A gingival display of more than 2mm is...
...considered to be an attractive smile.
Active Eruption is the movement of the tooth out of the alveolar bone...
...into functional position on the occlusal or incisal plane.
There are three markings you can see this bone sounding gauge.
The first marking denotes an average sulcus depth of 1 mm.
Final No-Prep veneers were seated sequentially...
...starting at midline and moving distally.
In today's episode, I will show you...
...how to incporate laser procedures...
...and elevate the esthetics with...BruxZir® Esthetic.
Here is Ashley.
Her main concern is this broken tooth on #9.
She says any time she looks in the mirror,...
...she sees large spaces between her teeth.
She thinks her teeth are small, with a lot of gum showing.
She broke her tooth #9 when she bit on her pierced tongue.
Her facial piercing was rubbing against the gingival tissue above #10...
...making this tooth #10 appear longer than #7.
A gingival display of more than 2mm is...
...considered to be an attractive smile.
Her gingival display was about 6-7 mm.
My diagnosis was...
...Altered Passive Eruption.
This was the cause of anatomical crown being submerged under the gum tissue.
To better understand the etiology of gingival excess, le's review the pattern of eruption.
Active Eruption is the movement of the tooth out of the alveolar bone...
...into functional position on the occlusal or incisal plane.
Passive Eruption is the exposure of the teeth...
...due to apical migration of the gingival tissue.
Altered Passive Eruption is the failure of the gingival tissue...
...to migrate apically to expose the entire clinical crown...
...and obtain a normal base position of the sulcus...
...relative to the CEJ.
Once the diagnosis is made,...
...the next step is to look at the best way to treat it.
Let's continue with the treatment.
I always start the process by look at the incisal edge position.
Then, I continue looking at the tooth proportions versus gingival display...
...and most importantly, at the osseo crest position.
I showed the patient that only closing spaces...
...will not address the gummy smile and the tooth proportions.
I created the markings and showed the patient...
...that the actual tangible margin have to be moved more apically.
From the diagnostic wax-up,...
...I created a mock-up to help plan...
...an ideal gingival display and teeth proportions.
Snap on the mock-up...
...and let the patient see what the final result will look like.
When looking at tooth proportion, it's not just looking at the number,...
...for example, the average length of a central incisor is 10.5 mm.
Instead, we have to look at the width-to-height ratio.
For a central incisor, it should be between 75% to 80%.
Next step is to sound down the bone using a perio probe.
Here, I am "sounding to the bone" using a perio probe or a bone sounding gauge...
...to decide if I need osseo contouring or just gingivectomy.
This will give me an idea of how much tissue can be removed safely...
...to improve the tooth proportion and correct the ginival asymmetry.
I like to use a bone sounding gauge because it is easy to manipulate...
...and provide easy access due to its curved tip.
There are three markings you can see on this bone sounding gauge.
First marking indicates average sulcus depth of 1 mm.
Second marking is about 3 mm on average.
5 mm denotes space between contact point and bone crest.
For this patient, the sulcus depth on the facial ranged from 5 mm to 6 mm...
...with the CEJ hidden under the sulcus.
For this reason, I don't need to raise up a flap to assess a new biological width.
Instead, I can use my Picasso™ Lite diode laser...
...to safely remove 2 to 3 mm of excess tissue.
The next step in correcting the ginival asymmetry...
...is to look at the existing tooth height and compare it with...
...the proposed height on the diagnostic model.
On average, the length of a lateral is about 9mm...
...and a central is about 10.5 mm.
We can use a snap-on template...
...or mark the zenith...
...and remove the gingival excess with a diode laser.
Here, I use brush-like strokes...
...and have my Picasso™ Lite laser...
...set at 1.8 W with "Continuous Wave".
The tissue management is easy and clean...
...without bleeding.
The healing is rapid.
I use perio gel to aid with tissue healing.
Most patients report very little to no post-op discomfort.
I send the patient home with this perio gel...
...and instruct her to apply 5 times a day for 5 to 7 days.
After a period of 4 weeks, the patient came in for an evaluation.
We can see here that the gingival margin of the central is still lower than the lateral.
So we can go ahead and recontour it!
The correct position for the gingival margin was...
...determined by the ideal incisal edge location.
The information was transferred to a model...
...and another trial snap-on was created to show the patient the ideal result.
She was asked to return in 6 weeks.
This is now six weeks after laser gingivectomy.
This case was a complete digital case...
...from the scan, design...all the way to the final restoration.
From this scanned image, we can see the amount of gingival tissue I removed...
...and the nice tissue response after 6 weeks.
We can try in the restorations with water or with try-in paste.
I feel that I have a better appreciation...
...of the margin integrity if I just use water.
After confirming the fit, function and phonetics are good,...
We are ready for the bonding procedure.
After try-in, Ivoclean is used to clean out the intaglio surface.
Will is applying Monobond Plus to the intaglio of the veneer.
No preparation was done on this case but...
...in order to prepare the teeth for etch and bond...
...I pumice the surfaces to remove the biofilms...
...then I sandblasted to get a more uniform etching surface.
For this case, I chose Variolink Esthetic LC luting composite...
...to ensure long-term color stability and ample seating time.
Final No-Prep veneers were seating sequentially...
...with gentle finger pressure...
...starting at mideline and moving distally.
...to ensure all area of the cement are polymerized,...
...I cure each side for 20 seconds...
...while applying pressure using wooden sticks.
All the interproximal excess cement was gently removed...
...with a serrated saw and floss.
Altering the gingical esthetics using Picasso™ Lite laser...
...proved to provide a rapid tissue healing...
...with beautiful gingiva with no post-op discomfort for the patient.
With these 10-unit No-Prep BruxZir® Esthetic veneers...
I was able to address all of patient's concerns...
...and put back confidence in her smile.