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Crown Lengthening #9 by Solea Laser

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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.

Solea Advantage:

  • 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.


How long after surgery is the final picture? Looks great!


Big fan of lasers but I would guess this case is soft tissue only. I believe this should be the first step and when successful... great! If a gingivectomy doesn’t work, Flap and crown lengthen doesn’t take long. I’m opposed to closed flap boney recontouring due to lack of predictability.


The SonicFlex from KaVo offers an instrument that allows crown lenthening without incisions, too.


Katherine.....how do you ensure that you are not damaging the root surface? Can the laser differentiate root from bone?


David,

I don't know if the Solea laser has a handpiece that accepts tips that can be placed in a handpiece to precisely direct the CO2 laser beam on the alveolar bone or if it has only a tipless handpiece.  I do know that the CO2 laser beam is very tightly columnated and can be very precisely directed on the alveolar bone, without hitting the root surface, provided the operator's hand is very steady.  This case is unquestionably a very beautiful result without the hassle of laying a flap, grinding away the bone with a handpiece, and placing sutures. 

This procedure can also be performed just as well, and maybe better, with one of the erbium lasers with which I am familiar, either the Fotona Lightwalker laser or the Biolase Waterlase.  When this procedure is performed with an erbium laser the laser energy is columnated and delivered directly to the alveolar bone via a saphire tip.  The saphire tip is a straight saphire rod which functions much like a bur but without the mechanical vibration or noise.  The tip is held essentially parallel to the tooth surface, thus avoiding damage to the root.  If the Solea laser has a tipped handpiece, it would work as well as an erbium laser for this procedure. 

I have seen the Solea demonstrated at DS World with a tipless handpiece and I am very impressed with the very sharp cut it makes in soft tissue.  There is no bleeding and it is essentially painless.  But I have a difficult time believing that the tipless handpiece is as safe to use next to a tooth root as a tipped handpiece although if the operator has a very steady hand I can see that it is possible. 

I do not understand why the Solea is being aggressively promoted on this website unless Dentsply Sirona has a financial interest in the company or Solea is paying for the promotion.  Why is this thread designated as a Blog Post?  The Solea laser is a very good product but it is not clearly superior to one of the Erbium lasers.  In fact, the Erbium lasers can do some things that a CO2 laser cannot do, especially enhancing root canal irrigation and the Nightlase and Smoothlase functions of the Lightwalker.  I have listed these things in the past.  Therefore the Erbium lasers are more versatile than the CO2 lasers and the choice of which laser to buy comes down to what the dentist wants to do with the laser and what the dentist's state dental practice act allows.  I have posted enough.

 


Another option is to move the tooth orthodontically, with alignersn (or brackets) then veneer, then no surgery


I totally agree with Dr. Chuck.

I've been doing these kinds of procedures even with my "white box" Biolase years and years ago although my newer version is easier with the disposable tips.

I routinely have it ready to go throughout the day.  From hemostasis with the iLase diode laser on the top of the unit or the Biolase Waterlase for more invasive procedures, the tipped laser handpiece has more control.  They do have a turbo tip/handpiece but I never used it much and although it doesn't cut as fast or precise as the Solea, but it can prep teeth.

Since I've owned my new Biolase, I've never used a scalpel since.  It cuts tissue well, controls bleeding and it heals much faster and nicer than a typical "slice".

 


https://youtu.be/9FKfyJq6FoE


I would rather use a laser than an ultrasonic chisel or file system. But I would rather use the ultrasonic system in the video than reflect a flap and use a handpiece and a bur.


I would use the scalpel for the exact incision, SONICflex for the bone reduction 2-3 mm below the edge and my diode laser for reducing the bleeding and a little conturing.

 (In the absence of a Solea laser 🙂).