Surgical Crown Lengthening
-
Upload
jevin-stivie-cialy -
Category
Documents
-
view
49 -
download
4
description
Transcript of Surgical Crown Lengthening
![Page 1: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/1.jpg)
SURGICAL CROWN SURGICAL CROWN LENGTHENING IN THE ESTHETIC LENGTHENING IN THE ESTHETIC
ZONE ZONE
Trijani Suwandi, drg, Sp. Perio
![Page 2: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/2.jpg)
CROWN LENGTHENINGCROWN LENGTHENINGperiodontal procedure that
reshapes the ggv and supporting tissues to expose more of the tooth.
-Function- Form-Retention-Marginal seal
![Page 3: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/3.jpg)
INDICATIONS for Crown INDICATIONS for Crown Lengthening Lengthening (Cohen, 2009)(Cohen, 2009)
![Page 4: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/4.jpg)
GINGIVAL ASYMMETRIESGINGIVAL ASYMMETRIES
Crown length discrepancies.Some teeth appear longer while others appear shorter
(Patil. 2002)
![Page 5: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/5.jpg)
SMILE LINESMILE LINE
HIGH SMILE LINE>75% interprox ggvAll of marginal ggv
MEDIUM SMILE LINE25-75% interprox ggvMarg ggv terlihat
LOW SMILE LINE<25% interprox ggvMarg ggv tdk terlihat
![Page 6: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/6.jpg)
Excessive Gingival Display Excessive Gingival Display (Gummy Smile)(Gummy Smile)
A gingival display >3 mm in active / moderate smile (Patil, 2002; Jim Hinrich, 2007)
![Page 7: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/7.jpg)
Exposure of sound tooth Exposure of sound tooth structurestructure
![Page 8: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/8.jpg)
Clinical Evaluation before CL Clinical Evaluation before CL (Cohen, 2009)(Cohen, 2009)
Apical extent of fracture, caries, perforations
Loss of mesial, distal or oclusal space
Final margin placement
![Page 9: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/9.jpg)
Radiographic analysis Radiographic analysis (Cohen, 2002)(Cohen, 2002)
![Page 10: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/10.jpg)
CONTRAINDICATION & CONTRAINDICATION & LIMITATING FACTOR LIMITATING FACTOR (Cohen, 2002)(Cohen, 2002)
Non maintainability
![Page 11: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/11.jpg)
Sequence of TreatmentSequence of Treatment (Allen, 2002)(Allen, 2002)
1. Clinical & radiographic evaluation2. Caries control3. Placement of provisional
restoration 4. Endodontic therapy5. Control ggv inflammation : plaque
control, Scaling root planing6. Reevaluation for ortho th7. surgery
![Page 12: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/12.jpg)
SURGICAL DIAGNOSIS & SURGICAL DIAGNOSIS & TREATMENTTREATMENT
Kois (1994) : only 3 mm is necessary to satisfy requirements for a stable BW (2.04 mm BW, 1 sulcus depth) determining total dentoggv complex (DGC)
location
Crest facialDGC (mm)
Crest interprox DGC
TreatmentCL
Low
Normal
High
> 3
3
< 3
> 3 – 4.5
3 – 4.5
< 3 – 4.5
No
No
Yes
![Page 13: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/13.jpg)
BW considerations during restorative procedure natural architecture of the gingiva
The distance that must exist between a dental restoration and the alveolar bone
Consider :◦ Location of the restorative margins◦ Location of the gingival margin◦ Location of the crestal bone
1. BIOLOGIC WIDTH = BW
![Page 14: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/14.jpg)
BIOLOGIC WIDTHBIOLOGIC WIDTH
BIOLOGIC WIDTH =2.04 MM
(Takei et all, 2002)
![Page 15: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/15.jpg)
In case Healthy Perio after the exact position of the restoration margin is decided the position of ggv margin is surgically established, with recontouring osseous crest min 3 mm of the flap can be placed coronal to the position of the recontoured osseous crest
A minimum 6 weeks of healing is required before final restoration
![Page 16: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/16.jpg)
When restorations do not take these considerations into BW :
![Page 17: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/17.jpg)
Esthetic crown Esthetic crown lengtheninglengthening
Ratio of 1.3 to 1.01.Typical distance between facial CEJ
and incisal edge of I1 = 11 - 12 mm
2.Typical mesial/distal width of I1 = 8.5 - 9.5 mm
3.Consequently 11.5 / 9 =length verses width ratio of 1.27
![Page 18: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/18.jpg)
LENGTHENING LENGTHENING PROCEDUREPROCEDURE1. Gingival reduction only
- Bone removal not required- Gingivectomy or gingival flap
surgery
