Periodontal surgical considerations for esthetics Flashcards
The essentials of a smile involve:
(3)
- The teeth
- The gingival scaffold
- The lip framework
Minimal gingival exposure
(3)
Display of 75-100% of the crowns and all interproximal tissue
Symmetric display and harmony between the maxillary gingival line and the
upper lip
Lower lip parallel to the incisal edges of the maxillary teeth and in close
approximation
Ideal gingival contours
Zenith position
Centrals:
Laterals:
Canines:
1 mm distal to midline
0.3 mm distal to midline, 1 mm coronal to centrals and canines
centered M-D
Crown lengthening definition
a surgical procedure designed to increase the extendt of supragingival tooth structure for restorative or esthetic purposes by apically positioning the gingival margin, removing supporting bone, or both. may be accomplished by ortho tooth movement
Indications for
Crown
Lengthening
Esthetic Crown Lengthening
(3)
- Excessive gingival display
- Gingival overgrowth
- Altered passive eruption
Indications for
Crown
Lengthening
Functional Crown Lengthening
(4)
- Subgingival restorative margins
- Tooth fracture
- Endo perforations
- Cervical root resoprtion
Periodontal considerations
(3)
Width and thickness of keratinized tissue
Location of CEJ in relation to attachment
level
Gingival health
Active eruption:
eruption of tooth through bone and
soft tissue into occlusion with opposing tooth
Passive eruption:
apical migration of dentogingival
complex following the completion of active eruption
Normally concludes when sulcus depth is at the
level of the CEJ, placing the gingival margin 1-2 mm
coronal to the CEJ
Contraindications
for Crown
Lengthening
(6)
- Removal of supporting bone
- Furcation exposure
- Aesthetic concerns
- Anatomic landmarks
- Poor oral hygiene
- Medical considerations
GINGIVECTOMY
Definition:
The excision of a portion of the
gingiva; usually performed to reduce the soft
tissue wall of a periodontal pocket
GINGIVECTOMY
INDICATIONS
(2)
Elimination of suprabony pockets
Elimination of gingival enlargements
GINGIVECTOMY
CONTRAINDICATIONS
(3)
- The need for bone surgery.
- Bottom of the pocket is apical to the mucogingival junction
Esthetic considerations
Prior to consultation:
3 Steps
Step 1: Most important thing: Make sure tooth is RESTORABLE.
Step 2: When an inadequate restoration exists and/or decay is present, they
should be removed before consultation.
Step 3: Take another PA after Step 2 is completed
Prior to surgery:
(2)
If endodontic treatment is indicated and tooth can be properly isolated, root
canal therapy should be completed prior to the surgery.
A proper provisional restoration should be fabricated
