“The Use Of Dental Lasers And Ridge Preservation To Maximize Esthetic Outcomes”
True dental esthetics comes from a delicate balance of the morphology and color of the dentition silhouetted against the backdrop of a healthy periodontium in a functionally sound occlusion. A major challenge for the restorative dentist is to reconstruct these natural biologic parameters when a tooth (or teeth) is (are) lost and the harmony of this biologic balance is upset. Tooth loss in the esthetic zone can be handled by placement of dental implants or by conventional crown and bridge procedures. Whichever route is chosen, the key to esthetic success lies in the preservation of facial and interproximal alveolar bone and symmetry of the soft tissue envelope that surrounds and frames the teeth. Only then can the contours and color of the dental units be exploited to create a maximal esthetic dental reconstruction. This article will describe a case where dental lasers (hard and soft tissue) and synthetic bone grafting material was used to create an esthetic periodontal environment for the replacement of porcelain laminates and an all ceramic bridge for a patient after a root fracture and resultant loss of the maxillary right lateral incisor.
The patient (Figure 1) presented with porcelain laminate veneers on tooth numbers 4 to 12. Tooth number 7 had marginal gingivitis and was sensitive to percussion. She was treated for acute pulpitis with root canal therapy, but the pain persisted. The endodontics specialist made a diagnosis of root fracture and the tooth was scheduled for removal. Although there was adequate space for a dental implant to replace the lost tooth, the patient elected to have a three-unit bridge placed instead. Given the age of the patient (28 y/o), it is imperative to think about preserving the alveolar ridge for long-term esthetics. One of the advantages of implant placement is that the alveolar ridge will be preserved for the patient. In lieu of implant placement, bone (socket) grafting (filling the extraction site) will help preserve not only the interproximal alveolar ridge height that is critical for papillae retention, but just as important, the facial contour in the edentulous area 1,2. The surgical plan will involve atraumatic extraction of the maxillary right lateral incisor by carefully luxating the tooth toward the palatal aspect. Once the extraction site is filled with the bone grafting material, a provisional restoration with an ovate pontic design will form a primary closure over the surgical site retaining the graft material and helping to support the periodontal tissues during the healing phase of treatment.