Multidisciplinary Approach to Smile Restoration: Gingivoplasty, Tooth Bleaching, and Dental Re-anatomization

This article reports on the case of a patient who underwent a multidisciplinary treatment in smile design that entailed dental cosmetic techniques involving esthetic periodontal surgery, teeth bleaching, and re-anatomization of the upper incisors. The male patient presented with a chief complaint of an excessive gingival display while smiling, as well as small, darkened teeth with spaces between them. After diagnosis and patient consent, therapy began in the following stages: periodontal plastic surgery with probing, bleeding points delimitation, beveled incision, removal of the gingival band with periodontal curettes, and finishing with an electric scalpel. After 21 days following surgery, dental bleaching using a combined technique that included two sessions of in-office bleaching (35% hydrogen peroxide) and 2 weeks of at-home bleaching (carbamide peroxide 16% for 4 hours per day) was carried out, followed by dental re-anatomization using resin composite. Diagnostic waxing, mock-up, fabrication of a palatal silicone index, incremental sculpturing, and structuring the restoration of the palatal shell to the vestibular surfaces was then completed, followed by occlusal adjustment, finishing, and polishing. The multidisciplinary intervention was fundamental for the accomplishment of the proposed treatment that combined biological, functional, and esthetic concepts.