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Crown lengthening- Review Flashcards

1
Q

Only category in which gingivectomy alone is successful:

A

unstable low crest

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2
Q
A
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3
Q
A
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4
Q

Only category in which gingivectomy alone is successful:

A

Unstable low crest

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5
Q

List the objectives to crown lengthening:

A
  1. to allow for restoration of tooth (caries removal, clamp placement)
  2. increasing crown length for retention or restoration
  3. restoration of tooth in harmony with supracrestal attached tissue (biologic width)
  4. esthetics via alteration of the gingival labial profile
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6
Q

Functional indications for crown lengthening include: (4)

A
  1. subgingival restorative margins
  2. tooth fracture
  3. endo performations
  4. cervical root resorption
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7
Q

Esthetic indications of crown lengthening: (1)

A
  1. excessive gingival display
  2. gingival overgrowth (meds)
  3. altered passive eruption
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8
Q

List the components of the supracrestal attached tissue (biologic width):

A

CT attachment (1.07mm) + JE (0.97mm) = 2.04mm

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9
Q

T/F: Epithelium gets its blood supply and nutrients from the underlying connective tissue

A

True

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10
Q

What is the most consistent dimension of the suprarenal attachment?

Most variable dimension?

A

Consistent= CT attachment 1.07 mm

Variable = JE 0.97 mm

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11
Q

Vertical axial wall that surrounds the tooth that is desired everytime a crown is fabricated to help resist fracture and/or crown displacement:

A

Ferrule

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12
Q

T/F: You need atleast 1mm of ferrule (natural tooth structure) circumferentially beyond the core

A

False- you need atleast 2 mm of ferule

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13
Q

What bur is used for osteoPLASTY:

A

Large round bur

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14
Q

What bur is used for ostECTOMY:

A

End cutting bur

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15
Q

Before beginning a crown lengthening procedure, tooth should ideally be:

A

caries free & provisionalized

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16
Q

T/F: Before begining the crown lengthening procedure, the tooth should ideally be caries free AND provisonalized

A

True

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17
Q

Witha crown lenghtening procedure, ostectomy is generally only required on the _____

A

Facial

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18
Q

At end of crown lengthening procedure, a well-fitting temporary crown should be placed back on the tooth to prevent:

A

migration

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19
Q

When should the final restoration be placed following crown lengthening procedure?

A

minimum of 6 weeks to 6 months

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20
Q

T/F: If in doubt, following a crown lengthening procedure, a good rule of thumb is to wait 1-6 months before final restoration placement

A

False: 3-6 months

(6 weeks to 6 months)

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21
Q

CEJ should be approximately ____ mm from osseous crest

A

2mm

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22
Q

The _____ should be approximately 2mm from osseous crest

A

CEJ

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23
Q

The gingival margin should be ____ coronal to the CEJ (covering anatomic crown)

A

0.5-2mm

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24
Q

The _____ should be 0.5-2mm ______to the CEJ (covering the anatomic crown)

A

Gingival margin; coronal

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25
Q

As tooth breaks through gingiva, it erupts until it meets its antagonist and occludes & then ceases or slows, this is referred to as:

A

active eruption

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26
Q

T/F: Eruption potential continues throughout life (think supraeruption of tooth that has no opposing tooth)

A

True

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27
Q
  • Shift of tooth itself (no gingival movement)
  • as tooth breaks through gingiva, it erupts until it meets antagonist and occludes, then eruption ceases/slows
    -eruption POTENTIAL continues throughout life (think supraeruption with a tooth lacking an antagonist)
A

Active eruption

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28
Q

Morphological variant where CEJ is LESS than 2 mm from the osseous crest:

A

Altered active eruption

29
Q

Altered active eruption can result in ____ and be exacerbated by ____

A

shorter than normal clinical crown; orthodontic brackets

30
Q

Apical shift of dentogingival junction (gingival movement not tooth):

A

Passive eruption

31
Q

(T/F): Passive eruption occurs during and active eruption

32
Q

Eruption in which the tooth does not move, rather the gingiva move apically:

A

Passive eruption

33
Q

When direction does the gingiva move in passive eruption:

34
Q

List the stages of passive eruption:

A
  1. JE rests on enamel surface
  2. JE rests on enamel & cemental surface apical to CEJ
  3. Epithelium attachment rests on cementum
  4. Epithelial attachment migrates apically
35
Q

Normal passive eruption concludes when:

A

sulcus base is at level of CEJ, placing the gingival margin 1-2mm coronal to the CEJ

36
Q

When passive eruption does not progress past stages 1 or 2 (seen in about 12% of adult population):

A

Altered passive eruption

37
Q

Altered passive eruption is seen in about ___ % of adult patients

38
Q

Morphological variant where gingiva is more than 2mm coronal to the CEJ:

A

Altered passive eruption

39
Q

Altered passive eruption can be exacerbated by:

