Minimally Invasive Surgical Approaches for Esthetic Implant Dentistry: A Case Report

Figure 1. Radiograph of the maxillary incisors. After the maxillary right central incisor was extracted, an implant fixture was placed. Figure 2. Six months after second-stage implant surgery, the marginal gingiva between the marginal tissues of implant and left incisor appeared to be asymmetric. Figure 3. The desired marginal line (red line) was planned based on the gingival line (blue line) and width-to-length ratio of the crown (green line).

Minimally invasive esthetic crown lengthening (MIECL) was performed at the left incisor. (a) Following administration of local anesthetic, an intrasulcular incision was made using a No. 15c scalpel blade. (b) The preoperative biologic width parameters and crestal bone position of the patient were verified using a periodontal probe. (c) A periodontal curette was inserted into the gingival crevice and extended over the osseous crest, and 1 mm of bone was resected. (d) The distance from the top of abutment to the osseous crest was confirmed using the periodontal probe. The distance increased from 11 mm to 12 mm after MIECL.

Figure 5. (a) Photograph taken before minimally invasive esthetic crown lengthening (MIECL). (b) Photograph taken immediately after MIECL was performed. (c) Photograph taken 1 month postoperatively. Figure 6. Procedure of semilunar coronally positioned flap (SCPF). (a) A semilunar incision was made along the curvature of the receded gingival margin ending 2 to 3 mm short of the tip of the papillae. (b) A partial-thickness dissection was performed coronally from the incision and connected to the sulcus. (c) The tissue collapsed coronally. It was then held in its new position for a few minutes with moist gauze. Photograph taken immediately after SCPF.

Figure 7. (a) Photograph taken 4 days after the semilunar coronally positioned flap (SCPF). (b) Photograph taken 1 month postoperatively. Note the marginal tissues framing the implant and the left incisor in a harmonious manner. Figure 8. (a) The definitive superstructure and crown restoration were installed 3 months after the SCPF. (b) Photograph taken 3 years after SCPF.