International Journal of Dentistry 3 Figure 4 5. Clinical Protocol 5.1. Surgical Procedure. To prepare for the execution of the treatment plan, ﬁrst a simulated gingivoplasty was per- formed on the patient cast, followed by a diagnostic wax- up. This procedure was performed so that the height of the gingival margins of the central incisors would be higher than that of the laterals and be even with the canines. The mock surgery and diagnostic wax-up were followed to help better visualize the outcome and allow for the fabri- cation of the periodontal surgical guide and for provisional. The surgical guide was fabricated utilizing a clear vacuform matrix. The patient received inﬁltration local anaesthesia extend- ing from tooth number 5 to number 12 area utilizing 2% lidocaine with 1 : 100,000 epinephrine. Intrasulcular inci- sions were made along the gingival margin from tooth num- ber 5 to number 12, and a 1 mm to 2 mm submarginal in- cision in the palatal region to expose previous prosthetic margins wherever FPDs were present, in order to facilitate restorative treatment. Interdental papillary tissues were pre- served as much as possible during incisions and ﬂap ele- vation in order to avoid compromising the papillary height. No vertical release incisions were utilized. Full-thickness facial and lingual ﬂaps were elevated to expose the underlying bone. The facial tissue was elevated beyond the mucogingival attachment. Ostectomies and osteoplasties were performed with a high-speed rotary instrument and, number 2 and number 4 carbide round burs were used as dictated by the surgical guide. A distance of 3 mm was measured from the desired gingival margin, determined by the stent (Figure 2), to the crest of bone, in order to allow for the biologic width and sulcus to be reestablished [3]. No interproximal bone was removed. Flaps were repositioned, and primary closure was achieved with interrupted and vertical mattress sutures, as described by a modiﬁcation of the “curtain procedure” [4], in order to avoid shrinkage of the interdental tissues as much as possible. 5/0 Vicryl sutures (Ethicon, Midwest Dental) were used. The patient was instructed to rinse twice a day for 14 days with a 0.12% chlorhexidine rinse and to avoid brushing the area. Ibuprofen 800 mg was prescribed for pain, 3 times a Figure 5 Figure 6 day for 5 days. Sutures were removed 14 days postsurgery. The patient received hygiene instructions, and soft tissue was permitted to heal for 8 weeks to allow for soft tissue contraction, and a secondary procedure was scheduled in order to reﬁne the level of the gingival margins precisely [5] following the contours of the wax-up by means of the same surgical guide. Local anaesthesia 2% lidocaine with 1 : 100,000 epinephrine was used in the areas of teeth number 5 to number 12, and an internal bevel gingivectomy was carried out in all areas necessary to achieve the desired gingival margin level (Figure 3). 6. Restorative Treatment Four weeks following the gingivectomy procedure, the pa- tient was scheduled to begin restorative work. At the ﬁrst appointment we planned to prepare the patients teeth, make ﬁnal impressions, and provide interim restorations utilizing the diagnostic models. The patient was anesthetized with 2% lidocaine with epinephrine 1 : 100,000 by inﬁltration. The porcelain fused to metal crown was removed from tooth number 7, a cast post was noted beneath the crown. Teeth number 6, 7, 8, 9, 10, and 11 were prepared for all ceramic crowns. The interproximal carious lesions were completely removed, and contours were restored with bonded composite