The patient came directly out of hygiene with a chipped tooth #8. The patient was aware that teeth #s 7-10 are in need of crowns. The tooth was bonded and the patient was told that this was a temporary fix, and agreed to schedule crowns for tooth #8 and #9. Due to wear secondary to bruxism, tooth #8 and #9 have super erupted, bringing their gingival margins too far coronally for proper esthetics. A pre-prosthetic esthetic crown lengthening was suggested to ensure optimal esthetics. Orthodontic intrusion would be another option but the patient was not interested. Mock-up of results in gingival margin improvement was demonstrated with flowable composite. Patient preferred this option to surgery with a periodontist, including flap and 4 – 6 sutures. Soft tissue and approx. 2 mm of bone needed to be removed in order to reestablish proper gingival levels. Patient requested to complete crown lengthening while they were already in the office.
The patient was anesthetized with 1 carpule of 4% septocaine with epi 1:100,000. The entire procedure was performed using the hard and soft tissue selection. Excess gingiva was removed using the Ultraguide handpiece (600 micron tip, 14 mm length) with the 0.25 mm spot size, 1% mist and cutting speed between 20% – 40%. The bone adjacent to the tooth was removed until proper gingival architecture was achieved with corresponding boney architecture 3 mm apical to desired gingival margins. This was accomplished using the same Ultraguide tip, 0.25 mm spot size, 100% mist and cutting speed between 40% – 60%. A Piezo scaler was used to smooth root surface and remove any spicules of bone on cementum. The total procedure time was approximately 40 minutes.
Solea’s precision and ability to maintain a clean surgical site allowed this procedure to be completed successfully and in the same appointment, as this procedure was unscheduled. Additionally, rapid healing was observed. With traditional instruments, there would have been more post-operative pain and slower healing. With Solea, this was a minimally invasive procedure. Preparation and impressions for emax crowns #s 8 and 9 were completed 3 weeks post operatively. Traditional surgery would require 6-8 weeks until proper conditions were established for definitive restorative work.