This 32 year old female presented to my practice with the primary concern that her gingival tissue above her anterior bridge bleeds and is very inflamed. The bridge is approximately 5 years old and has appeared this way ever since it was delivered. The bridge is a 3 unit FPD spanning #8-9-10. The sulcus around the inflamed tissue probes 3 mm and the bridge extends subgingivally approx 1.5-2 mm. The patient is open to all options and is looking to 1. resolve the inflammation and 2. improve the esthetics. She does not show the facial margins whenshe smiles however I can't get myself to just correct the biologic width violation, thus making the teeth even longer!

My initial thoughts are to section the bridge, and orthodontically extrude #8/10 using #6/7/11 as a reference for the future gingival tissue.

1. WIth this much extrusion I am assuming that Endo may become part of the treatment plan?

2. Can you extrude the teeth (#8/10) fast enough where the gingiva and bone does not follow (this would only be to correct the biologic width violation) and possibly be used in combination with ortho to also extrude the gingiva and bone.

3. Soft tissue graft to change the tissue height on #9 pontic area?

4. Any thoughts as to the etiology of why #11/22 would have so much incisal edge to edge wear?

What other tx options are available? Any thoughts would be appreciated in the early stages of treatment planning. Thanks...

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