It is the vertical axial wall that surrounds the tooth

As tooth breaks through gingiva Erupts until it meets its antagonist and occludes, then eruption ceases/slows Eruption POTENTIAL continues throughout life (think supraeruption of tooth that has no opposing tooth)

Crown lengthening Flashcards by sophie rosen

Indications for Crown Lengthening
Functional
(4)

Subgingival restorative margins
Tooth fracture
Endodontic perforations
Cervical root resorption

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Indications for Crown Lengthening
Esthetic
(3)

Excessive gingival display
Gingival overgrowth (meds)
Altered passive eruption

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Components of
Supracrestal Attached
Tissue (formerly Biologic
Width)
Connective Tissue Attachment
(2)
Junctional Epithelium
(2)
Added together =

Most consistent dimension
avg., 1.07 mm
Most variable dimension
avg., 0.97 mm

2.04 mm

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Crown Lengthening Indications
* To allow for —
* Increasing crown length for —
* Restoration of tooth in harmony with —
* Esthetics via alteration of the —

restoration of tooth (Caries removal, clamp placement)
retention of restoration (adequate ferrule)
supracrestal attached tissue (biologic width)
gingival labial profile

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What is Ferrule?

It is the vertical axial wall that
surrounds the tooth

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Ferrule
* Desired every time a crown is
fabricated to help —
* Need at least – mm of ferrule
(natural tooth structure)
circumferentially, beyond the
core

resist
fracture &/or crown
displacement
2

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Considerations and Limitations
* Is tooth actually restorable?
* May need — to determine
* PLEASE ensure …

O&R
caries free before crown lengthening consult as may not be restorable

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Considerations and Limitations
Is tooth strategically important?
(2)

Opposing tooth
Position in arch

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Considerations and Limitations
Prognosis
(5)

Amount of tooth remaining in supporting bone
Furcations
Mobility
Esthetic concerns
Thick or Thin Phenotype (or needs conversion?)

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**At end of
procedure
place well
fitting
temporary
back on
tooth to
prevent
–

tooth
migration

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Final Restoration placement
* Variations between (time), but NOT —
* Bragger and Sonick - 6 weeks
* Bragger, Lanning - 3-6 months
* Lee - 3-6 months
* Pontoriero - 6 months

6 weeks and 6 months
sooner

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If in doubt, provisionalize (well) and hold for — before final
restoration

3-6 months

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IDEAL scenario
In Health
* CEJ should be approximately – mm from osseous crest
* Gingival margin should be – mm coronal to the CEJ (i.e.,
covering anatomic crown)

2
0.5-2.0

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Active eruption
(3)

As tooth breaks through gingiva
Erupts until it meets its antagonist and occludes, then eruption
ceases/slows
Eruption POTENTIAL continues throughout life (think supraeruption
of tooth that has no opposing tooth)

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Passive eruption (Ainamo and Loe 1966)
* Apical shift of Dentinogingival junction
(2)

Occurs during and after active eruption
Tooth does not move, gingiva does (apically)

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Passive eruption (Ainamo and Loe 1966)
Stages
(4)

Junctional epithelium (JE) rests on enamel surface
JE rests on enamel and cemental surface apical to CEJ
Epithelial attachment rests on cementum
Epithelial attachment migrates apically

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Normally concludes when sulcus base is at level of CEJ placing the gingival
margin – mm coronal to the CEJ

1-2

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Altered Passive Eruption
* When …
* Frequency is about –% in adult population

eruption does not progress past Stage 1 or 2 it is termed Altered
Passive Eruption.
12

Altered Eruption (diagnosis)
includes Excessive Gingival Display aka ‘the Gummy Smile’
Altered Active
(2)

Morphologic variant where CEJ
is less than 2mm from osseous
crest
Can be exacerbated by
orthodontic brackets

Altered Eruption (diagnosis)
includes Excessive Gingival Display aka ‘the Gummy Smile’
Altered Passive
(2)

Morphological variant where
gingiva is more than 2mm
coronal to CEJ
Can be exacerbated by
inflammation, medications

Skipped
Classification and Treatment
Type 1 A: Adequate KG; MGJ apical to osseous crest; adequate
distance from CEJ to bone crest

Gingivectomy

Skipped
Classification and Treatment
Type 1 B: Adequate KG; MGJ apical to osseous crest BUT
osseous crest at CEJ

Gingival scallop with Internal bevel then ostectomy
with unchanged flap position

Skipped
Classification and Treatment
Type II A: Inadequate KG; MGJ at or coronal to osseous crest

Apically Positioned flap (don’t want to remove any KG)

Skipped
Classification and Treatment
Type II B: Inadequate KG; MGJ at or coronal to osseous crest
AND osseous crest at CEJ

Apically Positioned Flap with Ostectomy

What are the components of an appealing smile? (What is the ‘perfect’ smile??) (5)

* Teeth * Gingival scaffold * Lip framework * Skeletal profile * The eyes

* Teeth

* Size, shape and position

* Gingival scaffold

* Health and contour

* Lip framework

* Shape, length and mobility

* Skeletal profile

* Maxillary excess (may require oral surgery intervention)

Clinically * Show ---% of crowns and interproximal gingiva * Symmetrical display and harmony between the (2) * Lower lip parallel to the ...

75%-100 maxillary gingival line and the upper lip incisal edges of maxillary teeth and in close approximation

Smile Line

* Position of the upper lip relative to the maxillary incisors and gingiva during a natural full smile

Normal Anterior Tooth Length* Tooth Normal variation (mm) Minimum ‘normal’ (mm) Central Lateral Canine

11-13 10 10 9 11-13 10

Preferred anatomical crown width to height ratio is --% * Acceptable range --% * Regardless of (2)

78 66%-80 race or gender

* Central Incisor Width---% wider than the lateral incisor * Lateral incisor Width- --% wider than the mesial portion of the canine

60 60

If assign a value of -- to lateral incisor, then in anterior view * Central incisor would be -- x width of lateral incisor * Canine would be -- x width of lateral incisor

1.0 1.6 0.6

Esthetic Smile Gingival Zenith * Centrals- --- mm distal to midline * Laterals- --- mm distal to midline * Canines- centered --

1 0.3 M-D

Gingival Margin * Central and canine ON --- * Lateral -- mm CORONAL to central and canine

SAME LINE 0.5

To help determine classification and treatment * Perform detailed --- * Look at amount and location of --- * Evaluate location of supporting bone using (2) * Understand where the --- is located * Understand the Clinical vs Anatomic --- of the teeth (radiographs)

Smile Analysis (Esthetic Analysis Form available on AxiUm) keratinized tissue * radiographs &/or * bone sounding (under LA) CEJ size

To determine treatment * Diagnostic radiographs (3)

* Anatomic vs. clinical crowns * Location of CEJ * Location of osseous crest

To determine treatment * Assess probing depths (2)

* Location of CEJ * Location of osseous crest

To determine treatment * Keratinized tissue * Assess quantity (2)

* Thick, normal or thin * Narrow or wide

Skipped Smile Analysis for DDS (3)

* Refer to Operative III Course this semester specifically Sept 9th lecture (Dr. Seabaugh) * Additional Info-Lecture on Elements of Smile Design (Dr. Leal in Advanced Pros) * Esthetic Analysis Form and Instructions on AxiUm (updated Sept 2022 )