2. Mucoperiosteal flap with osteotomy* BONE REMOVAL REQUIRED
![Page 19: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/19.jpg)
Deeply placed crown margins causing gingival inflammation and pockets
![Page 20: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/20.jpg)
Both central incisors and right lateral incisor have crowns violating biologic width concepts
![Page 21: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/21.jpg)
Surgical procedures for Surgical procedures for crown lengtheningcrown lengthening1. Gingivectomy2. Flap surgery for osseous
recontouring
Choice depends on :1. Gingival crevice depth2. Need to maintain minimum of 1 mm
conn tissue between depth of crevice and bone
3. Adequate width of keratinized gingiva
![Page 22: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/22.jpg)
Adequate ggv and > 3 mm of tissue coronal to the bone crest :◦ Gingivectomy or flap
Inadequate ggv and < 3 mm of tissue coronal to the bone crest :◦ Flap procedure and
bone recountouring
![Page 23: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/23.jpg)
Crevice depth 5 mm will allow 3 mm of crown lengthening by GINGIVECTOMY
If more than 3 mm needed use FLAP SURGERY
![Page 24: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/24.jpg)
GINGIVECTOMY GINGIVECTOMY TECHNIQUETECHNIQUE
This patient requires 3 mm of CL
Sufficient crevice depth and keratinized tissue
![Page 25: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/25.jpg)
The lateral incisors were congenitally missing The canine teeth in the position of the lateral incisors added to the esthetic harmony
CASE 1
![Page 26: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/26.jpg)
A gingivectomy was performed to expose the anatomical crowns of the teeth
![Page 27: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/27.jpg)
One month post surgery
![Page 28: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/28.jpg)
Toothform and proportional balance were improved by bonding
![Page 29: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/29.jpg)
a years post treatment
![Page 30: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/30.jpg)
BEFORE AND AFTERBEFORE AND AFTER
![Page 31: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/31.jpg)
Sufficient crevice depth and keratinized gingiva
Frenum correction also needed
CASE 2
![Page 32: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/32.jpg)
Scalpel used to established 10 mm crown length on central incisors. Height of contour ggv is distalised
![Page 33: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/33.jpg)
Kirkland knife used to refine ggv contours by Kirkland knife used to refine ggv contours by gentle scrapinggentle scraping
![Page 34: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/34.jpg)
Length of I1 serves as basis for I2 and C
I2 ggv margin 1 mm coronal to centralC ggv margin at same level as I1
![Page 35: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/35.jpg)
The I 2 also has distalized gingiva margin
![Page 36: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/36.jpg)
Left I1 margin shapes for symmetry with right central
![Page 37: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/37.jpg)
Gingivectomy completed with bilateral symmetry
![Page 38: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/38.jpg)
Initial incision for frenectomyInitial incision for frenectomy
![Page 39: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/39.jpg)
Removal of wedge of tissue from frenumRemoval of wedge of tissue from frenuminterdental papilla is untouchedinterdental papilla is untouched
![Page 40: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/40.jpg)
Incision made through periosteum to expose boneThis ensures no muscle pull exists to interdental
papilla
![Page 41: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/41.jpg)
Wound closed with 4.0 gut suturesWound closed with 4.0 gut sutures
![Page 42: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/42.jpg)
Healing after 12 weeksHealing after 12 weeks
![Page 43: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/43.jpg)
BEFORE AND AFTERBEFORE AND AFTER
![Page 44: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/44.jpg)
ESTHETIC CROWN ESTHETIC CROWN LENGTHENINGLENGTHENING
Left/right side height discrepancy
Perform by :◦Gingivectomy
or flep with osseous resection
◦Only in facial aspect
![Page 45: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/45.jpg)
Esthetic CLEsthetic CLThe dotted line
indicate the oblique vertical incision without involving the interdental papillae
