The hidden smile : quick case review.
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A 31-year-old female came to the dentist for treatment. The patient did not feel confident with her smile. A thorough history and clinical examination was recorded. The patient was looking for a treatment that can give her something different, her smile was not pleasing to her.

During clinical examination, there were significant short anterior clinical crowns, no signs of inflammation of the gingival tissue, nor overgrowth, nor bleeding on probing, no plaque accumulation. The dentist observed that the periodontal probing was giving a reading of over 4mm, before reaching the alveolar bone. There was also a lack of contour of the gingival tissue between canine to canine. Even though the patient had good oral hygiene, the patient was willing to go under treatment to improve her smile. The diagnosis in this case was Stage 1 in passive alter eruption with fractured enamel in the anterior teeth due to a lifestyle choice such as labial piercing.

The treatment options offered for this case were:
Gingivoplasty,
Gingivectomy,
Ceramic veneers or
Direct composite veneers.

Patient decided to go for a gingivectomy with direct composite veneers. This treatment consisted of two stages. Study models were taken prior to the procedure. The cast was marked accordingly to the rise smile line to a symmetric position from canine to canine, exposing clinical crowns and showing uniformity throughout the smile. Patient was informed of possible complications right after the procedure. So, an appointment was scheduled for the first stage of the treatment.

For the surgical gingivectomy, the instruments needed were: mirror, probe, syringe, Kirkland and Orban interdental knives, surgical blade (15 C), surgical curette, gracey curette. 2 carps of 2 % lido, 1:100 K epi was given. Probing was done and the sites for incisions were marked with the periodontal probe. Then, the surgical blade was used to remove the gingival tissue leaving 2.00 mm (respecting biological width) and 1.00 mm of free gingival margin. A total of 2- 4 mm band of gingival tissue was excised. Post-operative instructions were given, chlorhexidine mouth rinse was prescribed.

Tooth eruption consists of active and passive phase. Active eruption consists of eruption of teeth to the occlusal plane, whereas passive eruption is related to the exposure of the teeth by apical migration of the gingiva. At times this passive eruption can be considered a pathological process. In this situation, it affects aesthetics, smile and self-confidence. This could be corrected by surgical dental procedures that uncover the anatomical crown to a more pleasing smile. In this case report, Gingivectomy combined with direct composite veneers gave esthetic appearance and self-confidence to the patient.

Source: http://ispub.com/IJDS/16/1/54750
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