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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
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UCLA SCHOOL OF DENTISTRY
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PresentsPresentsDr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics
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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
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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
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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.
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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.
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Five millimeters of crevice depth with adequate band of Keratinized tissue
Gingivectomy can be used to increase crown length by up to 3 mm
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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
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Crevice depth of five millimeters will allow three millimeters of crown lengthening by Gingivectomy
If more than three millimeters needed use Flap Surgery
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Gingivectomy Techniques
This patient requires 3 mm of crown lengthening
Sufficient crevice depth and Keratinized tissue
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Gingivectomy completed with surgical scalpels and knives
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Healing at three weeks
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Crowns placed twelve weeks after Gingivectomy
Next slide Before and After
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Gingivectomy to correct lack of symmetry and short crowns
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Sufficient crevice depth and Keratinized gingiva
Frenum correction also needed
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Scalpel used to establish 10 mm crown length on central incisor
Height of contour of gingiva is distalized
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Kirkland Knife used to refine gingival contours by gentle scraping
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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
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The lateral incisor also has distalized gingival margin
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Left central incisor gingival margin shaped for symmetry with right central
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Gingivectomy completed with bilateral symmetry
Right central incisor edge will need shortening
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Initial incision for Frenectomy
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Removal of wedge of tissue from frenum
Interdental papilla is untouched
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Incision made through periosteum to expose bone
This ensures no muscle pull exists to interdental papilla
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Wound closed tightly with 5.0 gut sutures
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Healing at twelve weeks
Next Slide Before and After
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Crown Lengthening requires Flap Surgery and osseous correction
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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
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Incisions on left symmetrical with right
Use new blade for each two teeth to minimize tissue trauma
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Flap carefully dissected with sharp scalpels
3 mm of bone crest exposed
Bone recontouring needed to provide adequate connective tissue apical to crevice depth
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Bone Margin has been moved apically of central incisor and cuspid
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Flap sutured with apical positioning of gingival margins on central
incisors and cuspids
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Final Result at Twelve Weeks
Next Slide Before and After
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Short clinical crowns with large gingival display on smiling
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Insufficient gingival crevice depth for Gingivectomy
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Premolars are included because of exposure with smiling
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15 c scalpel used to distalize gingival margin equally on
central incisors
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12 B scalpel begins sharp dissection of full thickness flap with
preservation of interdental papillae
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Incised gingiva gently removed with sharp back action hoe
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Flap elevated and bone recontoured
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Flaps sutured with simple 5.0 gut interproximal sutures
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Central incisors lengthening to 11 mm
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Firm pressure applied to flap for 5 minutes
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Healing at one week
No post surgical brushing or flossing
Chlorhexidine mouth washes three times per day
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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
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Short clinical crowns and excessive gingival display following
orthodontic treatment
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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
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Gingival crevice too shallow for Gingivectomy
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New gingival margins established with incisions
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Central incisor length at 10.50 mm
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Flap elevated to expose bone margin
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Bone recontoured to provide sufficient connective tissue for Biologic width
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Flaps sutured in final position
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Healing at twelve weeks
Next slide Before and After
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Upper and lower incisors, cuspids, and premolars with asymmetry and small
clinical crowns
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Size of clinical crowns too short for facial dimensions and smile
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Flap elevated to expose bone margins
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Osseous recontouring to move bone margins apical
Long anatomical crowns on central incisors
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Flaps sutured with apical position of gingival margins including
premolars
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Healing at twelve weeks
Cuspids elongated to give masculine emphasis
Next two slides Before and After
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Altered passive eruption
Short asymmetrical clinical crowns
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Healing at one week
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Healing at 12 weeks
Next Slide Before and After
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Gingival and tooth esthetics unacceptable to patient
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Flaps and osseous recontouring completed
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Final Restorations completed after 24 weeks of healing
Next Slide Before and After
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ONE WEEK POST SURGERY
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TEN WEEKS POST SURGERY
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Crown lengthening for esthetics and to provide sufficient root volume for crown retention
Need to establish incisal edge as baseline for gingival dimensions
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Provisional acrylic template establishes final crown
dimensions and incisal edge
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Patient can view template and suggest any necessary
changes
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At time of Flap Surgery, gingival margins outline on tissues
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Incisions made following template dimensions
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Flaps elevated to expose bone margins
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Bone recontoured to mirror final gingival margins
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Position of new gingival margins confirmed with stent
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Flap positioned with polytetraflurethylene sutures
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Palatal view
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Healing at 6 weeks
Lower incisors also treated
Next Slide Before and After
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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