Blog Author: Katherine Clements
Crown Lengthening (Closed) #9 performed by Timothy Anderson, DDS
This procedure includes the removal of both soft tissue and bone. It demonstrates Solea’s precision, minimal bleeding and very fast healing.
Case Summary: A 60-year-old female patient presented to the practice with complaints about the appearance of her front crown. After full consultation, it was determined that she was not only unhappy with color/contour of the existing crown, but also the gingival architecture that framed her smile. The patient had a defective restoration on tooth #8 PFM with asymmetry of the gingival zenith on the tooth #9, but did not want to undergo an invasive gum surgery. Therefore, the clinical objective was to obtain an esthetic restoration and gingival architecture on the tooth #9 utilizing a non-invasive closed crown lengthening surgical approach with Solea. The full coverage restoration on tooth #8 and partial coverage on teeth #7,9,10 were prepped immediately following the crown lengthening
Technique Used: To start, a gingivectomy was performed on tooth #9 to ablate the gingiva to desired height. The dentist used Solea utilizing the 1 mm spot size with cutting speed between 20-40% and 20% mist to remove the excess tissue. The bone was then sounded with a period probe to determine the amount of crestal bone that needed to be reduced to ensure adequate biologic width. The alveolar bone reduction was completed by directing the laser beam down the long axis of the tooth (slightly towards the tooth) using the 0.5 mm spot size with cutting speed between 20-40% and 100% mist. Sulcus depth was checked periodically to verify how much bone had been removed. Once adequate probing depth had been achieved, the teeth were then prepped and temporized. 1 carpule of 4% articaine with 1:100K epi was used during this treatment as 4 teeth were prepped for crowns at the same time.
- With traditional methods (e.g., a scalpel and sutures) the entire surgical procedure would have been a separate 60 min visit, compared to under 10 minutes with Solea.
- This case highlights Solea’s exceptionally clean surgical cutting with predictable, rapid healing and minimal bleeding.
- The dentist was able to perform this procedure in-house rather than refer it out.
- The patient was thrilled not only with the esthetic outcome, but also the speed and lack of the more invasive “traditional surgical approach” needed to complete the procedure.
Results: Solea’s precision enabled complete control of the tissue and the outstanding clinical results. The procedure was finished quickly and there was almost no bleeding. With Solea, the crown lengthening and tooth preparations could be completed in a single visit. This allowed for proper tissue healing around temporaries, fewer appointments for the patient, and less chair time for the clinic. The patient noted no post-op discomfort. She said that the final restoration and process exceeded her expectations.
Anterior CEREC Veneers with Esthetic Crown Lengthening Using Solea
performed by Dr. Jeffrey Rohde
This procedure demonstrates precision, minimal bleeding and very fast healing.
Case Summary: A 43-year-old female patient presented to the practice for her regular check-up. Patient has had chipping and various composite repairs for over two decades. She was unhappy with her smile and the way her teeth looked. The oral evaluation of the patient indicated that teeth #7,8,9,10 had discrepancy in the size of the teeth. The “Golden Proportion” was disrupted due to variable interproximal bonding, chipping on incisal edges, and widely variable height to the gingival contour of those teeth. The dentist advised a mix of esthetic gingival contouring and esthetic crown lengthening to correct variations in gingival height as well as porcelain veneers to restore the maxillary central and lateral incisors. The clinical objective was to reduce gingival height to improve esthetics in placement of veneers.
Technique Used: The treatment plan included diagnostic wax up, surgical guide fabrication (to show the height of reduction), crown lengthening using Solea, prep for veneers, fabrication of provisional crowns (to test out esthetic design and function). CEREC veneers were made using Ivoclar’s eMax. While performing the crown lengthening procedure, the dentist utilized Solea with the 1.25 spot size, 8 ml/min mist, and 40% cutting speed. He easily transitioned from soft tissue to bone by simply varying the pressure on Solea’ s footpedal. The procedure time was 4-5 minutes with Solea, whereas the average procedure time doing traditional flapped crown lengthening would be at least 45-60 min.
- No flap and no sutures were needed for this case, incredible precision of Solea made this procedure minimally invasive.
- Blood-free preparation, clear surgical site, and no charring of tissue.
- No heat transferred to bone causing unpredictable healing.
- Reduced procedure time to 4-5 minutes compared to approximately 45-60 minutes with traditional tools.
- Patient experience was improved compared to using traditional tools, and approach was minimally invasive resulting in faster healing (in under 1 week) and minimal discomfort in gingival tissue.
Results: Without Solea, this case would have been sent to a specialist for traditional crown lengthening that involves heavy local anesthesia, raising a flap, use of a drill creating heat and friction, and placement of sutures. The healing time would have been a minimum of 6 weeks. If a diode was used, it would not have been able to remove bone, and the tissue would have been left charred and ragged. The dentist was able to utilize multiple technologies (Solea and CEREC) for improved clinical results and patient experience than any traditional method.
Gingivectomy and restoration on tooth #8 performed by Joshua Weintraub, DDS
This case demonstrates how Solea can be used to ablate both hard and soft tissue with no anesthesia, no bleeding, and fast healing.
Case Summary: A 67-year-old male, who has been a long-time patient of the practice, presented for his follow-up appointment. The oral evaluation revealed the recurrent subgingival decay on tooth #8 DFL (Class III/V combination) under an old composite restoration. The clinical objective was to restore #8 while performing a gingivectomy to access subgingival decay. Total procedure time from start to finish was less than 30 minutes.
