crown lengthening. A 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(5,6). After procedures of crown lengthening and healing time needed for achieving it are important factors 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

Critical to any crown lengthening procedure’s longstanding success- whether achieved by traditional means or by laser, and whether entailing modification of soft tissue alone or in combination with osseous surgery- is preserving biological width(7). 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 aesthetic 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 cement-enamel junction, their measurement, is required. Alveolar crest’s transgingival sounding decides its relationship to the mucogingival junction, the gingival crest and the CEJ. The surgical treatments of correcting defects are built on the values of such parameters. The lasers’ ability of performing hard and soft tissue crown lengthening was defined in many published reports(8-11).Diode lasers use for bony and gingival recontouring has an important impact on the manner crown lengthening is 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 post-operative uneasiness and earlier healing of the patient(11).

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. (Fig.1,2)

Fig.1 Fig.2

Problems identified

Root canal treated tooth as referred in 21

Low gingival margin as detailed in 21

Tooth’s supra eruption as referred in 21

Discolored tooth as detailed in 21

Treatment

Before initiation of any clinical treatment a complete set of radiographs were taken for determining whether bone level was below or at the CEJ(Fig.3). 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 hand piece. Having the tip nearly parallel to the root surface, in a sweeping motion the soft tissue was cut from mesial to dis-tal to the level coronal to marked points, trailed by sloping of ninety degree gingival edge made in the first cut.(Fig.4)

12   Fig.3                                                15            Fig.4

Following are the operating parameters:

940nm, 2watts 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 two weeks starting the next day.

The ultimate prosthetic reconstruction occurred four weeks post operatively and comprised crowns on the central. The duration of recall period was a week and a month for professional cleaning and check-up(10).

Conclusion

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 940nm EPIC cuts soft tissue cleaner with good hemostasis, providing the best comfort for patient.