Patient-Reported Outcomes After Periodontal Surgical Procedures.

Background Patient satisfaction is the primary focus of the healthcare system. Patient-reported outcome measures (PROMs) are standardized and valid measures obtained directly from the patients and are used to assess and compare the efficacy of healthcare services. This can help improve the service provided by the healthcare system. Therefore, this study aimed to assess PROMs during the first week post-surgery across different periodontal surgical procedures and explore their correlation with surgical duration. Furthermore, the study sought to evaluate the occurrence of postoperative complications. Methodology A total of 30 healthy patients with no systemic history, requiring periodontal surgical procedures such as crown lengthening (CLP), open flap debridement (OFD), and soft tissue grafting (STG) were included in the study. The Visual Analog Scale (VAS) was utilized for gathering PROMs concerning bleeding, swelling, bruising, and pain at intervals of days zero, three, five, and seven after the surgical procedure. Results On the surgical day and over seven days, VAS scores were the lowest for CLP and highest for STG procedures. This result is in accordance with the duration required for surgery. VAS scores for OFD were intermediate. Prevalence of 20% soft tissue graft dehiscence and 40% tenderness on palpation was observed. Swelling and bleeding were noticed in 10% and 20% of OFD cases. Conclusions One week post-surgically, the mean VAS scores were minimum for CLP, whereas maximum for STG procedures. As CLP and OFD require less duration compared to STG, duration plays a significant role in post-surgical outcomes. Prevalence of the post-surgical complications is also related to the duration of the surgery.

The Use of Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) Technology for Zirconia Crowns After Laser-Assisted Crown Lengthening and Retraction: A Case Report.

Maintenance of biological width serves as a primary factor in periodontal-restorative relationships. Crown lengthening (CL) is a technique to prevent violation of biological width, with the laser method offering the advantage of surgical and patient-related outcomes. Laser CL with retraction helps with the excision of tissues, increasing the CL, maintaining the gingival contour with adequate exposure to the finish line to record the tooth preparation features. This helps to achieve the functional and esthetic outcomes essential for restorative dentistry. The marginal fit, contour, and adaptation of the crown can be further enhanced by computer-aided design and computer-aided manufacturing (CAD/CAM) technology improving patient and clinical outcomes. Hence, this case report aims to indulge the laser-assisted procedures and CAD/CAM technology to fabricate and deliver a zirconia crown maintaining the periodontal-restorative factors.

Factors Affecting Patients' Atttendance for Periodontal Follow-up Visits after Crown Lengthening Surgery.

PURPOSE: To assess adherence to follow-up maintenance visits among patients who had previously undergone crown-lengthening surgery and investigate the different factors impacting their compliance. MATERIALS AND METHODS: A total of 314 patients were identified for follow-up appointments. Based on their responses, participants were categorised into four groups: attendees, non-attendees, refusals, and unreachable. Furthermore, data on sociodemographic factors (age, sex, nationality, marital status, education, occupation, and residential area), medical history, dental history (including missing teeth, implants, or orthodontic treatment history), and past appointment attendance (average yearly appointments, missed appointment percentage, and last appointment date) were collected and analysed to understand their influence on patient compliance. RESULTS: In a sample of 314 patients, 102 (32.5%) attended the appointments successfully. Improved attendance rates were significantly associated with being female, Saudi Arabian, married, and employed (p < 0.05). Moreover, patients with a high frequency of annual appointments and a recent history of appointments exhibited better compliance. None of the analysed dental factors affected the attendance rates. CONCLUSION: About one-third of patients who had undergone crown lengthening surgery were compliant with the follow-up visits. Different factors influenced this compliance pattern to varying extents, with more efforts needed to enhance patients' commitment to these visits.

Soft Tissue Retraction Maneuver in Cone Beam Computed Tomography Prior to Crown-Lengthening Procedure-A Technical Note.

Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets' depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science.

Survival analysis of teeth following clinical crown lengthening and crown insertion procedures up to 14 years: A retrospective cohort study.

