Using A Nd:YAG Soft-tissue Laser for Crown Lengthening By: Jeffrey P. Cranska, DDS

Recently I had a new patient who presented with #7 fractured at the gingiva. The patient was a recently laid-off flight attendant whose smile was very important for future job interviews. In addition, the patient was anxious to have the problem taken care of because he was leaving within a week for a vacation in the Florida Keys.

The following details outline how I helped this patient in one appointment doing a soft-tissue crown lengthening with my laser, a core build-up and taking the final impression for a Captek crown and temporary.

PHOTO 1: Pre-treatment photo. A free running, pulsed Nd:YAG laser (PerioLase) with a contact fiber tip will be used to cosmetically contour the facial gingiva, expose solid tooth structure, and trough the gingival sulcus for a cordless impression. Core buildup was done with a Flexi-Flange #1, 3M Single Bond Adhesive, 3M RelyX ARC (resin cement) and Lee Core paste (Prosthodent Crown Paste tinted natural). Caries on the mesial of canine restored with EsthetX light cured composite.

PHOTO 2: Immediate post-lase. Laser parameters 3.0 Watts 20 Hertz 110 usec. Note: no bleeding, no scalpel, no sutures, no charring, no impressiom cords, no hemostatic agents. Impression with Impergum Penta Soft, Anterior triple tray. Temporized with 3M ion polycabonate crown, lined with Jet acrylic, cemented with TempBond NE, then dismissed patient. Only prescpriptions were warm saline rinses and Motrin 800 for inflammation.

PHOTO 3: One week later at crown insertion. Captek crown was cemented with 3M Vitremer Luting Cement.

I like the biocompatibilty of gold, in this case I needed ultimate ethetics to match the natural teeth. Captek allows for a minimal thickness, reinforced gold substrate, porcelain margins for ethetics and strength for durability.

Thanks to Marvin Stockett, CDT, and First Choice Dental Studio, Millersville, MD for my Captek crown.

PHOTO 4: One month post-surgery. Observe complete healing, no inflamation, proper gingival contours. Note: no shrinkage or recession of gingiva.

The Nd:YAG laser is still the instrument of choice for soft-tissue procedures. With Diodes or electrosurges you need to let the burns heal before gingival healing can occur and final height of contour can be established. Erbium lasers don't coagulate. Everyday I wonder what I did in the old days before lasers.

Jeffrey P. Cranska, DDS, graduated from the University of Maryland, School of Dentistry in 1979 and has maintained a Family Practice in Annapolis/Arnold, MD since.

He was certified as a laser dentist in 1999 on an Nd:YAG and earned the Academy of Laser Dentistry Advanced Proficiency Dental Laser Certification in 2001. Dr. Cranska is a clinical consultant for Millennium Dental Technologies, Inc. His website can be viewed at www.Cranska.com. He can be contacted by phone at (410) 757-4644 or by email at DrCranska@Cranska.com.

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Townie Comment on Dr. Jeffrey Cranska’s Clinical Presentation

glennvanas

7/19/2002 9:12:04 PM

Great case, very well done. I like how you used the Nd:YAG for the case. I presently have used the diode and an old argon laser and would beg to differ in your description of “burns” needing to heal. The 980 Biolitec laser leaves very little charring and even the 810 lasers used with an initiated tip at the proper wattage can leave very little “burn”. The Nd:YAG is a good laser with a proven track record but please don’t discount the newer laser wavelengths. I do own an erbium laser and use it for a lot of soft tissue where it cuts very fast but as you say in many cases there is more difficulty in obtaining hemostasis. Thanks for the nice case. If you would like to add your own question/comment on this case, go to DentalTown.com’s homepage, look under Townie Talk (on the right side of the screen) and click on Today’s Active Cases. In the Keyword box type in Laser Crown Lengthening. Then, click on the DT Member Name benchwmer.

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