A

Inflammation & mediation

40
Q

Altered active eruption can be exacerbated by:

A

Orthodontic brackets

41
Q

Kois categories for supracrestal tissue attachment include:

A

Normal crest (85%)
High crest (2%)
Low crest (13%)

42
Q

Low crest can further be categorized as:

A

stable vs. unstable

43
Q

Provide the kois category for the following situation:

Bone sounding 3mm from gingival crest to alveolar crest in midfacial

3-4.5mm from gingival crest to alveolar crest at line angles:

A

Normal (85%)

44
Q

Provide the kois category for the following situation:

Bone sounding of less than 3mm from alveolar crest midfacial

Less than 3mm from gingival crest to alveolar crest at line angles:

45
Q

Provide the kois category for the following situation:

Bone sounding of greater than 3mm from gingival crest to alveolar crest midfacial

More than 4.5mm from gingival crest to alveolar crest at line angles

Sulcus must be probed in order to determine sulcus depth in addition to bone sounding:

A

Low crest (13%) (stable vs. unstable)

46
Q

Provide the kois category for the following situation:

  • Normal attachment apparatus (approximately 2mm)
    -Greater than normal sulcus depth
    -Prone to recession due to the deeper sulcus depth and unsupported gingival crest
    -Only category in which a gingivectomy alone is successful
A

UNSTABLE low crest

47
Q

T/F: In an unstable low crest, there is a greater than normal sulcus depth

48
Q

Provide the kois category for the following situation:

-Normal sulcus depth
-Longer than normal attachment apparatus
-Susceptible to gingival rebound after crown lengthening due to inadequate ostectomy to accommodate the longer attachment apparatus

A

Stable low crest

49
Q

What type of low crest is more susceptible to gingival rebound following crown lengthening:

A

stable low crest

50
Q

What would be the indications for gingivectomy only:

A

Unstable low crest

51
Q

Describe a clincially esthetic smile:

A
  1. shows 75-100% of crowns and interproximal gingival (papilla)
  2. symmetrical display and harmony between the maxillary gingival line and the upper lip
  3. lower lip parallel to incisal edges of maxillary teeth and in close approximation
52
Q

In an esthetic smile, there should be parallelism between the _____ and _____ to create facial harmony

A

Interpupillary line & commisural line

53
Q

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

A

smile line

54
Q

List the normal variation & minimum normal value of the following teeth to have an esthetic smile:

A) Central
B) Lateral
C) Canine

A

A) Central= 11-13 (10)
B) Lateral = 10 (9)
C) Canine= 11-13 (10)

55
Q

T/F: To accomplish an esthetic smile, the central incisors and lateral incisors should be in the range of 11-13mm

A

False- laterals should be 10mm (minumum of 9) while centrals and canines should be 11-13 (minimum of 10)

56
Q

The preferred anatomical crown width-to-height ratio:

Acceptanble range:

A

78%

Acceptable: 66-80%

57
Q

The width of the central incisor should be ____% wider than the lateral icisor

58
Q

The width of the lateral incisor should be ____% wider than the mesial aspect of the canine 60%

59
Q

If assigned a value of 1.0 to the lateral incisor, the central incisor would = ____ while the mesial aspect of the canine would = ____

A

CI= 1.6x
Canine= 0.6x

60
Q

List the gingiva ZENITH of the following teeth:

Centrals:
Laterals:
Canines:

A

Centrals: 1mm distal to midline
Laterals: 0.3mm distal to midline
Canines: centered MD

61
Q

The gingival margin of the central and canine should be:

A

on the SAME line

62
Q

The gingival margin of the lateral incisor should be:

A

0.5-1mm CORONAL to the central and canine

63
Q

To help determine classification and treatment of an esthetic smile:

A
  1. perform detail smile analysis (axium)
  2. look at amount and location of keratinized tissue
  3. evaluate location of supporting bone (radiographs & or bone sounding under local anesthetics)
  4. understand where CEJ is located
  5. understand the clinical vs. anatomic size of teeth (radiographs)
64
Q

List the criteria that must be met to diagnose altered passive eruption: (2)

A
  1. the tooth is short by measurement
  2. the CEJ can not be detected in the sulcus with the tip of the explorer
65
Q

Treatment goals for passive eruption smile:

A
  1. thin & move alveolar bone 2mm apical to CEJ from facial line angle to facial line angle
  2. position the gingival crest 3mm coronal to the new alveolar crest position
  3. level the tissue at the new position
66
Q

When surgically treating passive eruption, ____ incisions are used

These incisions extend to ____ most of the time

A

sulcular; mesial of second molar

67
Q

Give post-op instructions for crown lengthening:

A
  1. no brushing teeth for 4 days
  2. no brushing maxillary teeth for 2 weeks
  3. rinse BID with antimicrobial rinse
  4. do not activate lower lip (kissing, straws, etc.)

Perio II (12 decks)

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