This article presents an innovative approach to crown lengthening that offers predictable esthetics and harmonious bone and gingival contours. Following fabrication of the diagnostic wax-up, a provisional fixed prosthesis is constructed. At the time of provisional insertion, the tooth, marginal gingiva, and crestal bone are prepared with rotary instruments using a prosthetic template as a guide. This procedure is known as guided soft and hard tissue preparation. The provisional is then inserted, thus invading the biologic width. Within no more than 2 weeks, bone resective surgery is performed to recreate normal biologic width. A well-defined preparation margin acts as a guide during the osteoplasty procedure, which is used to reestablish the correct distance between the crown margin and crestal bone. A total of 10 patients in need of crown lengthening have been treated with this procedure, and 1-to 7-year follow-ups have shown good esthetic results and stable tissue levels.
The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.
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