Er:YAG Laser for Surgical Crown Lengthening: A 6-Month Clinical Study.

This study evaluated use of a solid-state laser to avoid the flap technique and suturing. An Er:YAG laser was used in 26 consecutive patients referred for osseous crown lengthening in 32 posterior teeth. The distance from the planned restoration margin to the alveolar crest (B) satisfied a 3-mm dentogingival complex. No tissue necrosis and no significant change in the distance from the gingival margin to B or probing depth were detected at 3 and 6 months. Minimally invasive Er:YAG laser surgery decreases the time needed to establish the gingival margin necessary for definitive restoration.

Predictable interproximal tissue removal with a surgical stent.

The correction of diastemas in the anterior region with composite resin is considered to be practical and conservative. Harmony between the restorative material and the periodontium is necessary to achieve satisfactory functional and esthetic results. Whenever excessive gingiva occurs in the interproximal region, removal is necessary to avoid excessively contoured restorations. A predictable technique is described to conservatively remove interproximal tissue in situations in which crown lengthening is required to treat bilateral diastemas. A surgical template based on the diagnostically waxed cast was produced to serve as a reference during periodontal surgery.

Laser-assisted flapless crown lengthening: a case series.

As part of the paradigm shift toward more minimally invasive surgical procedures, increasing numbers of references to laser-mediated flapless crown lengthening are noted in the published literature. The vast majority of these references are noncontrolled case reports or technique-focused articles. Therefore, prospective, randomized controlled studies that objectively examine the safety and efficacy of flapless crown lengthening are lacking. The current case series represents an initial attempt to examine some of the clinical issues posed by this minimally invasive flapless approach. Ultimately, only well-designed controlled clinical trials can yield the type of evidence-based data necessary to categorize this approach to crown lengthening as standard-of-care treatment.

Biologic rationale of esthetic crown lengthening using innovative proportion gauges.

Research shows that practitioners tend to underestimate the amount of tooth structure that must be exposed during a crown lengthening procedure. In the anterior portion of the mouth, this can lead to biologic width problems and subsequent cosmetic issues. This paper presents a biologically based, step-by-step approach to periodontal esthetic crown lengthening. Using a series of innovative measuring gauges, the ideal clinical crown length of a tooth as well as the proper occlusogingival placement of the interproximal papilla will be determined based on established, documented tooth proportion relationships. The biologic crown length of the tooth, defined as the distance from the incisal edge to the bone crest, will subsequently be determined as a function of the clinical crown length, with the ultimate goals being adequate tooth structure for the placement of a restorative margin, establishment of a healthy dentogingival complex, and the placement of an esthetically pleasing definitive restoration.

The use of a diagnostic wax set-up in aesthetic cases involving crown lengthening--a case report.

UNLABELLED: Crown-lengthening surgery (CLS) consists of recontouring and repositioning the gingival margin as well as the alveolar crest. This technique results in the increase of the clinical crown height of teeth, which can consequently be advantageous in terms of improving retention and resistance, as well as aesthetics.The aim of this article is to demonstrate the uses of the diagnostic wax set-up and the subsequent production of surgical stents and templates to provide the patient with an initial intra-oral diagnostic mock-up for the process of obtaining consent, as well as acting as a useful guide for gingival and osseous recontouring in order to achieve a predictable, healthy and stable dento-gingival complex with pleasing aesthetics. CLINICAL RELEVANCE: The use of a well made diagnostic wax-up can provide valuable information to the dentist, laboratory, and patient which can be otherwise difficult to communicate.

Microscope-enhanced periodontal therapy: a review and report of four cases.

AIM: The aim of this report is to review the status of the use of surgical microscopes and microsurgery and their clinical application in the field of periodontics. BACKGROUND: The use of magnification systems and periodontal microsurgery are part of a broad movement in dentistry toward the use of minimally invasive procedures to replace the need for more extensive surgical procedures. While magnification systems are widely used in endodontics, their application in periodontics is still in its nascent phase. However, clinicians have reported that use of magnification facilitates the use of minimal invasive periodontal surgery. TECHNIQUE: The surgical microscope is an invaluable aid for periodontists in the diagnosis and treatment of periodontal disease. Magnified vision used in conjunction with microsurgical instruments and techniques can lead to a higher quality of care and an improved surgical outcome. SUMMARY: Surgical operating microscopes have shown promising results in the hands of periodontists who are properly trained in their use. Despite the apparent advantages, there is still a lack of "high level of evidence" in the form of controlled clinical trials to estimate the magnitude of the real benefits of the microsurgical approach over the conventional approach. CONCLUSION: The scientific community understands the need for more investigations to completely understand the conditions that would best favor the creation of a tooth substitute. Recent gains in the understanding of the molecular regulation of tooth morphogenesis, stem cell biology, and biotechnology offers the opportunity to realize this goal. CLINICAL SIGNIFICANCE: Even though all the procedures shown in this review can be performed using normal vision, performing these procedures using a surgical microscope and microsurgical instruments offers definite advantages in terms of improved visual acuity, superior approximation of wounds, rapid wound healing, decreased post-operative morbidity, and increased acceptance by the patients.

A biometric approach to aesthetic crown lengthening: part II--interdental considerations.

Optimizing the aesthetic outcome for patients requiring periodontal aesthetic restorative treatment has become a primary objective in contemporary dentistry. Techniques that simplify and enhance quality of treatment provide substantial benefits to patients and clinicians. This article describes new concepts associated with interdental changes due to alterations in tooth and contact area position, and addresses the need for treatment of the interdental papillae. An innovative approach to aesthetic interdental periodontal crown lengthening will be discussed.

A biometric approach to aesthetic crown lengthening: part I--midfacial considerations.