Technique Used: No topical anesthetic or injectable anesthetic were used for this procedure. To start, a gingivectomy was performed to enable removal of the subgingival decay and achieve a clean margin for proper restoration. Next, the old composite and recurrent decay were removed with Solea. The removal of gingiva was performed using the 1 mm spot size with cutting speed between 30-50% with 20% mist. This took less than a minute and did not require anesthetic. The 1 mm spot size with cutting speed between 30-60% with 100% mist was used for removing the decay and old composite. The enamel was beveled with a diamond bur. Finally, the tooth was restored. The entire procedure was completed blood-free (the slight redness on the ‘Restored’ photo was caused by the finishing bur at the gingival margin).
- The treatment was completed without anesthetic, was blood-free, and completed in less time compared to traditional approach.
- The soft tissue healed extremely rapidly due to the minimally invasive precision of Solea.
- The patient experience was enhanced due to not being injected with anesthesia, avoiding post-operative pain, and a shorter appointment time.
Results: With other instruments, the patient would require an injection in the maxillary anterior region – one of the most uncomfortable places to receive an injection, regardless of dentist’s skill level. This procedure would have likely taken much longer to complete with traditional instruments and techniques, compared to under 30 minutes with Solea. Time savings were achieved without the need to inject the patient and then wait for the patient to become numb. In addition, rapid and easy management of the soft tissue saved time. The patient was excited to avoid the shot, possible post-op pain, and hours of numbness after the appointment.
Deep Troughing for Margin Isolation #5 performed by Timothy Anderson, DDS
This case demonstrates how Solea easily enables virtually blood-free soft tissue procedures without anesthesia resulting in better digital impressions for CEREC restorations.
Case Summary: This patient of record presented to the practice with a failing restoration and recurrent decay on tooth #5. The patient stated that he really disliked being numb and wanted to avoid the injection. As can be seen radiographically and in the pre-op photo, the distal restoration was significantly subgingival. No anesthetic was used during the treatment.
Technique Used: The existing composite and decay were removed using Solea. The tooth was prepared for an Emax crown with the Meisinger CEREC Doctors prep kit. Solea was then used to remove adequate tissue for imagining in a clean, bloodless field. No cord was needed and the troughing took less than 15 seconds. The final scan was taken with the CEREC Omnicam. The restoration was designed with CEREC 4.6 Chairside software. The crown was milled, stained and glazed. Crown was then bonded with Variolink Esthetic.
- Solea enabled the dentist to perform this treatment anesthesia-free.
- With Solea, the procedure was completed in less than 15 seconds compared to several minutes traditionally.
- Solea’s ability to precisely and virtually blood-free trough gingiva allowed for an effortless perfect scan.
- The dentist delivered an impeccable patient experience including not administering anesthetic, a shorter appointment time, and increased patient comfort post operatively.
Results: The key to a successful CEREC same-day restoration is the ability to have smooth clear margins with separation at the time of scanning. Traditional methods, like retraction cord in a single or two-cord technique, increase procedure time and don’t always deliver predictable outcomes. Solea’s unparalleled precision enabled the dentist to sculpt the tissue for restorative excellence and immediately proceed with definitive restoration. Thus, the Solea and CEREC combination allows for the simplified same day dentistry.
Crown Lengthening (Clinical) #14 performed by Timothy Anderson, DDS
This case highlights Solea’s exceptionally clean and precise cutting of soft and osseous tissue that enhances the CEREC’s same day dentistry workflow.
Case Summary: A 62-year-old male patient presented to the practice with very deep decay to the level of the alveolar crest. Tooth #14 required clinical crown lengthening to restore with a crown. With Solea, performing the surgery and placing the definitive restoration on the same day was possible.
Technique Used: To start, the existing amalgam was removed with a carbide bur. Caries was then removed utilizing Solea. A full coverage crown preparation was completed using Meisinger CEREC Doctors prep kit and an electric handpiece, and some minor troughing was performed to expose margins for a final scan without the need for retraction cord. An Emax crown was designed utilizing the CEREC 4.6 Chairside software and fabricated. Crown lengthening was performed during milling and glazing. A minimally invasive flap was reflected with a periosteal elevator. There was minimal tooth structure coronal to osseous crest on the distal and distal-lingual surfaces. Solea was used to remove and sculpt osseous tissue until there was 2 mm of tooth structure coronal to the bone. Positive bony architecture was maintained. Solea provides unsurpassed precision and clear visualization allowing removal of bone without iatrogenic damage. The final restoration was inserted with SpeedCem Plus self-adhesive resin cement. A single 4-0 chromic gut suture was placed.
- Solea’s remarkable precision and improved visualization allowed for removal of osseous tissue without iatrogenic damage.
- Solea enabled complete control of soft and osseous tissue resulting in a very fast and minimally invasive surgical procedure (completed in under 10 minutes with only minimal bleeding).
- The Solea and CEREC combination allowed the dentist to finish the entire treatment, crown lengthening and the crown itself in the same visit – a true “crown in a day”.
- The dentist was able to perform this procedure in-house rather than refer it out.
- The patient was thrilled not only with the esthetic outcome but the speed, comfort, and efficiency, at which the treatment was completed in one visit.