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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
UCLA SCHOOL OF DENTISTRY
PresentsPresentsDr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics
E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S.
Tarrson Family Endowed Chair in Periodontics.
Professor and Chairman Division of Associated Clinical Specialties
UCLA School of Dentistry
ESTHETIC SURGICAL PROCEDURES FORCROWN LENGTHENING
1. Gingivectomy
2. Flap surgery for osseous recontouring
Choice depends on
Gingival crevice depth
Need to maintain minimum of 1 mm connective tissue between depth of crevice and bone
Adequate width of Keratinized gingiva
Need minimum of one millimeter connective tissue coronal to bone margin
Gingival margin will be two millimeters coronal to this with 2 mm crevice depth.
•Red line- Gingival margin.Pink area connective tissue.Black line probe to depth of crevice.
Distance of gingival margin to bone on labial is 3mm.Two mm of this is crevice depth, and 1mm. is for connective tissue
between probable depth and crest of bone.
2mm
1mm.
Five millimeters of crevice depth with adequate band of Keratinized tissue
Gingivectomy can be used to increase crown length by up to 3 mm
Advantages of Gingivectomy
Precise control of gingival contours
Low risk of inadvertent necrosis of tissue during healing
Advantages of Flap Procedure
Wide range of suitable cases
Crevice depth of five millimeters will allow three millimeters of crown lengthening by Gingivectomy
If more than three millimeters needed use Flap Surgery
Gingivectomy Techniques
This patient requires 3 mm of crown lengthening
Sufficient crevice depth and Keratinized tissue
Gingivectomy completed with surgical scalpels and knives
Healing at three weeks
Crowns placed twelve weeks after Gingivectomy
Next slide Before and After
Gingivectomy to correct lack of symmetry and short crowns
Sufficient crevice depth and Keratinized gingiva
Frenum correction also needed
Scalpel used to establish 10 mm crown length on central incisor
Height of contour of gingiva is distalized
Kirkland Knife used to refine gingival contours by gentle scraping
Length of central incisor serves as basis for lateral incisor and cuspid
Lateral incisor gingival margin 1 mm coronal to central
Cuspid gingival margin at same level as central
The lateral incisor also has distalized gingival margin
Left central incisor gingival margin shaped for symmetry with right central
Gingivectomy completed with bilateral symmetry
Right central incisor edge will need shortening
Initial incision for Frenectomy
Removal of wedge of tissue from frenum
Interdental papilla is untouched
Incision made through periosteum to expose bone
This ensures no muscle pull exists to interdental papilla
Wound closed tightly with 5.0 gut sutures
Healing at twelve weeks
Next Slide Before and After
Crown Lengthening requires Flap Surgery and osseous correction
Initial Incisions
Central incisor and cuspid new gingival margins at same level
Sulcular incision used on lateral incisor to make it harmonious with central and cuspid
Interproximal incisions preserve papillae
Incisions on left symmetrical with right
Use new blade for each two teeth to minimize tissue trauma
Flap carefully dissected with sharp scalpels
3 mm of bone crest exposed
Bone recontouring needed to provide adequate connective tissue apical to crevice depth
Bone Margin has been moved apically of central incisor and cuspid
Flap sutured with apical positioning of gingival margins on central
incisors and cuspids
Final Result at Twelve Weeks
Next Slide Before and After
Short clinical crowns with large gingival display on smiling
Insufficient gingival crevice depth for Gingivectomy
Premolars are included because of exposure with smiling
15 c scalpel used to distalize gingival margin equally on
central incisors
12 B scalpel begins sharp dissection of full thickness flap with
preservation of interdental papillae
Incised gingiva gently removed with sharp back action hoe
Flap elevated and bone recontoured
Flaps sutured with simple 5.0 gut interproximal sutures
Central incisors lengthening to 11 mm
Firm pressure applied to flap for 5 minutes
Healing at one week
No post surgical brushing or flossing
Chlorhexidine mouth washes three times per day
Healing at twelve weeks
Gingival margins now stable
Gentle brushing with soft brush and chlorhexidine from second week post operative
Gentle flossing after four weeks healing
Next slide Before and After
Short clinical crowns and excessive gingival display following
orthodontic treatment
Level of Incisal edge is established
Central incisor and cuspid incisal edges at same level
Lateral incisal edge 1 mm apical to central incisor
Incisal plane parallels lower lip
Gingival crevice too shallow for Gingivectomy
New gingival margins established with incisions
Central incisor length at 10.50 mm
Flap elevated to expose bone margin
Bone recontoured to provide sufficient connective tissue for Biologic width
Flaps sutured in final position
Healing at twelve weeks
Next slide Before and After
Upper and lower incisors, cuspids, and premolars with asymmetry and small
clinical crowns
Size of clinical crowns too short for facial dimensions and smile
Flap elevated to expose bone margins
Osseous recontouring to move bone margins apical
Long anatomical crowns on central incisors
Flaps sutured with apical position of gingival margins including
premolars
Healing at twelve weeks
Cuspids elongated to give masculine emphasis
Next two slides Before and After
Altered passive eruption
Short asymmetrical clinical crowns
Healing at one week
Healing at 12 weeks
Next Slide Before and After
Gingival and tooth esthetics unacceptable to patient
Flaps and osseous recontouring completed
Final Restorations completed after 24 weeks of healing
Next Slide Before and After
ONE WEEK POST SURGERY
TEN WEEKS POST SURGERY
Crown lengthening for esthetics and to provide sufficient root volume for crown retention
Need to establish incisal edge as baseline for gingival dimensions
Provisional acrylic template establishes final crown
dimensions and incisal edge
Patient can view template and suggest any necessary
changes
At time of Flap Surgery, gingival margins outline on tissues
Incisions made following template dimensions
Flaps elevated to expose bone margins
Bone recontoured to mirror final gingival margins
Position of new gingival margins confirmed with stent
Flap positioned with polytetraflurethylene sutures
Palatal view
Healing at 6 weeks
Lower incisors also treated
Next Slide Before and After
If amount of crown lenthening needed will result in depth of crevice being less than 1mm from bone margin then flap sugery and bone removal is required to give adequate BIOLOGICAL WIDTH
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