Crown Lengthening Procedures Flashcards
What is crown lengthening surgery?
Surgical procedures to expose adequate clinical crown to prevent the placement of crown margin into the area of the biologic width.
What factors should be considered before crown lengthening?
Esthetics, Length of remaining root in osseous support, Adjacent teeth, Furcation involvement, Tooth mobility after surgery, Tooth condition, Root perforation, Amount of remaining attached gingiva.
What are the types of crown lengthening?
Surgical: Gingivectomy, Flap surgery. Non-Surgical: Orthodontic procedures.
When is crown lengthening indicated?
Gummy smile with a high lip line and short clinical crown, Subgingival carious lesions, Subgingival fracture lines, To facilitate impression of subgingivally prepared tooth structure, To facilitate restorations of subgingival margins.
When is crown lengthening contraindicated?
If surgery creates an unesthetic outcome, When excessive bone removal is required, Poor tooth restorability.
What are the steps in the gingivectomy technique?
Proper anesthesia, Use of pocket marking forceps, Gingiva is pierced at the pocket bottom, Beveled incision below bleeding points (towards base of the pocket), Tissue removed with a curette, Periodontal dressing placed.
What is an apically repositioned flap?
A procedure where the entire complex of soft tissue (gingiva and alveolar mucosa) is displaced apically.
What are the steps in the apically repositioned flap technique?
- Inverse bevel incision with BP Blade 12 or 15 to follow the scalloped out line.
- Vertical releasing incisions extending into alveolar mucosa at each end points.
- A full thickness mucoperiosteal flap is raised with mucoperiosteal elevator.
- Marginal collar is removed with
curettes. - Root surface is cleaned.
- Alveolar bone crest is re contoured
- Flap is repositioned to the level of newly recontoured alveolar bone crest and secured in this position with sutures.
What are the two types of orthodontic tooth movement in crown lengthening?
Slow eruption, Rapid eruption.
What is slow eruption of teeth?
Moderate eruptive forces move the entire attachment apparatus along with the tooth.
What are the indications for slow eruption?
- When removal of attachment and bone from adjacent teeth must be avoided.
- To reduce pocket depth with angular bone defect.
What is rapid eruption of teeth?
The tooth moves coronally or out of its socket with the crestal bone and gingival margin retained at pretreatment location.
What are the indications for rapid eruption?
To maintain the gingival margin location at adjacent teeth.
What is a contraindication for rapid eruption?
Not indicated for teeth associated with angular bone defects because of further deepening of pockets.
What is biological width?
The distance established by the junctional epithelium and connective tissue attachment to the root surface of a tooth.
The distance from the crest of the bone to the base of the pocket.
What are the components of biological width?
Junctional epithelium (~0.97 mm)
Connective tissue attachment (~1.07 mm)
What is the average biological width measurement?
Approximately 2.04 mm
What is the dentogingival complex?
Sulcus, junctional epithelium and connective tissue attachment.
What is another name for biological width?
Supracrestal tissue attachment
What happens if biological width is violated?
Inflammation & CAL
What are the different crown lengthening surgical procedures?
- Gingivectomy
- Apically repositioned Mucogingival flaps
- Ostectomy
- Non surgical procedures
- Orthodontic procedures
What are the esthetic complications of crown lengthening, especially in anterior teeth?
Improper contour, Loss of papilla, Open interdental space, Longer crown than adjacent teeth
What are the functional complications of crown lengthening?
Improper crown-root ratio, loss of periodontal ligament (PDL) and bone of adjacent teeth, not enough bone for future implants.
What surgical complications can occur during or after crown lengthening?
Prolonged bleeding, Risk of infection