BACKGROUND: The purpose of this study was to conduct survival analysis of teeth following clinical crown lengthening procedures (CLPs) and crown insertions via a retrospective cohort study. METHODS: Patient- and tooth-related data were collected from 268 participants who received CLPs from 2009 to 2015. The Kaplan-Meier curve and the log-rank tests were used to estimate the probability of survival and compare the survival probabilities among different variables. A Cox multivariate proportional hazard regression model was used to investigate the collective effects of root canal treatment (RCT) and the types of opposing dentition. RESULTS: The rate of tooth loss was 21.6% during the observation period from 1 to 14 years, with 58 teeth extracted. The most attributable reason for tooth extraction was coronal tooth fracture, followed by endodontic failure such as root fracture. The survival probability was 0.87 at 5 years and 0.7 at 10 years. No significant differences in the survival probabilities were found among different providers and locations, the presence of a post, and the types of crowns. The hazard ratio for tooth loss was 6.3, 95% confidence interval (CI) [2.6 to 20.9] in the teeth with RCT (p < 0.001) and 2.4, 95% CI [1.1 to 4.8] in the teeth occluding implant-retained prostheses (p = 0.016). CONCLUSIONS: Tooth loss following CLPs and crown insertions appeared least among the teeth without RCT when occluding natural teeth, while tooth loss was most among the teeth with RCT when occluding implants.

Influence of crown-lengthening surgery on teeth rehabilitated with ceramic single crowns: A 12-month prospective clinical study.

OBJECTIVE: To compare the clinical periodontal parameters of teeth restored with a single ceramic crown, with and without crown lengthening procedure. METHODS: This prospective, longitudinal, controlled, and single-blinded clinical trial involved 22 patients with a total of forty-one teeth with ceramic crowns. The teeth were divided into two groups: test (n = 21), comprising teeth rehabilitated post crown-lengthening surgery, and control (n = 20), comprising teeth rehabilitated without crown-lengthening surgery. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL) were compared between groups (surgically treated and non-surgically treated) and within each group for each type of site (treated -tt; adjacent - ad; and nonadjacent - nad). Additionally, gingival phenotype (GP), gingival recession (GR), and keratinized tissue width (KTW) were also assessed post- restoration. Statistical analyses used a significance level set at 5 %. RESULTS: PI, GI, and BoP were reduced, but no statistically significant differences were observed within each group or between groups for most follow-up periods. CAL of the TT sites was consistently higher in the test group, and PD was also higher in the test group (p < 0.05), except at T3. adPD, nadPD, adCAL, and nadCAL demonstrated no significant differences between groups and periods. A significant association was identified between GP and the occurrence of GR, with the thick-flat phenotype demonstrating less association with GR, regardless of whether crown lengthening was performed or not. CONCLUSION: Crown-lengthening surgery in rehabilitated teeth does not significantly affect PI and GI after 12 months. Although crown-lengthening surgery affected PD and CAL in TT sites, it did not affect adjacent and non-adjacent sites. CLINICAL RELEVANCE: These findings emphasize the importance of considering individual patient factors and the potential impact on periodontal tissues when planning crown-lengthening surgery. Clinicians must have a comprehensive understanding of the dynamics of the periodontal tissues involved in restorative treatments to optimize the procedure, increase success rates, and minimize potential complications.

Tratamiento de Sonrisa Gingival. Informe de Caso

El recontorneo estético es una cirugía plástica periodontal que tiene como objetivo restablecer una sonrisa más armoniosa de acuerdo al aspecto facial del paciente, el principal motivo para realizar este procedimiento es cuando existe un diagnóstico de una erupción pasiva alterada o sonrisa gingival. La sonrisa gingival es una de las principales preocupaciones de acuerdo a la estética cuando existe una exposición gingival de más de 3 mm en lo cual es justificable realizar el recontorneo estético. Paciente femenino de 28 años de edad, con diagnóstico de erupción pasiva alterada 1B con un seguimiento de 4 meses. El tratamiento consistió en realizar el recontorneo estético para corregir la sonrisa gingival. El recontorneo estético es un procedimiento quirúrgico que se realiza con el objetivo de mejorar la estética del paciente cuando existe una exposición gingival excesiva y para facilitar la armonía de acuerdo a su aspecto facial.

