The perio-esthetic-restorative approach for anterior rehabilitation

Abstract

Ensuring clinical success begins with a careful discussion of treatment planning, comprehensively covering all variables in simple to complex cases. Procedures including the crown lengthening surgery, furcation treatment and mucogingival therapy and tooth restoration are essential treatment regimens requiring multifaceted expertise. The interplay of periodontics and restorative dentistry is present at many fronts including the response of the gingival tissue to the restorative preparations. Dental restorations and periodontal health are inseparably interrelated. The adaptation of the margins, the contours of the restoration, the proximal relationships and the surface smoothness have a critical biological impact on the gingiva and the supporting periodontal tissues. The different surgical procedures used for crown lengthening are gingivectomy/gingivoplasty, apically positioned flap with or without osseous resection and orthodontic extrusion. The paper presents crown lengthening of severely mutilated teeth to increase the clinical crown height for adequate restoration.

Pronóstico individual de dientes pilares

“…50,51 La cantidad de estructura dentaria expuesta por encima de la cresta con la cirugía de aumento coronario debe ser 4 mm, suficiente para proveer una unión dentogingival estable y ancho biológico adecuado que permita la preparación dentaria y el establecimiento de línea de terminación. 52 Esto puede ser demasiado para algunos…”

“…50,51 The amount of tooth structure exposed above the crest following surgical crown lengthening must be of 4 mm, which is enough to provide a stable dentogingival bond and appropriate biological width to allow tooth preparation and the establishment of an end line. 52 This may be too much for some pilares, así que debe considerarse la longitud radicular de algunos dientes en boca y los tallos radiculares. La opción de extrusión ortodóncica para aumento de corona es la ideal en compromiso estético, pero tiene el mismo efecto biomecánico sobre la proporción coronaraíz óptima o ideal mínima.…”

Modificación de forma de corona clínica

“…La denominación de espacio biológico fue sustentada en el trabajo de Gargiulo (1961), que describe la dimensión y relación de la unión dentogingival en humanos: profundidad de surco de 0.69 mm, adherencia epitelial de 0.97 mm, inserción del tejido conectivo de 1.07 mm, dando un total para ancho biológico de 2.04 mm. (1,4,7,9). Inmediatamente, se realizó la restauración de las piezas dentarias (2.1 -2.2 -2.3) con resina de fotoactivación Z350 para dar la nueva forma anatómica de dichas piezas.…”

Crown lengthening surgery and transurgical restoration

“…Appropriate restorative procedures do not always provide optimal clinical conditions for its implementation. Thus, suboptimal clinical conditions may prevent the expected and desired procedures through technical and biological standards [3,19,18]. Different protocols must be designed to access to t he cerv ica l cav it y wall, in addition to a dry operative field free of contamination by blood and saliva [5].Thus, among the alternatives of restorative treatment planning and implementation in some of these situations, only the surgical periodontal procedures may create favorable technical conditions [15].…”