![Page 46: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/46.jpg)
Esthetic CLEsthetic CLA full thickness
flap is raised to gain acces for osseous reduction, the bone dotted line indicated the amount of bone to be resected
![Page 47: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/47.jpg)
Esthetic CLEsthetic CLThe flap is
sutured back into placed
![Page 48: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/48.jpg)
Gingival asymmetry between central incisors
CASE 3
![Page 49: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/49.jpg)
![Page 50: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/50.jpg)
A full thickness flap
![Page 51: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/51.jpg)
With a low speed hand piece and carbide bur, osseous reduction is carried out
![Page 52: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/52.jpg)
The flap repositioning back into place using suture
![Page 53: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/53.jpg)
Post operative frontal view after the placement of veneers
![Page 54: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/54.jpg)
BEFORE AND AFTERBEFORE AND AFTER
![Page 55: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/55.jpg)
FUNCTIONAL CLFUNCTIONAL CL
A labial and palatal view of a fractured central incisor; the blue dotted line indicates the incision to be followed for the raising of a full thickness flap
The gingiva and bone follow a definite pattern interproximally, facially and palatally (> 2 mmof bone resection)
![Page 56: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/56.jpg)
Functional CLFunctional CL
A full thickness flap raised labially as well as palatally , here the blue dotted Line indicated the amount of bone to be resected
![Page 57: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/57.jpg)
Functional CLFunctional CL
Osseus reduction carried out around the tooth using a round diamond bur
![Page 58: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/58.jpg)
Functional CLFunctional CL
The flap sutured back in place
![Page 59: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/59.jpg)
Flap surgery and osseous correction
CASE 4
![Page 60: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/60.jpg)
INITIAL INCISIONSINITIAL INCISIONS
I1 and C new ggv margins at same level
Sulcular incision used on I2 to make it harmonious with I1 and C
Interprpox incisons preserve papillae
![Page 61: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/61.jpg)
Incisions on left symmetrical with rightUse new blade for each two teeth to
minimize tissue trauma
![Page 62: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/62.jpg)
Flap carefully dissected with sharp scalpels3 mm of bone crest exposedBone recontouring needed to provide
adequate conn tissue apical crevice depth
![Page 63: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/63.jpg)
Bone margin has been moved apically of I1 and C
![Page 64: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/64.jpg)
Flap sutured with apical positioning of ggv margin on I1 and C
12 weeks
![Page 65: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/65.jpg)
BEFORE AND AFTERBEFORE AND AFTER
![Page 66: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/66.jpg)
ALTERED PASSIVE ERUPTION = ALTERED PASSIVE ERUPTION = GUMMY SMILEGUMMY SMILE
A gingival display > 3 mm in active or moderate smile :” gummy “
![Page 67: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/67.jpg)
TOOTH ERUPTION TOOTH ERUPTION (Weinberg & Eskow, 2000)(Weinberg & Eskow, 2000)
ACTIVE ERUPTION PASSIVE ERUPTION
The physical movement of the tooth from its prefunctional subggv position through the ggv tissue, into the oral cavity finally, into functional occlusion
The continued apical movement of the free ggv margin epithelial attachment or junct epith and connec tissue attachm that occurs after the tooth reaches functional occlusion
![Page 68: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/68.jpg)
Classified passive eruption Classified passive eruption (Gargiulo et al (Gargiulo et al (1961)(1961)
Stage I = sulcus & JE are on the enamelStage II = sulcus on enamel. JE is part on the enamel and part on the
cementumStage III = sulcus at CEJ, JE completly on cementumStage IV = sulcus and Je apically to CEJ
![Page 69: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/69.jpg)
Classification Delayed or Classification Delayed or Altered Passive Eruption Altered Passive Eruption (Coslet et (Coslet et all, 1977)all, 1977)
TYPE IAType I = ggv margin is incisal to CEJ, MGJ is apical to crest of boneSubgroup A = the alv crest is located 1.5 – 2 mm from CEJTherapy = GINGIVECTOMY
