This situation document items the complicated oral rehabilitation of a feminine affected person with serious enamel put on and over the top gingival show. A multidisciplinary means combining restorative tactics with a complicated laser protocol was once used to revive serve as and strengthen aesthetics. Remedy integrated an build up within the vertical measurement of occlusion (VDO), laser-assisted crown lengthening, zirconia restorations, laser-assisted enamel whitening and non-invasive perioral procedures. The medical goal prolonged past enamel recovery by myself, incorporating structural correction of the occlusal courting and enhancement of the perioral area to give a boost to the entire aesthetic consequence.
Fig. 1b: Preliminary medical scenario. Intra-oral view demonstrating generalised attrition and decreased incisal duration.
Affected person presentation and medical analysis
A 42-year-old feminine affected person introduced with the main criticism of brief, elderly tooth and over the top gingival show when smiling. Medical findings printed generalised attrition, characterized by way of important lack of enamel construction because of bruxism, resulting in a collapsed VDO. As well as, over the top gingival show was once seen, brought about by way of altered passive eruption and a hyperactive higher lip (Figs. 1a & b). Perioral getting old was once additionally obvious, together with effective traces across the mouth and lack of lip quantity, contributing to the elderly look of the decrease 3rd of the face. The remedy goals had been to revive the misplaced enamel construction, right kind the gingival margin and strengthen the perioral look the use of the LightWalker laser machine (Fotona).
Section I: Diagnostic wax-up and VDO recovery
The primary problem was once recovery of the VDO. A virtual smile design and a diagnostic wax-up had been performed, permitting the affected person to guage the proposed enamel lengths and occlusal courting (Figs. 2a & b).
The use of the wax-up as a information, a full-arch build-up of the maxillary tooth was once carried out the use of a extremely stuffed aesthetic resin composite. This provisional section stabilised the brand new occlusal place and allowed the masticatory muscular tissues to evolve to the greater VDO. The affected person wore those composite restorations for 3 months to substantiate purposeful convenience and aesthetic acceptance earlier than continuing to definitive remedy.
Section II: Exact laser gingival sculpting and bone recontouring
After the three-month stabilisation length, consideration shifted to gingival aesthetics. Typical crown lengthening continuously comes to scalpels, sutures and prolonged therapeutic occasions. On this case, the Er:YAG laser wavelength was once used for a minimally invasive means.
The use of the laser’s exact ablative functions, a gingivectomy was once carried out to take away extra comfortable tissue. Owing to the prime absorption of the Er:YAG wavelength in water, tissue ablation happens with minimum thermal injury, leading to decreased swelling and quicker therapeutic when put next with typical tactics. Moreover, flapless laser-assisted bone recontouring was once additionally carried out to regulate the alveolar bone crest the place indicated (Fig. 3). This ensured preservation of the organic width and supported long-term periodontal balance. The precision of the laser enabled the introduction of symmetrical gingival contours, setting up an appropriate basis for the definitive restorations.
Fig. 3: Intra-operative view all over laser-assisted crown lengthening the use of the Er:YAG laser.
Section III: Definitive restorations and mandibular enamel enhancement
3 months after the laser process, the gingival tissue had matured and stabilised. The provisional composite build-ups had been got rid of, and the tooth had been minimally ready for the definitive restorations (Fig. 4). Monolithic zirconia crowns had been decided on for the recovery of the maxillary arch, owing to the fabric’s prime fracture resistance and beneficial aesthetics, specifically related homes in a affected person with a historical past of enamel put on. The restorations had been designed to check the brand new gingival structure completed within the earlier section.
To harmonise the entire look, the mandibular tooth had been brightened the use of the TouchWhite protocol. Against this to standard whitening programs that depend on heat-producing mild assets, the laser complements the formation of unfastened radicals throughout the whitening gel with out expanding pulpal temperature. This means reduces sensitivity whilst attaining efficient whitening inside of a shorter medical time.
Fig. 4: Minimally invasive enamel preparation of the maxillary anterior tooth previous to definitive recovery.
Section IV: Perioral procedures—LipLase and SmoothLiftin
The perioral comfortable tissue performs a very powerful function within the total aesthetic consequence. On this case, an adjunctive laser remedy means (FotonaSMILE) was once used to strengthen the encompassing tissue.
The affected person expressed a desire for lip enhancement, however was once hesitant about injectable fillers. The LipLase remedy was once carried out as a non-invasive process to stimulate collagen remodelling of the lips. Remedy of each the labial mucosa and the exterior lip floor ended in progressed, natural-looking lip quantity and definition with out the hazards related to injectable approaches, akin to overcorrection, asymmetry and post-injection bruising.
To deal with perioral wrinkles, the SmoothLiftin process was once performed the use of non-ablative Er:YAG pulses implemented intra-orally. This induces managed bulk heating of deeper connective tissue, triggering collagen contraction and synthesis. The ensuing impact is progressed tissue firmness and aid of perioral traces, together with the nasolabial folds.
Effects and dialogue
The remedy ended in a marked development in each serve as and aesthetics (Figs. 5a & b). Recovery of the VDO contributed to progressed facial proportions. The gingivectomy and bone recontouring corrected the over the top gingival show, and the zirconia crowns supplied a sturdy aesthetic consequence.
The adjunctive perioral laser therapies contributed to progressed lip look and soft-tissue high quality. As those procedures are non-invasive and don’t require injectable brokers, affected person acceptance was once prime. The usage of the FotonaSMILE means, combining hard- and soft-tissue programs —together with perioral therapies—on a unmarried laser platform, facilitated an effective workflow and a prime stage of remedy precision.
Conclusion
This situation demonstrates that the way forward for aesthetic dentistry lies within the holistic remedy of the affected person. The mix of organic ideas with complex laser generation enabled a predictable purposeful and aesthetic consequence. The FotonaSMILE means lets in clinicians to increase remedy past the dentition, attaining effects which can be harmoniously built-in with the affected person’s total facial look.
