A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure

Abstract

Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent sites: Plaque and Gingival Indices (PI) & (GI), Position of Gingival Margin from reference Stent (PGMRS), Probing depth (PD), and Biologic Width (BW). Statistical Analysis Used. Student “t” Test. Results. Initial baseline values of biologic width were 2.55 mm (Gingivectomy procedure B1 Group) and 1.95 mm (Ostectomy procedure B2 Group) and after surgical procedure the values were 1.15 mm and 1.25 mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening.

Periodontal plastic surgery for treatment of gummy smile with cosmetic restauration treatment

“…In this case report, care was taken regarding the preservation of a healthy periodontium, because this is a critical point for the long-term success of the restored tooth [7]. The Dentists must constantly balance the restorative and esthetic needs of the patients with the periodontal health.…”

Crown lengthening procedures: A literature review

“…In such cases, if gingivectomy is performed, the postsurgical BW dimension and probing depths tend to return to presurgical values resulting in more tissue rebound and less crown exposure when compared with apically positioned flap combined with ostectomy. 17 Osseous resection can be described in terms of ostectomy and osteoplasty. In contrast with osteoplasty, ostectomy refers to the removal of supporting bone attached to the root surface via periodontal ligament.…”

“…6 With the current acceptance of the wide variability in SGT dimensions between individuals, arches, gingival biotypes, tooth types, and sites, 6,[11][12][13][14][15] ostectomy in CLP has become patient-customized, based on individual and localized soft and hard tissue parameters. Several clinical studies seem to agree that the vertical height of SGTs is a dimension that reestablishes itself following surgical CLP 9,16,17 (Fig. 2).…”

“…It seems therefore that the presurgical assessment of SGT dimension could facilitate the surgical planning of crown lengthening by giving precise indications as to the expected postoperative soft tissue levels and therefore the correct amount of osseous resection required prosthetically for specific sites and individuals. 7,9,17,18 Other publications indicated that postsurgical SGT dimensions are somewhat reduced when compared to presurgical measurements. Perez et al 6 reported an overall mean reduction of 0.51 mm in SOG dimension at 6 months postsurgery in 19 patients that underwent CLP.…”

Op kronen en bruggen uitgeoefende krachten en het weerstaan daarvan 1. Retentie en resistentie

“…Voor het handhaven van de biologische breedte kan worden volstaan met een lokale gingivectomie als de sulcus gingivalis diep genoeg is. Mocht dit naar verwachting niet mogelijk zijn, dan moet een lokale flapoperatie worden uitgevoerd met verwijdering van alveolair bot (Hempton en Dominici, 2010; Ganji et al, 2012).…”