Closed Osseous Crown Lengthening Followed by Minimal Indirect Veneer Preps

This patient wanted to have a fuller and brighter smile and display less gingiva when she laughed.
The maxillary teeth were all lingually inclined and there was an adequate band of attached gingiva.

The gingival marginal tissue has been lased with a diode laser (Navigator by Ivoclar) and the enamel acid etched for composite placement. The laser is ideal for this application because of the precise control of the cutting element and a bloodless incision. This allows for immediate composite placement.
A highly polishable microfill composite (Heraus Durafill) was placed in the gingival areas of the lengthened teeth to act as a healing matrix for the tissue, reduce root sensitivity and provide nice aesthetics. After the composite was cured a full thickness flap was dissected over all four incisors but the papillae were not cut. The tissue was carefully stretched to gain access to the osseous margin which was reduced and contoured. With the tissue reflected the gingival margins of the composites were finished and polished.

Immediately post surgery with 3 interrupted Vicryl 6-0 sutures in place to retighten the tissue. The sutures were removed 7 days later and the area allowed to heal three months before the final preparation appointment.

Diagnostic wax-up of final form. The shiny surface on the model is from a coating of liquid floor wax (Future by Johnson and Johnson) that seals the stone and keeps unset putty from sticking during the stint construction.

Stint made from condensation silicone putty (Siltech by Ivoclar) adapted over the diagnostic wax-up.
Luxatemp (Zenith) placed over the teeth prior to preparation was allowed to set for 2 1/2 minutes before removal of the stint.

A 0.5mm wheel diamond was used to cut depth grooves and stopped cutting when hubbed. Use a single wheel instead of multiple wheels on a single shaft because the tooth has a curve to the surface.

The wheel diamond was used to cut through the temporary matrix and left marks on the tooth structure identifying where less than 0.5mm clearance existed. You could certainly cut multiple horizontal lines for more guidance.

You can just see a few spots (wheel bur marks) where the projected shape of the final restorations would have inadequate reduction. Because all of these teeth are tipped lingually, the only areas that needed reduction were gingival to the marks. The incisal edges were reduced just to give a bit of room for translucency to be built into the restorations and the remaining enamel was scuffed. You can be more conservative in preparation if you reference the final form in three dimensions as you prep.

The completed preparations prior to the impression. To adequately close the gingival embrasure between the central incisors, the contact was broken and the the finish line moved to the lingual. Another choice would have been to fill the embrasure by bulking the gingival of each tooth in composite before prepping and keeping the mesial margins facial of the contact. This design even though more aggressive, gives better longevity to the restorations.

The completed shaped, glazed and polished provisionals at the end of the preparation appointment. The occlusion is verified for proper clearances and function. The nuances of aesthetics, phonetics and function will be reviewed with the patient while the final restorations are being fabricated. In addition to good clinical photos, your ceramist will certainly appreciate a precise impression or model of the provisionals as you have finally shaped them.