hello welcome to cheer side live I'm Megan strong and I'm will Schmitt registered dental assistant
here at the light well dental today's episode we're continuing dr. Murray Shawn's three-part
breakfast ascetic veneer case this is part 2 episode 2 the first episode was all about the
treatment plan now episode 2 well what do we got in store well tell you what and dr.
Murray Shawn's own words lazing is amazing when you have gummy smiles for miles that's exactly
what we're talking about today dr. Murray Shawn is going to change the gingival height using a
series of ginger vitami procedures over time and allowing them to heal let's see how this
works let's check it out dr. Marsha welcome back let's dive right in where we left off from the
last episode and continue with the treatment I always start the process by looking at the
incisal edge position then I continue looking at the tooth proportions versus gingival display and
most importantly at the osseous crest position to help in communication I show the patient that only
closing the spaces will not address the gummy smile and the tooth proportions to determine
the ideal gingival margin that will suit the patient smile I created the markings and show
the patient that the actual gingival margin have to be moved more apical e from the diagnostic
walks up I create a mock-up to help plan the ideal gingival display and tooth proportions
snap on the trial smile and let the patient see what the final result will look like when
looking at tooth proportion is not just looking at the number for example the average length of
a central incisor is ten point five millimeters instead we have to look at the width to height
ratio which for central should be between 75 to 80 percent next step is to sound down the bone
using a pareo probe or a bone sounding gauge to decide if I need also three contouring or just
Jinja vechta me this will give me an idea of how much tissue can safely be removed to improve the
tooth proportion and correct the gingival asymmetry I like to use the 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 sound engage first marking denotes an average sulcus depth
of one millimeter second marking denotes the mid facial osseous crest location which is about three
millimeter on average the third marking denotes five millimeter interproximal bony pick for this
patient the sulcus taps on the facial range from five millimeter to six millimeter with
the CJ hidden under the sulcus for this reason I don't need to raise up a flap and create also
selective surgery to assess a new biological width instead I can use my Picasso light diet laser to
safely remove two to three millimeter of excess tissue to improve the pink aesthetics the next
step in correcting the gingival asymmetry we 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
nine millimeter and a central is about ten point five millimeter we can use the snap-on template
or mark the Zenit and remove the gingival excess with a diode laser I use brush like strokes with
the initiated tip and have my Picasso light laser set at one point eight watts continuous wave the
tissue management with the Picasso light diode laser is easy and clean without bleeding the
healing is rapid I use per your job to aid with tissue healing and most patients report very
little to no post-op discomfort I send patient home with this per euro science gel and instruct
to apply five times a day for five to seven days after a period of four weeks the patient came in
for valuation we can see here that the gingival margins of the centrioles are still lower than
the laterals so we can go ahead and recon turret the correct position for the gingival margins was
determined using tooth proportion beginning at the reference of the correct incisal edge
location the information was transferred to a model and another snap on trial smile was created
to show the patient the ideal result patient was asked to return in six weeks join me in the next
episode for final delivery of ten no prep rocks at aesthetic veneers thanks for watching well
thank you so much for that dr. Maria Sean and be sure to come back for the final episode of this
three-part series and if you missed episode one of course you can head to chairside live.com to get
filled in on all the details but for today this episode's all wrapped up so on behalf of everyone
here at global dental thank you so much for watching we'll meet you right back here next time