After adding the Waterlase, Dr. Eshom began using a technique he calls "closed-flap" crown lengthening to shave and contour bone tissue to achieve biologic width without laying a soft tissue flap. His innovative technique is featured in the clinical case below.

Dr. David Eshom graduated from the University of Pacific School of Dentistry in 1985. He is a member of the American Academy of Cosmetic Dentistry, Southwest Chapter AACD, American Dental Association, California Dental Association, San Diego County Dental Association, Paul Revere Study Club and West Coast Society for Cosmetic Dentistry. Dr. Eshom has presented on the topic of high-tech dentistry, laser dentistry, bleaching, and lasers for more than four years. He is the chairman and founder of “Kids in the Klinic”, a fund-raising golf tournament, benefits underprivileged children in pediatric clinic at U.O.P. Dental School. The foundation has raised over $100,000 over the last three years According to Dr. Eshom, "The Waterlase® is a remarkable tool in my practice. Time and time again, I’ve been so impressed with its clinical capabilities from cutting soft tissue, enamel – even bone. The results are excellent for the patient, and my patients have never been happier.”

Dr. Eshom noticed that many treatment plans and patients that required bony crown lengthening were getting lost in what Dr. Eshom calls “the periodontal penalty box.” Because osseous crown lengthening procedures require a visit to the periodontist and 6-8 weeks of healing time, quite often, the treatment plans would never be completed.

Dr. Eshom elected to use the Waterlase® all-tissue dental laser to perform an innovative procedure known as “closed flap crown lengthening.”

	Fig. 1. Pre-op view. The patient desired a gum lift for smile enhancement. However, Dr. Eshom was concerned that by trimming away soft tissue, there would not be enough biologic width between the newly trimmed gingival zenith and the underlying bone, which would result in irritated, inflamed gum tissue. Some crestal bone beneath the gums would need to be contoured to ensure adequate biologic width.
	Fig 2. Because the Waterlase MD has very atraumatic soft tissue settings, Dr. Eshom first used the laser to mark the gum tissue that would be removed, without damaging any underlying tissue.
	Fig 3. Immediately after trimming the gum tissue, Dr. Eshom used an explorer to lightly remove the tissue. Note the lack of bleeding, swelling, or charring around the incision.
	Fig 4. After trimming the gums, Dr. Eshom used the Waterlase to contour the crestal bone beneath the gums -- remember, any time a soft tissue crown lengthening is performed, it is critical to ensure that biologic width is adequate to prevent irritation of the gums. Dr. Eshom accomplished the bony crown lengthening using a "closed flap" technique, meaning he shaved and contoured the bone without cutting away the gums, lifting a flap, or suturing.
	Fig. 5. Immediately post-op, the bone has been shaved and contoured to an adequate level. Dr. Eshom tested the integrity of the bone crest by sounding for bone with a periodontal probe.

Sincerely,
L. Lang
San Diego, California

To learn more about these types of innovative applications made possible by the Waterlase, be sure to sign up for a World Clinical Laser Institute symposium, or contact BIOLASE directly at 888-424-6527, or online by clicking here.

Some of the clinical images, claims, descriptions, and steps listed here represent the judgment and decisions made by the clinician(s) who conducted this procedure. BIOLASE, its employees, and the U.S. Food and Drug Administration do not necessarily endorse or support any procedural claims listed hereon. Also, some of the components, steps, or items used to perform the procedure may be the intellectual property of the clincian(s) Actual results in a clinical setting may vary. If you have any questions, lease contact BIOLASE for more information.