Achieving maxillary anterior esthetics is dependent on a multitude of factors including tooth position, clinical crown form and gingival harmony. Surgical modification is often required to improve the position of the gingival crest while providing appropriate biologic width and ideal tooth display. Many courses in esthetic dentistry suggest gingivectomy procedures for a gummy smile. However, this can be problematic in that the coronally positioned gingival crest associated with the gummy smile issometimes associated with a similarly positioned alveolar crest. Traditional methods for osseous resection have involved elevation of a mucoperiosteal flap. This report describes an alternative procedure using minimally invasive techniques for esthetic enhancement.

A 39 YOM presented with the desire for “a better smile.” An orthodontic diagnosis of class II division I malocclusion was applied. In addition a periodontal diagnosis of type 1 delayed passive eruption subgroup A was noted. With complete orthodontic therapy the desired tooth position was achieved and most critically the position of the CEJ’s were leveled. The relationship of the CEJ to the osseous crest was confirmed under local anesthesia for Teeth #6 through 11. Laser recontouring was employed to create the desired clinical crown form. The required biologic width of 3mm was accomplished via ostectomy for Teeth #7, 8, 10 and 11 using a sulcular approach
without flap elevation. Follow-up visits were performed at 2 and 6 weeks postoperatively to ensure the result. The patient reported
that only a single dose of ibuprofen was utilized for pain management during this period. We welcome your comments, questions and feedback on the surgical methods utilized in this case. If you have similar cases you would like to discuss, please feel free to contact our office.

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What is Laser Periodontal Therapy™?
Laser Periodontal Therapy™ is a laser based technique for the treatment of periodontal disease using the Millennium Dental Technologies, Inc., PerioLase® Laser. Fear of periodontal treatment vanishes when the patients find out no scalpel or sutures will be used. Patient friendly laser treatment gets patients to agree to treatment they need and continue with the follow-up care that is prescribed.

Our office is one of the first in the area to offer Laser Periodontal Therapy™ for the treatment of gingivitis and/or periodontitis. Following are commonly asked questions about this technology.

How does it work?
Tartar, associated with inflamed and bleeding gums, is removed from the root surface of the tooth using an ultrasonic scaler and small instruments. Then, a small amount of light energy from a laser is directed through a tiny fiber, which is gently placed between the gum and tooth. This light energy removes a tiny amount of diseased tissue and aids in reducing the bacteria associated with the disease. After the area is thoroughly cleaned, the body can heal the area naturally.

Does it hurt?
Although the procedure itself can be virtually painless, we may anesthetize the area for the patient’s comfort. In this way we can precisely direct the laser for treatment. Post-procedure discomfort is typically minimal and of short duration.

How long does it take?
Initial treatment is focused on the scaling and the use of small instruments to remove the tartar. Then, the laser portion of the treatment is performed and normally only takes a few minutes. Depending on the severity of the patient’s periodontal disease, treatment may be accomplished in one visit or in multiple visits. The estimated treatment time is reviewed with patients when we discuss their treatment plan.

Does this treatment cost more than traditional gum surgery?
Typically we use the same billing codes as traditional gum surgery and the laser surgery is generally no more expensive than traditional gum surgery. There are other factors which may affect the cost, such as severity of periodontal disease, and how many teeth are involved. Many dental benefit plans pay only for a portion of this treatment. Patients should discuss their payment options with their treatment coordinator as we offer financing for this treatment.

The dramatically increased comfort of our patient’s made the new system attractive to our office. We do encourage patients to take care of the need now to reduce further damage to their gums, teeth and bone.