Crown Lengthening

Question 1

Indications

Answer 1

• excessive gingival display/ lack of gingival line symmetry

- exposure of sound tooth structure for restoration

Question 2

Contraindications to esthetics crown lengthening

Answer 2

• problem is hypermobile lip

- problem is skeletal- vertical maxillary excess

Question 3

Altered Passive Eruption

Answer 3

Anatomical crown insufficiently exposed during development- can cause asymmetry

Question 4

Ant Esthetic Considerations

Answer 4

Facial symmetry
interpupillary line
smile line
dental midline
gingival display
harmony of gingival margins
gingival margins relative to CEJs
tooth size/proportions
incisal/occlusal plane

Question 5

Ideal Gingival form

Answer 5

Laterals 0.5 coronal to centrals and canines - and lips come to ging lines of centrals and canines

Question 6

Biologic Width Consists Of:

Answer 6

Epithelial attachment and CT attachment

Question 7

Bio Width Avg Dimension

Answer 7

2.04 mm

Question 8

Dentogingival Complex Consists of:

Answer 8

Gingival sulcus, Epithelial attachment, and CT attachment

Question 9

Problems with Invading Bio Width with Restorations

Answer 9

Ging recession, or chronic inflammation

Question 10

Optimal Distances

Answer 10

From Ging Margin to Alv Crest- 3 mm

From sound tooth structure to alv crest- at least 4mm- or between 3-5.25 mm

Question 11

Approaches to Crown Lengthening

Answer 11

Gingivectomy
Apically positioned flap no osseous resection
Apically positioned flap w/ osseous resection

Question 12

Gingivectomy External

Answer 12

Leaves open wound that must heal secondarily
Indications: adequate keratinized tissue, adequate bio width after surgery
Contraindications: inadequate keratinized tissue, bio width invasion

Question 13

Electro-cautery - Uses

Answer 13

• Only for removing soft tissue that interferes w/ impressions
• Contraindications- if encroaches on bio width–> bone necrosis

Question 14

Gingivectomy Internal

Answer 14

• Scalloped
• Removes tissue w/out exposing wound during healing
• Indications: adequate keratinized tissue, adequate bio width after surgery
• Contraindications: Inadequate keratinized tissue, bio width invasion

Question 15

Apically Positioned Flap W/Out Osseous Resection

Answer 15

• Preserves keratinized tissue- but it may rebound if dont have bio width

Question 16

Apically Positioned Flap W/ Osseous Resection

Answer 16

• For when osseous resection needed to establish bio width

- Prevents Gingival rebound, maintains integrity of attachment apparatus

Question 17

Two Options for Lengthening w/ Osseous Surgery

Answer 17

• Submarginal incisions- if adequate keratinized tissue

- Sulcular incisions and apical positioning- if limited keratinized tissue

Question 18

Anterior Esthetics Golden Proportions

Answer 18

Width to length = 0.8

From frontal = 0.618 from centrals to laterals, from laterals to canines, etc

Question 19

Time to wait after Crown Lengthening for Restoration

Answer 19

At least 6 weeks

- if insufficient osseous surgery, tissues will rebound