![Page 70: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/70.jpg)
TYPE I BType I = ggv margin is incisal to CEJ, MGJ is apical to crest of boneSubgroup B= the alv crest is coincident with CEJTherapy = GINGIVECTOMY or SCALLOPED inverse bevel flap & osseous reduction
![Page 71: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/71.jpg)
TYPE II AType II = ggv dimension is normal. The free ggv margin is incisal to CEJ, MGJ is positioned at the CEJSubgroup A = the alv crest is located 1.5 – 2 mm from CEJTherapy = APICALLY POSITIONED FLAP
![Page 72: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/72.jpg)
TYPE IIBType II = ggv dimension is normal. The free ggv margin is incisal to CEJ, MGJ is positioned at the CEJSubgroup B = the alv crest is coincident with CEJTherapy = Apically positioned flap with osseous reduction
![Page 73: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/73.jpg)
The causes gummy smileThe causes gummy smile
![Page 74: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/74.jpg)
Planning for gummy smilePlanning for gummy smile
![Page 75: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/75.jpg)
CASE 5
![Page 76: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/76.jpg)
Gingivectomy in the maxillary arch
![Page 77: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/77.jpg)
Flap sutured back after osseous reduction
![Page 78: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/78.jpg)
Veneer preparation performed after 2 months of post operative healing
![Page 79: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/79.jpg)
Post operative view after veneer placement
![Page 80: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/80.jpg)
Postoperative view after 6 months. Note : the convex smile line, Good progressive abating and adequate periodontal health
![Page 81: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/81.jpg)
BEFORE AND AFTERBEFORE AND AFTER
![Page 82: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/82.jpg)
Pontoriero and Carnevale (2001)- CL : considered removal of osseous support- in esthetic area, sulcular marginal placement await final ggv stability ( 3 weeks)
Lanning et al (2003)◦≥ 3 mm osseous reduction stable
BW, adequate tooth exposure
![Page 83: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/83.jpg)
CONCLUSIONCONCLUSION
![Page 84: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/84.jpg)
CONCLUSIONCONCLUSION
![Page 85: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/85.jpg)
![Page 86: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/86.jpg)
Biologic width peridental and Biologic width peridental and implantimplant
![Page 87: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/87.jpg)
Biologic width peridental and Biologic width peridental and implantimplant
![Page 88: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/88.jpg)
![Page 89: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/89.jpg)
A Systematic Approach to A Systematic Approach to Treatment PlanTreatment Plan
![Page 90: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/90.jpg)
Mankoo, 2002
![Page 91: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/91.jpg)
Biologic widthBiologic width
When implant-abutment connection was placed at the ggv level supracrestal to the alv bone (single implant placement) : BW was similar to that of natural dentition
facilitated maintenance of the BW with minimal apical bone resorption
![Page 92: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/92.jpg)
In Aesthetic ZoneIn Aesthetic Zoneimplant level should always be
placed subgingivally produce the proper emergence profile & soft tissue contours around the implant restoration
As general rule, the implant head should be placed 3 mm apical to the desired labial gingiva margin position in order to allow emergence profile & aesthetics
![Page 93: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/93.jpg)
The Role of Interdental Bone on The Role of Interdental Bone on Papilla DevelopmentPapilla Development
Distance From interdental bone to apical of contact area
Incidence of the Papilla Being Completely Present
5 mm or less 100%
6 mm 56%
7 mm 27%
(Tarnow et all, 1992)
![Page 94: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/94.jpg)
![Page 95: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/95.jpg)
![Page 96: Surgical Crown Lengthening](https://reader034.fdocuments.in/reader034/viewer/2022052213/55cf8edf550346703b9686b9/html5/thumbnails/96.jpg)
trijani [email protected]