Interdisciplinary management of a patient with a gummy smile

Abstract

This article describes the novel use of cone-beam computed tomography (CBCT) to predictably plan a crown-lengthening procedure without osseous contouring. The method aimed to achieve maximum incisal tooth reduction while avoiding endodontic treatment as a method for conservative management of a patient with excessive gingival display. Managing the case involved performing gingivoplasty without osseous recontouring. Prosthetic reconstruction was also performed to replace the missing canines and adjust the incorrect position of the maxillary incisors. A CBCT was used to precisely locate the alveolar bone level and pulp chamber level to avoid the risk of pulp exposure during tooth preparation. Laser was used to perform gingivoplasty. Computer-aided design/Computer-aided manufacturing technology was used to construct all-ceramic restorations making the use of smile design and virtual articulator features in the software. The patient's excessive gingival display was conservatively treated without osseous surgery or root canal treatment. Six monthly checks were performed for 5 years to check pulp vitality, and all teeth responded normally to vitality tests. The patient expressed great satisfaction with the result with minimal postoperative pain. With careful preoperative planning and novel use of CBCT, esthetic, and conservative treatment of excessive gingival display was made possible, while avoiding osseous resective surgery and root canal treatment. This made the treatment prompt with little need for a recovery period, more appealing to the patient, and longevity of treatment was ensured.

Keywords

• Computer-aided design/computer-aided manufacturing
• cone-beam computed tomography
• gingival display
• gummy smile
• laser