crown lengthening of tooth

7/23/2019 Crown Lengthening of Tooth

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Nidoy, John Patrick M.

Crown Lengthening of tooth #15

Crown Lengthening

Restorative margin cannot be closer than 2mm to crestal bone, or will disrupt

osseous structure - Sounding bone probing through the biologic width to the bone,

gives an idea of what bone contour is like

Biologic width epose !-"mm of tooth coronal to bone during surger# to

accommodate 2mm biologic

$he aim of the modi%ed &idman 'ap surger# is healing and reattachment of

periodontal pockets with minimum loss of periodontal tissues during and after

surger#

Advantages

() Root cleaning with direct vision

2) *rotective of tissues, reparative

!) +ealing b# primar# intention

") Lack of pain or complications postoperativel#

Indications

()Caries etending under the gingival line) Crown lengthening will provide better

access to remove caries

2) Lack of available tooth structure for prosthetic retention or lack of ferrule eect

Instr!"ents and Materias

() *robe

2) Basic nstruments

!)(2 blade

!) Blade holder

") round carbide bur

.) +andpiece

/)Saline solution

0)+#podermic s#ringe

1) periosteal elevator

) suturing material

(3) needle

(() Lidocane

(2)4spirating S#ringe

(!) Coe *ack

(") +igh 5acuum suction

(.) needle holder

(/) curettes


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Proced!res

() 4prepoperative consultation is perforemed and determine the restorabilit#

of the of the

tooth2) $ooth should be ideall# be prepared and have a tempor# restoration to

batter evaluate the %nal prosthetic margin

$!rgica Proced!re

() 4nestheti6e the area, perform and *osterior superior alveolar nerve block,

7iddle Superior 4lveolar nerve block and greater palatine nerve block

%. Modi&ed'id"an (a) *M'(+

() nitial incision8continuous, 9scalloping,: paramarginal

;intragingival< incision= no vertical releasing incisions)$his incision

determines the shape of the 'ap and is performed both linguall# using

a (2B scalpel) t is an inverse bevel incision, etending to the alveolar

crest

2) *artial mobili6ation of the mucoperiosteal 'ap ;full thickness

'aps both lingual and orall#< within the attached gingiva to the

alveolar crestusing small elevator to permit direct visuali6ation of the

roots

!) Second ncision8 ntrasulcular $his incision is a purel#

intrasulcular incision that is carried around each tooth, between the

hard structure and the gingiva, be#ond the base of the pocket and

etending to the apical etent of the pocket epithelium

")$hird ncision8+ori6ontal $he hori6ontal incision is carried

along the alveolar crest from the lingual to the oral aspect, or the

reverse, thus separating the supracrestal pocket tissue from its

supporting sub>acent tissues, especiall# in the interdental area)

.) Root *laning with ?irect 5ision @ine curettes are used in the

depth of interdental craters to remove remnants of pocket epithelium

and granulation tissue distance from the crestal bone to the

preprosthetic margin is measured to determine where and how much

osteotom# is needed)

/) $ight Coverage of nterdental ?efects $he facial and oral 'aps are

tightl# adapted over the bone and between the teeth b# means of interrupted

interdental sutures)

0)Suture Removal8 Carefull#, Sutures should be removed at one week

or up to (3 da#s) B# this time the wound margins have adhered to each other


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1$ooth Cleaning @ollowing suture removal, the surfaces of the teeth are

cleaned using soft rubber cups and mildl# abrasive proph# paste )Since

wound healing is not #et complete ;regeneration at the depth of the pocket,

new >unctional epithelium< care must be eercised that no paste is forced into

the sulcus, beneath the formerl# re'ected soft tissue 'ap)

Post )erative Instr!ctions

() $ake 3)2 A Chlorheidinemouthrise to be used twice a da# fro two weeks and

until the patient can resume to mechanical plaue control

2)$ake 4moicillin ;.33mg< for 0 da#s, take ( capsule ever# 1 hours )

!) $ake 7efenamic 4cid ;.33mg


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crown lengthening of tooth

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