Esthetic recontouring is a periodontal plastic surgery that aims to restore a more harmonious smile according to the patient's facial appearance, since the main reason to perform this procedure is when there is a diagnosis of an altered passive eruption or gingival smile. The gingival smile is one of the main concerns according to aesthetics when there is a gingival exposure of more than 3 mm in which it is justifiable to perform the aesthetic recontouring. 28-year-old female patient with a diagnosis of altered passive eruption 1B with a 4-month follow-up. Treatment consisted of esthetic recontouring to correct the gingival smile. Esthetic recontouring is a surgical procedure performed with the aim of improving the patient's esthetics when there is excessive gingival exposure and to facilitate harmony according to facial appearance.

Aesthetic Crown Lengthening: Case Reports

The crown lengthening is indicated for aesthetic purposes, exposure of subgingival caries, crown fractures or a combination of these, which can be characterized as aesthetic or functional, related to restorative indications, and restoration of biological width. Several factors need to be evaluated in the aesthetic planning for optimizing the smile, with the inclusion of an increase in the clinical crown, emphasizing the quality of the thin or thick periodontal phenotype, an adequate band of keratinized tissue and the size of the biological width. A correct diagnosis of the gummy smile etiology, as well as an assessment of clinical characteristics and anatomical dimensions, is of fundamental importance prior to the patient's approach. It determines and guide decisions regarding the possibilities of treatment and prognosis of cases. The aim of this study was to report two cases of cosmetic periodontal surgery with techniques commonly used for this purpose: gingivectomy and flap surgery with osteotomy.

El alargamiento clínico de corona está indicado con fines estéticos, exposición de caries subgingivales, fracturas coronarias o alguna combinación de estas, y puede caracterizarse como estético o funcional, relacionado con indicaciones restaurativas y restauración del espacio biológico. Varios factores deben ser evaluados en la planificación estética para optimizar la sonrisa, con la inclusión del aumento clínico de coronas, destacando la calidad del fenotipo periodontal delgado o grueso, la gama adecuada de tejido queratinizado y la dimensión del espacio biológico. Un diagnóstico correcto de las causas asociadas a la sonrisa gingival, así como una valoración de las características clínicas y dimensiones anatómicas, son de fundamental importancia antes de abordar al paciente, para determinar y orientar decisiones respecto a las posibilidades de tratamiento y pronóstico de los casos. El objetivo de este estudio fue reportar dos casos de cirugía periodontal estética con técnicas comúnmente utilizadas para este fin: gingivectomía y cirugía de colgajo con osteotomía.

Biologic Width Following Different Crown Lengthening Procedures: A Six-Month Follow-Up Study.

BACKGROUND: One of the important things to preserve during crown lengthening is the biologic width (BW), recently called supracrestal tissue attachment. A healthy periodontium with adequate BW is very essential for the success of restored teeth. There are various techniques to perform crown lengthening procedures. Most of the studies have focused on assessing the changes in the position of the marginal gingiva and bone as outcome parameters rather than BW. Also, most of the research was done on animal models. AIM: The purpose of this study was to assess the periodontal tissue changes at three months and six months following two different surgical crown lengthening procedures. MATERIALS AND METHODS: Sixty mandibular first molars among 60 patients that required surgical crown lengthening were enrolled in the study and subjected to two different procedures, gingivectomy (Group I; n=30) and apically positioned flap with ostectomy (Group II; n=30). The following parameters were recorded at baseline, three months, and six months, position of free gingival margin (FGM), probing depth (PD), relative attachment level (RAL), bone level (BL), and BW. These measurements were made at three sites in every patient: treated tooth sites (TT), adjacent tooth's adjacent sites (AD), and adjacent tooth's non-adjacent sites (NAD). The data was then subjected to statistical analysis using SPSS software (Version 20.0). Statistical significance was set to p<0.05. RESULTS: When groups I and II were compared at three and six months, there was no statistical difference in terms of position of FGM, PD, and RAL (p>0.05). When BW was compared between the two groups at three and six months, group II showed better reestablishment of BW at any given time period and was statistically significant (p<0.05). CONCLUSION:  Following surgical crown lengthening, the bone level was shifted apically and allowed for the reestablishment of BW. At six months of follow-up, the apically positioned flap with ostectomy was superior in restoring the BW compared to gingivectomy.

