Maximizing esthetic transformations using a closed flap ErCr:YSGG modality.

Charles Darwin said that “Beauty is the association of many complex associations.” Undoubtedly this can be applied to the art and science of esthetic dentistry. Harmony of function, biology, and appearance is paramount when creating long-term results for patients. Fortunately, the efforts of many pioneers like Pankey, Dawson, and Lee1-3 have allowed contemporaries to achieve bioesthetic results more predictably. Gingival symmetry and health are 2 challenging aspects of these multiple associations. Rufenacht4 and Chiche5 have detailed the artistic components (contours, proportions) of a memorable smile. Kois’ classic study6 defined the anatomic relationships of the dentogingival complex. Biologic width is predictable when measured at 3 mm facially and at 3 mm to 5 mm interproximally from the free gingival margin to the osseous crest. Ultimately the gingival margin must mimic the osseous curvatures to maintain a healthy gingival restorative interface. In the world of minimally invasive care, dentistry has an amazing ally in laser technology. When used carefully, dental lasers are a safe, conservative, and reliable method of aseptically improving the health and contour of hard and soft periodontal tissues. Wang’s 2002 study7 showed that osseous crown lengthening with ErCr:YSGG laser could be completed without laying a flap, suturing, or damaging the bone. Out of contact the energy density is less and so there would be less cutting of the hard tissue. It’s not what cuts best but how the laser cuts according to the physics of the laser. This is further supported in the literature by Rizoiu,8 who found that the thermal coagulative results and ablation qualities were similar to those created by a dental bur. From a patient perspective, the decreased need for suturing and shorter healing times should increase case acceptance to complement the growing demand for esthetic dentistry. In addition, there is a huge advantage to giving the restorative dentist artistic control of the periodontal framework.9 The clinical study presented in this article demonstrates that, in selected cases, combining minimally invasive laser therapy with detailed restorative design and technique can satisfy the bioesthetic functional requirements.