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    White Minimalist Business Chart Presentation

    Uploaded by

    Nimra Meraj

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    © All Rights Reserved
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    White Minimalist Business Chart Presentation

    Uploaded by

    Nimra Meraj
    4 views28 pages

    Copyright

    © © All Rights Reserved

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    PPTX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    4 views28 pages

    White Minimalist Business Chart Presentation

    Uploaded by

    Nimra Meraj

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 28

    Crown Lengthening procedure

    Presented by
    Nimra Meraj
    Definition
    Surgical procedure designed to increase the extent of supragingival tooth
    structure for restorative and esthetic purposes.
    ??????
    ??????

    Gummy Smile
    ??????
    ??????

    Uneven gingival Contours


    ??????
    ??????

    Subgingival Caries
    ??????
    ??????

    Can’t Afford ;)
    indications
    Restorative needs
    • ? To increase clinical crown height lost due to wear or fracture
    • To access subgingival caries;
    • To produce a ‘ferrule’ for post-crown provision
    • To access a perforation in the coronal third of the root;
    • To relocate margins of restorations that are impinging on biological width.
    Aesthetics
    • ? Short teeth;
    • ? Uneven gingival contour; ?
    • ‘Gummy smile’.
    contraindications
    • Inadequate crown to root ratio
    • Non-restorability of caries or root fracture
    • Esthetic compromise
    • inadequate predictability
    • Tooth arch relationship inadequacy
    • Compromise of adjacent periodontium or esthetics
    • Insufficient restorative space
    • Non-maintainability
    CONSIDERATION TO DETERMINE A TOOTH’S PERIODONATAL AND RESTORATIVE PROGNOSIS
    Biological width??
    Biological width (BW) is the distance established from the
    junctional epithelium and connective tissue attachment to the
    root surface of a tooth.
    epithelial (junctional epithelium) of 0.97 mm (0.71-1.35 mm)
    and a supra-alveolar attachment of connective tissue of 1.07 mm
    (1.06-1.08 mm)
    Hence, the overall width of the attachment is 2.04 mm
    Important before placing a
    restoration!!!
    There should be 3mm (recommended) of supracrestal tooth tissue between
    bone and the margins of the restoration.
    Treatment and Technique
    Periodontal Surgical Technique Orthodontic Technique
    Classification of aesthetic crown legthening
    Procedures performed for CROWN LENGTHENING.

    Surgical
    • Gingivectomy
    • Conventional (scalapel or Surgical Extrusion using
    1 kirkland knife) 2 peritome
    • Laser
    • Electrocautery

    Internal Bevel Gingivectomy with Apical positioning of flap with or


    or without ostectomy (also referred without ostectomy
    3 as flap surgery with or without 4 • Combined (Surgical & non
    osseous surgical) Orthodontic
    surgery) treatment
    procedure
    Step 1: Internal bevel incision given (no more than 1 mm of crest of
    gingiva and directed to the crest of bone)
    Step 2: Crevicular incisions made,initial elevation of flap
    Step 3: Vertical incisions made, extending beyond the MGJ

    Step 4: Removal of all granulation tissue. Osseous surgery,if required

    Step 5: Flap is displaced Apically


    Step 6 :Sling sutures are placed around the tooth to prevent flap
    from sliding more
    Step 7: Apically Periodontal dressing placed to prevent
    Complications
    • Possible poor aesthetics due to 'black triangles'
    • Root sensitivity
    • Root resorption
    • Transient mobility of the teeth.
    • Gingival retraction - change of marginal gingival contour
    • Clinical tooth crown higher than adjacent teeth
    • Unfavorable crown-root relationship.
    Healing After Crown Lengthening
    • Restorative procedures must be delayed until a new gingival crevice develops after
    periodontal surgery.
    • In nonesthetic areas, the site should be re-evaluated at least 6 weeks post surgically before
    final restorative procedures.
    • In esthetic areas, a longer healing period is recommended to prevent recession.
    • Wise recommends 21 weeks for soft tissue gingival margin stability. Therefore, restorative
    treatment should be initiated after 4-6 months. The margin of the provisional restoration
    should not hinder healing before the biologic width is established by surgical procedures.
    • Shobha et al. in a study on clinical evaluation of crown lengthening procedure had
    concluded that the biologic width can be re-established to its original vertical dimension
    along with 2 mm gain of coronal tooth structure at the end of six months.
    Post OP care.
    • Diet
    • Comfort (medications)
    • BleedingSwelling for first 24 hours
    • Oral hygiene maintenance
    • Avoid Smoking if smoker
    • Post Op followups
    Referances
    • Carranza's clinical periodontology. 10th edition
    • Surgical crown lengthening. Dent Update 2007;34:462-468 • Crown Lengthening Procedures-
    A Review Article Dr. Gunjan Gupta IOSR Journal
    • of Dental and Medical Sciences (IOSR-JDMS)
    • Biological width: The silent zone Amit Parashar
    • Tissue Management in Restorative Dentistry J. WILLIAM ROBBINS, DDS, MA
    • Crown lengthening and restorative procedures in the esthetic zone-Perio 2000 • Surgical
    lengthening of the clinical tooth crown Liudvikas Planciunas, Alina
    • Puriene, Grazina Mackeviciene,2006
    Thank you
    For your attention

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