Although human dental anatomy is taught in university curricula, clinicians often witness restorations that are not proportional to one another. Dental restorations should also be proportional to periodontal supporting tissues as an essential aspect of dental anatomy. Measurements can be performed directly on a patient's teeth with aesthetic gauges used to confirm the correct position of the supporting osseous topography. This article demonstrates a technique using these gauges to objectively determine the correct position of the underlying hard tissues and render predictable, aesthetic treatment.

Laser-assisted gingival tissue procedures in esthetic dentistry.

Soft tissue lasers are increasing in popularity among clinicians in part due to their potential value in preprosthetic gingival procedures. The ability of soft tissue lasers to control moisture and facilitate hemostasis appears particularly promising for clinicians excising gingival tissues, performing esthetic crown lengthening, and using resective techniques for gingival troughing--and these applications will grow as practitioners become more familiar with such technologies. This presentation highlights the use of the 810 nm diode laser for perio-restorative procedures in the anterior maxilla.

Clinical use of the Er,Cr: YSGG laser for osseous crown lengthening: redefining the standard of care.

UNLABELLED: To design the optimal outcome for a patient during aesthetic enhancement, the restorative dentist must seek to create a symmetrical and harmonious relationship between the lips, gingival architecture, and the positions of the natural dentate forms. In the author's experience, the Er,Cr: YSGG laser has been a useful adjunct for performing aesthetic surgical crown lengthening procedures. This article will highlight the associated biological principles and demonstrate techniques for the application of this laser in closed and open crown lengthening procedures. LEARNING OBJECTIVES: This article demonstrates the use of the Er,Cr: YSGG laser for osseous crown lengthening . Upon reading this article, the reader should have: Enhanced awareness of criteria for developing a biologically stable free gingival margin. Greater familiarity with the open and closed crown lengthening procedures, including case selection and surgical approaches.

Use of interdisciplinary team approach in establishing esthetic restorative dentistry.

Managing crown lengthening in cases of attrition (wear or loss of tooth substance) and achieving desired esthetic outcomes, especially in the esthetic zone, is challenging. This case report presents an interdisciplinary approach to case management. Concomitant use of digital imaging, along with model wax-ups and surgical guide, were used to enhance patient acceptance during treatment planning and to facilitate communication and treatment implementation among dental professionals and laboratory technicians. Resulting surgical template was used for crown lengthening to apically position the gingival zenith (margin) to a predetermined level, crown preps and final restorations, respectively, ultimately improving esthetics and patient satisfaction. Supplementing esthetic treatment planning with digital imaging, model wax-ups and a surgical template allows a dentist to carry information into the mouth and incorporate it into the surgical procedure, crown preps, temps and, ultimately, the final restoration.

Forced eruption after crown/root fracture with a simple and aesthetic method using the fractured crown.

Forced eruption offers a method of treatment of teeth fractured close to the alveolar crest. We introduce a modification of this common technique. The fractured fragment of a patient's crown is bonded to the adjacent teeth and used as anchorage, permitting the root extrusion while offering acceptable aesthetics. The bonded crown does not impede the eruption of the root so that the frequent occlusal adjustment of other methods is not required. The final result is acceptable and a low cost alternative to common techniques.

Orthodontic extrusion of subgingivally fractured incisor before restoration. A case report: 3-years follow-up.

Orthodontic forced eruption may be a suitable approach without risking the esthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest. Extrusion of such teeth allows elevating the fracture line above the epithelial attachment and so the proper finishing margins can be prepared. Restoration after orthodontic eruption may present a more conservative treatment choice in young patients compared with the prosthetic restoration after extraction. This case describes a multidisciplinary approach using the orthodontic forced eruption facilitating the composite restoration of a fractured upper permanent central incisor.

Surgical extrusion technique for clinical crown lengthening: report of three cases.

Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths < or = 3 mm around the teeth at all sites, without bleeding on probing. The teeth functioned normally, with near-normal mobility. Radiographs showed normal periodontal contour consistent with new bone formation in the periapical area. Radiographic analysis did not show any evidence of root or crestal bone resorption or endodontic problems. The technique presented could constitute an alternative surgical approach to performing crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.

Closed-flap laser-assisted esthetic dentistry using Er:YSGG technology.

Use of a hard-/soft-tissue laser is a wonderful adjunctive tool for esthetic and restorative dentistry. The cases described here demonstrate some of the many ways in which this laser technology allows clinicians to make significant soft- and hard-tissue changes. These changes not only improve the final esthetic outcome of the case but also provide the biologic functional parameters required for successful dentistry.

Forced eruption for preservation of a deeply fractured molar.

BACKGROUND: The treatment of deeply fractured and irreparably damaged teeth often confronts the dentist with a complex problem: Besides extraction, re-implantation and surgical crown lengthening, forced eruption is a reasonable differential alternative. HISTORY AND CLINICAL FINDINGS: In the following case a second lower molar was deeply fractured as a result of an internal granuloma. The tooth had undergone endodontic treatment and had been shortened to alveolar bone level, as the patient had refused extraction. THERAPY: A forced eruption with fibrotomy was performed using an unphysiologically high force. The buccal teeth (canine to first molar) served as the anchorage unit. The mechanics consisted of a lever arm activated to 230 cN. The duration of extrusion was 8 weeks. The tooth was subsequently hemisectioned and provided with an abutment, and the two posts were distalized because of root crowding and moved apart from each other. This was followed by an 8-week retention period, after which the finished crown could be inserted. CONCLUSIONS: The technique of forced eruption accompanied by fibrotomy enabled the roots to be elongated by ca. 4 mm without apposition of alveolar bone. This permitted restoration with physiologic gingival conditions, eliminating the need for surgical crown lengthening with marginal ostectomy or tooth extraction.