Multidisciplinary approach for aesthetic rehabilitation in gummy smile and fluorosis: a case report

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Background: Teeth, gingiva and lips are the three interrelated primary components in aesthetic dentistry. These combinations warrant a multidisciplinary approach for planning and predictable treatment outcome. Objective: The aim of this article is to describe the multidisciplinary approach for aesthetic rehabilitation involving gingivectomy and minimally invasive tooth preparation with porcelain laminate veneer (PLV) restorations and resin bonded bridge. Case: A 25-year-old female patient attended with existing space between maxillary anterior teeth post orthodontic treatment and missing mandibular anterior teeth. Intraorally, patient had uneven interdental spacing in between 13 to 23, missing 31 and 32, with merging and irregular opacities suggestive of enamel fluorosis appearance. The zenith lines were asymmetrical with short clinical crowns and disharmonious teeth axes. To optimize the aesthetic outcome and overall smile appearance, gingivectomy was performed after confirmation of biologic width. Eight weeks after healing, PLV restorations were delivered from 13 to 23, and zirconia resin bonded bridge were used to restore missing mandibular lateral incisors. Conclusion: The present case illustrates the sequential and predictable approach for management of gummy smile and fluorosis. An alternative treatment modality such as electrocautery may enhanced the smile and obtain positive outcome.