Orthotown April 2021 - 54

3.

4.

5.

6.

7.

The numbing gel is administered
using a small syringe (Fig. 9) along
the gingival margin, left on for
5 minutes, then suctioned off. The
patient then sits for 5 more minutes.
Prepare the laser! We use the
Spectralase 980, an ultrapulse diode
laser, which requires the patient,
assistants and doctor to all wear
protective eyewear. We prepare a cup
of water with microbrushes and a cup
with a diluted solution of hydrogen
peroxide and a toothbrush, and use a
high speed to cut a surgical suction.
Begin the procedure. We typically
perform the contour from second
bicuspid to second bicuspid on the
upper arch, starting with a test spot
in the posterior, then scalloping the
gingival margins. Contact with the
tissue is not necessary; the longer the
laser is held active in a location, the
more tissue that will be removed, so
many times, slow passes accomplish
the most.
In many cases, it is helpful to debulk
the tissue to aid in proper margin
creation. This is done simply by
thinning the tissues and papilla.
Normally this procedure is done at
the 12 o'clock position. Once the
initial pass is complete, it can be
helpful to take a photograph for
evaluation or to approach the patient
from the front to detail the margins
of the incisors.
During the procedure, the clinical
assistant uses a slow surgical suction
to eliminate odor and to catch pieces
of tissue (Fig. 10). The microbrushes
are used to wipe away excess tissue
to allow for better visibility, while
the toothbrush dipped in diluted
hydrogen peroxide does a wonderful
job of cleaning tissue at the end of the
procedure.
After the procedure is completed,
patient instructions are provided: The
patient should brush aggressively, can
take Tylenol as needed and should
avoid hot, spicy and sour foods.

54

Vitamin E oil can also be used to aid
in tissue healing. New photographs
are taken and scans for new clear
retainers.
Figs. 11a and 11b show photographs
directly after the procedure.
The patient is recalled about 3 weeks
later to update records and to check healing
and retention. In most cases, the healing
process is completed by this time; Figs. 12a
and 12b show the patient 3 weeks after the
procedure; Figs. 13a and 13b compare before
and after the soft-tissue contour.

Additional details
and suggestions
Having a stellar finish includes several key
characteristics. Of these, it is important to
show 100% of the upper incisor with 1-2mm
of gum tissue; showing more gum tissue can
be distracting to the smile and leads people
to have insecurities with their full smile.
Gummy-smile treatment with TADs or
surgery should be distinguished from those
in need of gingivectomy. There are many
references to judge this from measurement of
tooth size, incisor display at rest and more.

Fig. 9

Fig. 12a

Fig. 12b

Fig. 10

Fig. 13a

Fig. 11a

Fig. 13b

Fig. 11b

APRIL 2021 // orthotown.com

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Orthotown April 2021

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