Evaluation of minimally invasive esthetic crown lengthening using an open flap versus flapless surgical approach: A randomized controlled clinical trial.

OBJECTIVES: Esthetic crown lengthening (ECL) is commonly advocated to treat patients with altered passive eruption (APE). Since the introduction of the minimally invasive surgical concept, a limited number of studies have investigated this technique in a standardized manner, with further studies required to verify the validity and predictability of the minimally invasive FL-technique. The current randomized trial compares a minimally invasive (ECL), using piezosurgery with flapless-approach (FL), versus an open-flap (OF) approach in the management of patients with APE Type 1B. MATERIALS AND METHODS: Twenty-four patients diagnosed with APE Type 1B were randomly assigned into test (FL) with tunneling approach or control (OF) group with minimally invasive flap reflection (n = 12/group). Postoperative pain was assessed during the first 48 h. Gingival margin (GM) level relative to a custom-made stent (rGM) and patient satisfaction were assessed preoperative, immediately after surgery, at 3 and 6 months postsurgically. Postoperative swelling was reported for the first week postsurgically. Plaque index (PI), bleeding on probing (BoP), clinical attachment level (CAL), pocket depth (PD) and pink esthetic score (PES), were evaluated at baseline and 6 months. Linear regression analysis was conducted for pain. RESULTS: OF-group reported significantly higher pain and swelling scores than FL-group during the first 48 h (p < 0.05). FL-group showed no significant differences regarding rGM between 3 and 6 months, in contrast to OF-group, where a significant decrease in rGM was notable (p < 0.05). No significant differences in PI, BoP, CAL, PD, PES, and patient satisfaction scores were evident between groups (p > 0.05). Regression analysis demonstrated that treatment and gender were significant predictors for pain (p < 0.05). CONCLUSIONS: Within the current study's limitations, piezo-surgical ECL with FL-approach presented significantly lower postoperative pain, swelling, and early GM stability compared to OF-approach. CLINICAL SIGNIFICANCE: Piezosurgical ECL with a FL-approach can be considered a predictable technique with advantages over the OF-approach in the management of patients with APE Type1B.

Minimally Invasive Aesthetic Suturing Technique for Anterior Aesthetic Crown Lengthening Surgery: A Case Series with 24- month Follow-Up.

BACKGROUND: A minimally invasive aesthetic suturing technique was employed in aesthetic crown lengthening surgery (ACLS). The objective of this report was to evaluate the clinical and patient- reported outcomes of this technique for ACLS. METHODS: Fifteen patients who underwent ACLS were treated utilizing the described suturing technique. Clinical parameters, including plaque index (PI), gingival index (GI), bleeding index (BI), papilla index score (PIS), early wound healing index (EHI), visual analogue scale (VAS), pink esthetic score and white esthetic score (PES/WES), were recorded at baseline, immediately post-surgery and during follow-up visits spanning 5 days to 24 months. The two-sample t-test was performed to evaluate statistical significance (α = 0.05). RESULT: 100% of the patients reported a high level of satisfaction, with a stable high postoperative VAS scores. From baseline to 5-day postoperation, there was no statistically significant increase in PI, although there was a slight deterioration observed in GI (0.13Å}0.23, P＜0.05) and BI (0.49Å}0.55, P＜ 0.05). Early wound healing (EHI 1) was achieved by all patients at 5 days post-surgery. Additionally, 3 patients exhibited changes in PIS within the initial 3 months following surgery, after which, all patients attained an optimal degree of papilla filling (degree III). CONCLUSION: The application of the minimally invasive aesthetic suturing technique in ACLS demonstrates favorable outcomes in terms of patient satisfaction and long-term stability. However, the assertion of its superiority over conventional suturing methods for ACLS necessitates substantiation through rigorous investigation via well-designed randomized controlled clinical trials.

Digitally planned surgical crown lengthening: a novel bone reduction strategy to correct a gummy smile.

