AEID layout.QXD

relies heavily on the position of the teeth and the position and architecture of the soft tissue.1-4 Often, an interdisciplinary treatment approach is needed to address the different treatment parameters and provide the most esthetic outcome. Many different treatment options for altering gingival levels have been documented in the literature.5-11 Regardless of the treatment modality selected, the correct diagnosis is paramount to the overall success of the treatment. One of the most frequently used treatment options for altering gingival levels is clinical crown lengthening. Unless the clinician restoring the teeth is also providing the surgical treatment, communication between the restorative dentist and the surgeon is imperative with regard to defining the desired tooth position and corresponding free gingival margin locations. This is ultimately accomplished as part of the treatment planning process by taking into consideration things such as the maxillary incisal edge position, tooth proportion, probing depths, and biologic width. Communicating the specific tooth position and free gingival margin location to the surgeon can be done in several ways. A diagnostic model with the appropriate diagnostic lines that define the location of the desired free gingival margin can be sent to the surgeon for reference. Using the measurements from the reference model and transferring them to the mouth during surgery is an effective form of communication. Another method of transferring the desired gingival alteration is to fabricate and use a surgical overlay guide.12 The surgical overlay guide provides the surgeon with all of the necessary information on tooth position and effectively communicates the intended surgical and restorative outcome to the patient before the surgical procedure. One of the challenges with either of these two techniques is maintaining a high level of esthetics throughout the course of treatment. While the desired tissue levels can be adequately communicated, the patient generally must wait a significant amount of time after the surgery for tissue healing and maturation before initiating provisional restorative therapy. It is during this time that the recession created by the excisional gingivectomy and osseous surgery can lack an esthetically pleasing appearance. For patients with a high smile, two treatment options exist for maintaining esthetics throughout the entire treatment. One option is to use one of the aforementioned techniques to transfer Esthetic Crown Lengthening: An Alternate Technique for Surgical Communication