Guided Soft and Hard Tissue Preparation: A Novel Technique for Crown Lengthening

Abstract

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.

Aesthetic management of young patients with adverse social habits

“…The ultimate goal of CLP is to provide adequate crown dimensions for a stable dentogingival complex and for placement of restorative margins, thereby achieving the best marginal seal and an aesthetically pleasing final restoration (Cabunac et al, 2023;De-Oliveira et al, 2015). Surgical guides are often utilized to achieve adequate aesthetic results; on the basis of diagnostic waxing, they are made with acrylic resin or vacuum transparent shells or 3D prints (Alhumaidan et al, 2020;Amato et al, 2013). Surgical guides with diagnostic wax-up are commonly created as a point of reference for CLPs, particularly in cases involving anterior teeth.…”

Three Dimensional Digitally Designed Surgical Guides in Periodontal and Implant Surgeries: A Review

“…In the case of crown lengthening is needed to be performed, the surgeon should receive all information on optimal gingival contours and tooth esthetics when. Diagnostic waxing was suggested to generate a vacuum-formed surgical guide and an acrylic resin [29,30,31]. However, these devices are not precise in most times [32].…”

Crown lengthening procedures: A literature review

“…Anecdotally, an average distance of 2.5-3 mm between the apical buccal contour of the template and the newly created crestal bone level is created to accommodate for the newly formed SGTs. 72 This is based on the finding that a mean dimension of approximately 2 mm between the alveolar crest and CEJ is present in 85% of the population. 8 In cases of APE, baseline SGT values are higher than those documented in periodontally healthy maxillary anterior teeth.…”