This report describes the bone reduction guide which was digitally obtained to improve diagnosis, treatment outcome and follow-up. Treatment of gingival smiles due to altered passive eruption should include interdisciplinary planning and smile design to facilitate the prediction of treatment outcome. Crown lengthening surgery can be supported by digital tools to improve surgical planning and follow-up. A 30-year-old female patient was referred to a private dental clinic seeking solutions for her gingival smile. Based on the anatomical crown length, a smile design was created, and the patient was presented with a simulated smile before treatment. In the surgical phase, a full-thickness flap was raised in the upper jaw to achieve the desired outcome. Using cone-beam computed tomography to determine cementoenamel junction for smile design and treatment planning brings many benefits. Patients and clinicians can foresee treatment results. From there, appropriate changes can be made. The bone reduction guide is designed to rest on the bone to help the clinician cut the bone accurately and thoroughly follow the established plan.

A comparative study of the use of digital technology in the anterior smile experience.

OBJECTIVES: this study aims to compare the clinical outcomes of traditional and digital crown extension guides in the aesthetic restoration of anterior teeth. Additionally, the study will analyze the differences in the results of various digital crown extension guides in anterior aesthetic restorations. METHODS: Sixty-two patients who required aesthetic restoration of their anterior teeth were selected for this study. The patients had a total of 230 anterior teeth and were randomly divided into three groups: a control group of 22 cases who received diagnostic wax-up with pressure film, an experimental group 1 of 20 cases who received 3D printed digital models with pressure film, and an experimental group 2 of 20 patients who received digital dual-positioning guides. The control group had a total of 84 anterior teeth, experimental group 1 had 72 anterior teeth, and experimental group 2 had 74 anterior teeth. The study compared three methods for fabricating crown extension guides: the control group used the diagnostic wax-up plus compression film method, while experimental group 1 used compression film on 3D printed models and experimental group 2 used 3D printed digital dual-positioning crown extension guides. After the crown lengthening surgery, the control group patients wore DMG resin temporary crown material for gingival contouring, while the experimental group patients wore 3D printed resin temporary crowns for the same purpose. The patients were followed up in the outpatient clinic after wearing temporary crowns for 1 month, 3 months, and 6 months, respectively. The clinical results were evaluated in terms of marginal fit, red aesthetic index, and white aesthetic index. RESULTS: Based on the statistical analysis, the experimental group required significantly fewer follow-up visits and less time for guide design and fabrication compared to the control group. Additionally, the surgical time for the experimental group was significantly shorter than that of the control group. During the postoperative period between the 1st and 3rd month, the PES index scores for the marginal gingival level, proximal, and distal mesiodistal gingival papillae of the experimental group showed a trend of superiority over those of the control group. By the 6th month, the marginal gingival level exhibited a significant difference between the experimental and control groups. The experimental group demonstrated superior results to the control group in terms of shape, contour, and volume of the teeth, color, surface texture, and transparency of the restorations, and features during the 1st and 3rd postoperative months. In the 6th month, the comparative results indicated that the experimental group continued to exhibit superior outcomes to the control group in terms of the shape, color, surface texture, and transparency of the restorations, as well as the characteristics of the teeth. Additionally, the experimental group demonstrated significantly fewer gingival alterations than the control group at 1 month, 3 months, and 6 months post-procedure, with this difference being statistically significant. Furthermore, the combination of 3D printing technology and restorative techniques was utilized, resulting in consistent patient satisfaction. CONCLUSION: Digitalisation plays an important role in anterior aesthetic restorations. The use of digital technology to manage the entire process of anterior cosmetic restorations can improve restorative results, reduce the number of follow-up appointments, shorten consultation time, and achieve better patient satisfaction.

Time management in multistep periodontal and implant treatments: a practical guide.

In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

Effects of polymethyl methacrylate-based bone cement graft for treating excessive gingival display and its dimensional facial changes: 12-Month clinical study.

