Guided Periodontal Surgery: Association of Digital Workflow and Piezosurgery for the Correction of a Gummy Smile

Abstract

Digital flow has become a part of currently practiced dentistry. Virtual planning ensures predictable aesthetic and functional rehabilitation, painless postoperative recovery, and better communication with patients, thus meeting their expectations. The purpose of this case report is to demonstrate the digital planning for the correction of a gummy smile with a personalized preparation using a piezoelectric surgical guide (PerioGuide) for gingival contouring and flapless osteotomy. The guide was designed using Nemo Studio software, based on the patient’s facial aesthetic analysis, through photos, videos, and facial scanning. These images were aligned with the scan and placed over the cone beam computed gingival tomography for prediction of results, based not only on the distance from the cementoenamel junction to the bone crest but also on the best gingival margin contour according to virtual aesthetic planning. Digital planning, combined with the use of a piezoelectric device, allows for a flapless guided surgical technique for gingival contouring and osteotomy. As a result, the surgical procedure is safer, faster, and more predictable with better postoperative outcomes.

Use of both the diode and Er: YAG lasers in esthetic crown lengthening with the aid of digitally guided dual technique: 3 years follow‐up

“…This helps to avoid complications and rework, saving time and resources. 14,15 The use of surgical guides allows the surgeon to minimize trauma to the surrounding gingival tissue and bone. This can result in less pain, inflammation and recovery time for the patient.…”

“…12,13 To improve the appropriate EGD diagnosis and ensure a predictable and safe crown lengthening procedure, the digital workflow can be used to achieve these objectives. 14 The digital guides help the procedure precision reducing the risk of errors during the surgery, such as over or under cuts. Furthermore, the use of surgical guides allows the surgeon to minimize trauma to the surrounding gingival tissue and bone.…”

Korrektur eines Gummy Smile mit Hilfe einer Mini-Implantat-Verankerung – Direkte versus indirekte Verankerung

“…Das Gummy Smile wird vor allem bei stärkerer Ausprägung zumeist als ästhetisch störend empfunden 3 . Zur Korrektur eines Gummy Smile kommen je nach Indikation eine chirurgische Impaktion des Oberkiefers 4 , eine Intrusion des oberen Frontzähne 1 , eine chirurgische Kronenverlängerung mittels Gingivektomie 5 6 und gelegentlich auch ein orofaziales Training zur Stärkung des Lippenschlusses oder Botox-Injektionen in Frage 7 8 9 . Der Umfang einer Gingivoplastik ist von sowohl von der Taschensondierungstiefe als auch von der Relation zwischen dem Limbus alveoloaris und der Schmelz-Zement-Grenze abhängig.…”

Digitally Guided Workflow for the Esthetic and Prosthetic Oral Rehabilitation of a Patient with Excessive Gingival Display: A Case Report

“… 13 Recently, this approach has been implemented in guided-surgical periodontal crown lengthening procedures to achieve the best esthetic and biological outcomes in patients suffering from excessive gingival display. 14 , 15 Previous reports have described the use of this treatment approach in patients with sound natural anterior teeth. We hypothesized that this approach can be adopted in patients with excessive gingival display and may substantially improve treatment outcomes when subsequent esthetic restorations are planned.…”