مريضة من إنجلترا: علاج الابتسامة اللثوية على مراحل، لأن الصبر جزء من العلاج

Case summary

Adult female living abroad (UK). Gummy smile and relatively deep bite. Previous treatment: laser gingivectomy only, then crowns with margins placed deep subgingivally. Presentation: marked gingival inflammation around the crowns and missing teeth.

Diagnosis

Soft-tissue removal without addressing the bone led to tissue rebound; deep margins encroaching on the supracrestal tissue attachment caused chronic inflammation.

Treatment

• Phase 1 (2024): surgical crown lengthening with osseous resection and soft-tissue management; implant placement; root canal treatment where needed; provisional restorations.
• Phase 2 (about 1.5 years later): removal of the old crowns, core build-ups, conversion from horizontal to vertical preparation, new anterior crowns.
• Pending: lower anterior teeth and premolars.

Treated as one plan

Gummy smile, smile line, deep bite, soft tissue, bone, implants, endodontics, prosthetic design and occlusion were addressed as one comprehensive treatment plan rather than as separate procedures.

Laboratory

Abdelhalim Faris: vertical preparation and characterization.

Take-home message

If you came to place an implant, don't look at the implant alone. If you came to make crowns, don't look at the crowns alone. And with patients who travel, stage the treatment instead of rushing it.