Objective: to present a 12-month follow-up with photographic and tomographic analyses of the effect of polymethyl methacrylate-based bone cement graft (PMMA) in gingival exposure (GE) in patients with excessive gingival display (EGD). Methods: Twelve patients with EGD were included. The PMMA was surgically placed. A frontal and lateral photograph protocol was performed at baseline (T0), 3 (T3), 6 (T6), and 12 months (T12) post-operatively. Soft tissue cone-beam computed tomography (ST-CBCT) was performed at T0 and T12. Measures included GE, length of the lip vermilion (LLV), lip shape (LS), nose width (NW), filter width (FW), nasolabial angle (NAS) while smiling, and nasolabial angle at rest (NAR). The height, thickness, and volume of the cement graft were also measured in the ST-CBCT. The comparisons were performed by Kruskal-Wallis test at 5 % of significance (p < 0.05). Results: The height, thickness, and volume of the PMMA were respectively 12.84 ± 1.59 mm, 3.83 ± 0.53, and 1532.02 ± 532.52 mm3. PMMA significantly decreased GE from 8.33 ± 1.25 mm (T0) to 6.60 ± 0.93 mm (T12) (p < 0.01). NAR was 98.34 ± 9.28° at T0 and increased to 105.13 ± 7.33° at T12; however, the angle value was not statistically different (p = 0.08). LLV, LS, NW, FW, and NAS did not exhibit statistical differences between the baseline and follow-up periods. Conclusions: PMMA significantly decreased GE in a 12-month follow-up without influencing adjacent soft tissue anatomical structures.

Is Deep margin elevation a reliable tool for cervical margin relocation? - A comparative review.

The permanence of deep subgingival restorations are questionable both functionally and biologically. Crown lengthening is one of the traditionally performing procedures to visualize and relocate the deep margins, but the limitations of the invasive surgical procedure are anatomical complications like exposure of root concavities or furcation, violation of biological width, post operative discomfort because of sutures or periodontal packs; and less patient compliance. Other than crown lengthening, researchers tried some other techniques like modified matrix adaptation technique, using retraction cord, making holes in matrix band and flowing resin modified glass ionomer cement (RMGIC) to the root or cervical caries, orthodontic extrusion. But most of these procedures are failed to give adequate clinical success. Deep margin elevation (DME) is one of the minimally invasive and successful procedure performing in deep subgingival caries. But the evidences and knowledge in this technique is limited among practitioners. This review is to evaluate the applicability of DME, the current clinical concepts, techniques and materials for DME; and a comparison with traditionally used various techniques for cervical margin relocation also concluding that currently available various clinical parameters with this technique.

Treatment of excessive gingival display using conventional esthetic crown lengthening versus computer guided esthetic crown lengthening: (a randomized clinical trial).

BACKGROUND: Surgical guides have been proposed in an attempt to reach more predictable outcomes for esthetic crown lengthening. The objective of the present study was to evaluate the effectiveness of esthetic crown lengthening using 3D-printed surgical guides in the management of excessive gingival display due to altered passive eruption type 1B. MATERIALS AND METHODS: Sixteen patients diagnosed with altered passive eruption type 1B, were divided into two groups. In the control group, the procedure was carried out conventionally, and in the study group, a dual surgical guide was used. The parameters of wound healing (swelling, color, probing depth, bleeding index, and plaque index), pain scores, gingival margin stability, and operating time were assessed at 1 week, 2 weeks, 3 months, and 6 months postoperatively. RESULTS: There was no statistically significant difference in terms of wound healing, pain scores, and gingival margin stability between both groups at different time intervals (P = 1), however, there was a statistical difference between both groups in terms of operating time with the study group being significantly lower (P < 0.001). CONCLUSION: Digitally assisted esthetic crown lengthening helps shorten the operating time and reduces the possibility of human errors during the measurements. This will be useful in helping practitioners achieve better results. PRACTICAL IMPLICATIONS: The conventional method remains to be the gold standard. However, shorter operating time and lower margins for errors will help reduce costs as the chair side time is reduced as well as the possibility for a second surgery is lower. This will improve patient satisfaction as well.

Individualized digitally designed surgical template for guided soft tissue surgery in cases with severe gingival enlargement: A clinical application in hereditary gingival fibromatosis.

