Esthetic Surgical Procedures

7/30/2019 Esthetic Surgical Procedures

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TARRSON FAMILY ENDOWED


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UCLA SCHOOL OF DENTISTR


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PresentsPresents


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E. Ba

Tarrs

Prof

UCL

ESTHETIC SURGICAL PROCEDURES FORCROWN LENGTHENING


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1. Gingivectomy

2. Flap surgery for osseousrecontouring


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Need minimum of one millimeter connectivetissue coronal to bone margin

Gingival margin will be two millimeterscoronal 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 mmof this is crevice depth, and 1mm. is for connective tissue

between probable depth and crest of bone.


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Five millimeters of crevice depth withadequate band of Keratinized tissue

Gingivectomy can be used to increasecrown length by up to 3 mm


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Advantages of Gingivectomy

Precise control of gingival contours

Low risk of inadvertent necrosis of tissueduring healing


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Crevice depth of five millimeters will allowthree millimeters of crown lengthening byGingivectomy

If more than three millimeters needed useFlap Surgery


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Gingivectomy Techniques

This patient requires 3 mm of crownlengthening

Sufficient crevice depth and Keratinizedtissue


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Gingivectomy completed with surgicalscalpels and knives


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Healing at three weeks


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Crowns placed twelve weeks afterGingivectomy

Next slide Before and After


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Gingivectomy to correct lack of symmetryand short crowns


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Sufficient crevice depth and Keratinizedgingiva

Frenum correction also needed


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Scalpel used to establish 10 mm crownlength on central incisor

Height of contour of gingiva is distalized


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Kirkland Knife used to refine gingivalcontours by gentle scraping


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Length of central incisor serves asbasis for lateral incisor and cuspid

Lateral incisor gingival margin 1 mmcoronal to central

Cuspid gingival margin at same levelas central


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The lateral incisor also has distalizedgingival margin


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Left central incisor gingival margin

shaped for symmetry with right central


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Gingivectomy completed with bilateralsymmetry

Right central incisor edge will needshortening


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Initial incision for Frenectomy


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Removal of wedge of tissue fromfrenum

Interdental papilla is untouched


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Incision made through periosteumto expose bone

This ensures no muscle pull existsto 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 newgingival margins at same level

Sulcular incision used on lateralincisor to make it harmonious withcentral and cuspid

Interproximal incisions preservepapillae


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Incisions on left symmetricalwith right

Use new blade for each two teethto minimize tissue trauma


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Flap carefully dissected with sharpscalpels

3 mm of bone crest exposed

Bone recontouring needed to provideadequate connective tissue apical tocrevice depth


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Bone Margin has been moved apically

of central incisor and cuspid


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Flap sutured with apical positioningof gingival margins on central

incisors and cuspids


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Final Result at Twelve Weeks



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Short clinical crowns with largegingival display on smiling


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Insufficient gingival crevicedepth for Gingivectomy


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Premolars are included because ofexposure with smiling


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15 c scalpel used to distalizegingival margin equally on

central incisors


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12 B scalpel begins sharp dissectionof 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 gutinterproximal 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 orflossing

Chlorhexidine mouth washes threetimes per day


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Gingival margins now stable

Gentle brushing with soft brush and

chlorhexidine from second week postoperative

Gentle flossing after four weekshealing



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Short clinical crowns and excessivegingival display following

orthodontic treatment


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Level of Incisal edge is established

Central incisor and cuspid incisal edgesat same level

Lateral incisal edge 1 mm apical tocentral incisor

Incisal plane parallels lower lip


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Gingival crevice too shallow forGingivectomy


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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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Upper and lower incisors, cuspids, andpremolars with asymmetry and small

clinical crowns


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Size of clinical crowns too shortfor facial dimensions and smile


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Flap elevated to expose bone margins


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Osseous recontouring to movebone margins apical

Long anatomical crowns on centralincisors


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Flaps sutured with apical positionof gingival margins including

premolars


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Cuspids elongated to give masculine

emphasisNext 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



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Gingival and tooth estheticsunacceptable to patient


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Flaps and osseous recontouringcompleted


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Final Restorations completed after24 weeks of healing



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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 toprovide sufficient root volume for crownretention

Need to establish incisal edge asbaseline for gingival dimensions


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Provisional acrylic templateestablishes final crown

dimensions and incisal edge


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Patient can view template andsuggest any necessary

changes


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At time of Flap Surgery, gingivalmargins outline on tissues


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Flaps elevated to expose bonemargins


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Bone recontoured to mirror finalgingival margins


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Position of new gingival marginsconfirmed with stent


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Flap positioned withpolytetraflurethylene sutures


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Palatal view


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Healing at 6 weeks

Lower incisors also treated



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If amount of crown lenthening needed will result indepth of crevice being less than 1mm from bonemargin then flap sugery and bone removal is requiredto give adequate BIOLOGICAL WIDTH

Esthetic Surgical Procedures

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