Journal of Pharmacy And Bioallied Sciences
Journal of Pharmacy And Bioallied Sciences Login  | Users Online: 1474  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 
    Home | About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions | Online submission




 
 Table of Contents  
DENTAL SCIENCE - ORIGINAL ARTICLE
Year : 2013  |  Volume : 5  |  Issue : 5  |  Page : 14-16  

Three different surgical techniques of crown lengthening: A comparative study


1 Department of Periodontics, Vivekanandha Dental College for Women, Elayampalayam, Tiruchengode, Namakkal, Tamil Nadu, India
2 Department of Orthodontics, Vivekanandha Dental College for Women, Elayampalayam, Tiruchengode, Namakkal, Tamil Nadu, India
3 Department of Orthodontics, Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India

Date of Submission02-May-2013
Date of Decision04-May-2013
Date of Acceptance04-May-2013
Date of Web Publication13-Jun-2013

Correspondence Address:
Ramya Nethravathy
Department of Periodontics, Vivekanandha Dental College for Women, Elayampalayam, Tiruchengode, Namakkal, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.113281

Rights and Permissions
   Abstract 

Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A), apically repositioned flap (Group B) and surgical extrusion using periotome (Group C). Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

Keywords: Biologic width, gingival zenith, gingivectomy, periotome


How to cite this article:
Nethravathy R, Vinoth SK, Thomas AV. Three different surgical techniques of crown lengthening: A comparative study. J Pharm Bioall Sci 2013;5, Suppl S1:14-6

How to cite this URL:
Nethravathy R, Vinoth SK, Thomas AV. Three different surgical techniques of crown lengthening: A comparative study. J Pharm Bioall Sci [serial online] 2013 [cited 2022 Nov 28];5, Suppl S1:14-6. Available from: https://www.jpbsonline.org/text.asp?2013/5/5/14/113281

A short clinical crown occurs as a result of, deep subgingival caries, tooth fracture, iatrogenic factors may lead to poor retention form which allow for proper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. [1],[2]

Several techniques such as gingivectomy, apically repositioned flap with or without respective osseous surgery, and orthodontic forced eruption with or without fibrotomy have been proposed for clinical crown lengthening. [2] The selection of one technique over another depends on several patient related factors such as esthetics, clinical crown to root ratio, root proximity, root morphology, furcation location, individual tooth position, collective tooth position and ability to restore the teeth. [3],[4],[5]


   Objectives for Crown Lengthening Top


  1. Exposure of sufficient sound tooth structure in case of deep subgingival tooth fracture and carious lesion
  2. To enhance retention of restoration
  3. Correct placement of margins of restorations without violating the biologic width
  4. Improved esthetics in patients with uneven gingival margin and excessive gingival display. [1]
Aim

The aim of this study is to evaluate clinically the three different surgical techniques of crown lengthening procedures.

Materials and Methods

Sample size

  • 15 patients (nine males and six females) reported to the Department of Periodontology, Vivekanandha Dental College for Women, Thiruchengode were included in the study
  • Patients were equally and randomly divided into three groups.
Group A: Gingivectomy
Group B: Apically repositioned flap
Group C: Surgical extrusion using periotome

Clinical measurements

Pre-operative and post-operative measurements of the following clinical criteria were taken:

  • Length of the clinical crown
  • Width of attached gingiva
  • Gingival zenith
  • Interdental papilla height
Surgical extrusion using periotome

Surgical procedure

Following local anaesthesia, the blade of the periotome was placed into the periodontal ligament space and manipulated in walking motion to luxate the tooth without inducing surgical trauma. [Figure 1] shows one of our patient pre-operative picture showing the tooth prior to crown lengthening. [Figure 2] is same patient immediate post-operative picture. Teeth was extruded to the desired clinical position using a hemostat. [1],[6] Simple interrupted sutures placed for stability. Periodontal pack given. Suture removal done after 10 days. Final restoration placed after 2 months.
Figure 1: Pre-operative photograph

Click here to view
Figure 2: immediate post-operative

Click here to view



   Results Top


[Table 1] shows that there was no change in the width of attached gingiva and minimal change in the interdental papilla height between pre-operative and post-operative measurements in the crown lengthening procedure done by surgical extrusion using periotome when compared to the other conventional surgical procedures.
Table 1: Preoperative and postoperative measurements of three different surgical techniques

Click here to view


Width of attached gingiva is measured using Williams periodontal probe. It is obtained by subtracting the probing depth from the total length from marginal gingiva to mucogingival junction.

Interdental papilla height is obtained by measuring the length from the tip of the interdental papilla to the line connecting the gingival zenith of the adjacent teeth on both the mesial and distal aspect. The mean value is calculated for both mesial and distal aspect of the interdental papilla.

Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss compared with the other conventional surgical techniques.


   Discussion Top


Clinically stable mobility of the extruded teeth was observed in 1 month and maintained during the observation period. There was radiographic evidence of periapical bone formation as early as 2 month post-operatively. No endodontic complication was observed. Several authors such as Kanhberg et al. 1996 and Kim et al. 2004 have demonstrated the clinical feasibility of surgical extrusion with short and long term results.

The clinical finding presented here suggest that clinical crown lengthening by surgical extrusion using periotome offers several advantages over the other conventional surgical approaches such as there was no change in the width of attached gingiva, interdental papilla height and gingival zenith level in pre- and post-operative measurements. This technique can be used to successfully treat a tooth with poor retention form and grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern when compared with other conventional surgical techniques such as gingivectomy and apically repositioned flap with or without respective osseous surgery. Further studies with larger sample size are needed to confirm this clinical evaluation.


   Conclusion Top


Surgical extrusion technique using periotome can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

 
   References Top

1.Sonick M. Esthetic crown lengthening for maxillary anterior teeth. Compend Contin Educ Dent 1997;18:807-12.  Back to cited text no. 1
    
2.Nemcovsky CE, Artzi Z, Moses O. Preprosthetic clinical crown lengthening procedures in the anterior maxilla. Pract Proced Aesthet Dent 2001;13:581-8.  Back to cited text no. 2
    
3.Levine RA. Forced eruption in the esthetic zone. Compend Contin Educ Dent 1997;18:795-803.  Back to cited text no. 3
    
4.Bensimon GC. Surgical crown-lengthening procedure to enhance esthetics. Int J Periodontics Restorative Dent 1999;19:332-41.  Back to cited text no. 4
    
5.Davarpanah M, Jansen CE, Vidjak FM, Etienne D, Kebir M, Martinez H. Restorative and periodontal considerations of short clinical crowns. Int J Periodontics Restorative Dent 1998;18:424-33.  Back to cited text no. 5
    
6.De Waal H, Castellucci G. The importance of restorative margin placement to the biologic width and periodontal health. Part II. Int J Periodontics Restorative Dent 1994;14:70-83.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Positional Stability of the Periodontal Tissues Following Crown Lengthening Surgery
Walid Altayeb, Roberto Rossi, Arnabat-Dominguez Josep
Dentistry Review. 2022; : 100059
[Pubmed] | [DOI]
2 Success rate of fractured teeth receiving modified crown lengthening surgery and restorations
Cui Wang, Xue-ting Jia, Min Zhen, Wen-Jie Hu, Hao Zhang, Kwok-Hung Chung
BMC Oral Health. 2022; 22(1)
[Pubmed] | [DOI]
3 Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review
Martina Cordaro, Edoardo Staderini, Ferruccio Torsello, Nicola Maria Grande, Matteo Turchi, Massimo Cordaro
International Journal of Environmental Research and Public Health. 2021; 18(18): 9530
[Pubmed] | [DOI]
4 Post-endodontic treatment using composite resin cement and fiber post
Daniel Cerný, Radek Mounajjed
Endodontics Today. 2021; 19(1): 23
[Pubmed] | [DOI]
5 Pre-restorative crown lengthening surgery outcomes: a systematic review
Ioannis Pilalas,Lazaros Tsalikis,Dimitris N. Tatakis
Journal of Clinical Periodontology. 2016; 43(12): 1094
[Pubmed] | [DOI]
6 Dental Extrusion with Orthodontic Miniscrew Anchorage: A Case Report Describing a Modified Method
Ricardo Fidos Horliana,Anna Carolina Ratto Tempestini Horliana,Alexandre do Vale Wuo,Flávio Eduardo Guillin Perez,Jorge Abrão
Case Reports in Dentistry. 2015; 2015: 1
[Pubmed] | [DOI]
7 Analysis of protein expression in periodontal pocket tissue: a preliminary study
Emanuela Monari,Aurora Cuoghi,Elisa Bellei,Stefania Bergamini,Andrea Lucchi,Aldo Tomasi,Pierpaolo Cortellini,Davide Zaffe,Carlo Bertoldi
Proteome Science. 2015; 13(1)
[Pubmed] | [DOI]
8 Cumin (Cuminum cyminumL.) from Traditional Uses to Potential Biomedical Applications
Sami Mnif,Sami Aifa
Chemistry & Biodiversity. 2015; 12(5): 733
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Objectives for C...
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed11530    
    Printed182    
    Emailed7    
    PDF Downloaded1162    
    Comments [Add]    
    Cited by others 8    

Recommend this journal