PMC4644817_01
Clinical photograph representing the preoperative facial view with presence of diastemas.
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The patient presented a good general health and maxillary anterior teeth with short clinical crowns and diastemas (Figures 1 and 2).
Preoperative intraoral view.
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The patient presented a good general health and maxillary anterior teeth with short clinical crowns and diastemas (Figures 1 and 2).
Diagnostic wax-up.
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Initially, an impression of the maxilla was obtained to realize the diagnosis wax-up (Figure 3), and then a surgical guide in silicone, with the edge tangent to the cervical region of wax-up, was confectioned (Figures 4 and 5).
Surgical guide manufactured with silicone.
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Initially, an impression of the maxilla was obtained to realize the diagnosis wax-up (Figure 3), and then a surgical guide in silicone, with the edge tangent to the cervical region of wax-up, was confectioned (Figures 4 and 5).
Surgical guide installed in the mouth.
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Initially, an impression of the maxilla was obtained to realize the diagnosis wax-up (Figure 3), and then a surgical guide in silicone, with the edge tangent to the cervical region of wax-up, was confectioned (Figures 4 and 5).
Register of new gingival margin with scalpel.
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The guide was inserted in mouth and the new gingival margin was registered with a scalpel (Figure 6).
Incision in the registered area and elevation of a full-thickness mucoperiosteal flap.
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Thus, a full-thickness mucoperiosteal flap was elevated (Figure 7) and the gingival collar extracted with a Gracey curette.
Measurements of the distance between the guide edge and the cervical bone for the osteotomy.
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For the osteotomy, measurement of the distance between the guide edge and the cervical bone was recorded (Figure 8).
Removal of bone tissue with manual instrument.
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The creation of a precise biologic width requires, in addition, a precise osseous contouring, which was performed using manual instruments (surgical chisels) and carbide/diamond burs with adequate irrigation, for preventing bone necrosis (Figures 9 -11); then, the flaps were sutured (Figure 12).
Bone tissue resection through rotating instrument.
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The creation of a precise biologic width requires, in addition, a precise osseous contouring, which was performed using manual instruments (surgical chisels) and carbide/diamond burs with adequate irrigation, for preventing bone necrosis (Figures 9 -11); then, the flaps were sutured (Figure 12).
Clinical aspect after the bone removal.
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The creation of a precise biologic width requires, in addition, a precise osseous contouring, which was performed using manual instruments (surgical chisels) and carbide/diamond burs with adequate irrigation, for preventing bone necrosis (Figures 9 -11); then, the flaps were sutured (Figure 12).
Suture of the surgical region.
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The creation of a precise biologic width requires, in addition, a precise osseous contouring, which was performed using manual instruments (surgical chisels) and carbide/diamond burs with adequate irrigation, for preventing bone necrosis (Figures 9 -11); then, the flaps were sutured (Figure 12).
Clinical aspect of soft tissues after six-month follow-up.
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After 6-month healing (Figure 13), the provisional facets were installed for aesthetic test and posterior definitive prostheses were delivered (Figure 14).
Installation of provisional facets.
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After 6-month healing (Figure 13), the provisional facets were installed for aesthetic test and posterior definitive prostheses were delivered (Figure 14).