AIM: The purpose of this study was to present the use of computer-assisted periodontal surgery utilizing a novel surgical guide for cases with severe gingival enlargement through a clinical application in a patient with hereditary gingival fibromatosis. MATERIALS AND METHODS: The treatment plan included nonsurgical periodontal therapy, surgical periodontal treatment, and regular periodontal maintenance before the initiation of orthodontic treatment. Due to the increased soft tissue thickness, a surgical guide with a novel design was fabricated to facilitate the periodontal surgery since most of the patient's teeth were malpositioned and underexposed due to fibromatosis. For this purpose, the patient's intraoral scan was merged with a CBCT image in order to plan surgical excisions based on the anatomy of the teeth and the bone contour. RESULTS: The customized surgical guide facilitated the gingivectomy by controlling not only the shape of the initial incisions but also their orientation toward the level of the cementoenamel junction, improving the efficiency of the clinical time compared with freehand surgery and assisting in the verification of the final soft tissue shape, based on the treatment plan. CONCLUSION: Digital technology through the superimposition of multiple data sets can assist in the diagnosis and multidisciplinary management of cases with gingival fibromatosis. The proposed design of the surgical guide can facilitate soft tissue surgery based on the digital treatment plan, leading to more predictable management of the soft tissue, especially in patients with severe gingival enlargement, as in cases with hereditary gingival fibromatosis or drug-induced gingival overgrowth.

Accuracy of three types of digital guides for crown lengthening surgery: An in vitro study.

Background/purpose: The guided protocols always yield a higher accuracy than freehand surgery. However, the accuracy of digital guides for crown lengthening surgery (CLS) is unknown. The purpose of this study was to evaluate the trueness of 3 types of digital guides for CLS. Materials and methods: Twenty individually designed maxillary models were divided into 4 groups according to surgical guides: type I (T1), type II (T2), type III (T3), and free-hand. T1 comprised a planed gingival margin at the tissue level. T2 included both the planed gingival margin and alveolar crest at the tissue level. T3 consisted of a planed gingival margin at the tissue level and an alveolar crest at the bone level. CLS was performed under the indication of the guides. Trueness of the guides was evaluated through the deviation of the gingival zenith and alveolar crest height. Results: The control group had higher vertical and horizontal distance deviations of gingival zenith compared to the 3 digital guide groups (P < 0.001). There were no significant differences among the 3 test groups in terms of gingival zenith deviations (P > 0.05). With regard to height deviation of alveolar crest, the control and T1 groups were higher than T2 group (P < 0.001), while T3 group had the lowest deviations among the 4 groups (P < 0.001). Conclusion: The digital guides assisted CLS procedures are more accurate than free-hand method. The trueness of type III guide was better than type I and type II.

Staged esthetic crown lengthening: Classification and guidelines for periodontal-restorative therapy.

OBJECTIVE: This article presents technical guidelines for perio-restorative esthetic crown lengthening, along with a discussion of the biologic rationale. A classification system is proposed to assist in treatment planning and sequencing the surgical and restorative phases. CLINICAL CONSIDERATIONS: When esthetic crown lengthening is performed as an adjunct to restorative therapy, the surgical approach must be determined by the anticipated position of the restorative margins. The removal of sufficient bone to achieve the desired clinical crown length and preserve the supracrestal gingival tissue dimensions is facilitated by the use of a surgical guide fabricated according to the design of the restorations. A staged approach allows sequencing the provisional restoration to minimize unesthetic sequelae during the healing period. Inadequate bone resection and/or alteration of the soft tissue dimensions results in delayed healing, leading to coronal gingival rebound and biologic width impingement. CONCLUSION: The identification and preservation of appropriate restorative and biologic landmarks is essential for success in pre-prosthetic esthetic crown lengthening treatment. A staged approach improves the esthetic management during the postsurgical healing and maturation period. CLINICAL SIGNIFICANCE: A restorative driven classification system for sequencing and staging adjunctive esthetic crown lengthening procedures is presented. Technical guidelines to enhance gingival margin predictability are suggested, accompanied by relevant evidence. In addition, wound healing timelines following gingival and osseous resection are provided.