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Crown Lengthening

Crown Lengthening

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Published by Kupfermann

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Published by: Kupfermann on Aug 19, 2009
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05/11/2014

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Crown Lengthening
Esthetic Parameters
Clinically, the patient’s tissue biotype is classified according to how thick or thins the supporting bone and gingival soft tissues are defined.Becker and Oschenbein (1997)Three distinct types; pronounced scalloped, scalloped and flat.
A thin periodontium will be pronounced scalloped or scalloped.
A thick periodontium will present with flat gingival architecture, andusually be supported by thick buccal and lingual plates of alveolar bone.Response to inflammation, restorative and surgical injury :Thin-scalloped periodontium → some degree of soft-tissue recession.Thick flat periodontium →resists recession and reacts with pocket formation.In the aesthetic zone :
It is extremely important to identify the position of the midline, and theamount of teeth and the soft tissues visible not only from the frontal view but also from the lateral view, both with the lip at rest and when smiling.
It is sometimes better to make compromises and understand that residual pocket depths may be maintainable.
 Nonsurgical therapy can keep interproximal papilla intact and is moredesirable as compared to the esthetic problems associated with pocketelimination and the creation of “black triangles.”Esthetic periodontal defects include:
Residual gingival/periodontal defects.
Violations of biologic width.
Gingival asymmetries.
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Inadequate amount of gingival.
Gingival recessions.
Deficient pontic areas.
Frena impinging on the gingival margin.
Excessive gingival display.
Deficient interproximal papillae.The biologic Zone
The biological width
The physiological dentogingival junction of natural teeth (“the biologicalwidth”) includes:
The length of the epithelial attachment.
The length of the connective- tissue attachment .
The depth of the sulcus.The mean value of the biological width around a natural tooth is 2.04 mm- 2.73mm.Keep in mind:
This dimension is an average of a range of attachment heights.
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There are several variations in dimension of the biologic width betweenindividuals as well as within the same person, depending on the locationof the tooth in the dental arch.
Crown Lengthening
Aim:To increase the extent of the supragingival tooth structure for restorative or esthetic purposes by apically positioning the gingival margin, removing bone, or  both.Rrationale:
Obtaining physiological or biologic width for the periodontal-restorativeinterrelationship.
A minimum of two millimeters of tooth surface should be available abovethe alveolar bone crest for tissue attachment.Therefore the biologic width is two millimeters (1 mm for connective tissueabove crestal bone and 1 mm for epithelial attachment) + sulcus depth (1mm)and resistance form (1-2 mm).Restorations that invade the zone of biologic width will cause inflammation, bone loss and periodontal pocketing.Indications:a) Caries. b) Tooth fracture. c) External resorption.d) Short clinical crowns e) Loss of tooth structure through attrition andabrasion.Contra-indications:1- When postsurgical healing will result in significant exposure of inaccessiblemolar or premolar furcations.2 - If Reduction of the supporting bone will result in a poor crown- root ratio.
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