PMC7171666_01
Initial smile.
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A 19-year-old woman (M.K.S.) with leukoderma sought clinical service dissatisfied with the aesthetics of her smile due to excessive gingival exposure (Figures 1 and 2).
Initial smile, approximate view.
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A 19-year-old woman (M.K.S.) with leukoderma sought clinical service dissatisfied with the aesthetics of her smile due to excessive gingival exposure (Figures 1 and 2).
(a) Initial smile. (b) Digital waxing.
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Based on the face-guided intraoral planning analysis, digital wax-up was prepared (Figure 3).
(a) Periodontal analysis and digital planning of the guide. (b) Printed surgical guide.
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The surgical guide was designed in the same software, according to the waxing of the new gingival margin position, and printed on resin (PerioGuide) (Figures 4(a) and 4(b)), with 1 mm thickness.
Surgical guide in the mouth. The superior contour of the guide denoted a measurement of 3.0 mm above the new position of the gingival margin defined by the aesthetic waxing.
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The superior contour of the guide denoted a measurement of 3.0 mm above the new position of the gingival margin defined by the aesthetic waxing, aiming to reestablish biological distances (Figure 5).
(a) CEJ was located. (b) Primary internal bevel incision.
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Using a millimeter probe (Hu-Friedy, Chicago, USA), the CEJ was located and compared with the delimitation of the surgical guide positioned in the mouth (Figures 6(a)). The primary internal bevel incision was performed with a 15C blade (Figure 6(b)) (Swann-Morton, England), followed by intrasulcular incisions for collar removal (Figures 7(a) and 7(b)).
(a) Gingival collar removal. (b) Gingival collar removed.
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The primary internal bevel incision was performed with a 15C blade (Figure 6(b)) (Swann-Morton, England), followed by intrasulcular incisions for collar removal (Figures 7(a) and 7(b)).
Specific insertion for tunneled osteotomy with the piezoelectric device, where the cut is only at the tip to avoid damage to the tooth root.
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Also, a slight inclination of the insert is made so that it touches the bone (Figure 8).
Tunneled osteotomy with a piezoelectric.
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Its tips measuring 3 mm were inserted into the gingival sulcus to reestablish biologic width (Figure 9).
60 days after surgery.
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In the immediate postoperative period, the patient presented better gingival contour and was completely satisfied with the treatment at the 60-day evaluation (Figure 10).