The main indications for clinical crown lengthening are to fulfill the need to:
• Increase tooth length for esthetic reasons
• Eliminate pseudo pockets
• Expose sufficient quantity of healthy dental structure above the gingival margin in case of cervical or interproximal caries, dental fractures, or inconsistent margins of subgingivally placed restorations.
A 29 years old male non-diabetic and non-smoker presented with extensive distruction of the crown on tooth no. 44. The margin of the preparation was below the gingiva and very close to the alveolar crest. In order to provide sound tooth structure and to preserve the natural tooth, an apically positioned flap along with minimal bone resection was carried out.
Lengthening of the clinical crown of a single-rooted tooth with concomitant increase in attached gingiva. Clinical views before the surgery.
Lengthening of the clinical crown of a single-rooted tooth with concomitant increase in attached gingiva. Radiographic views before the surgery.
Design of the split-thickness buccal double-papilla flap. Design of the full-thickness lingual flap with submarginal incision. Removal of the interproximal tissue.
Measurement of the distance between the preparation margin and the bone ridge (3 mm) at the distal aspect. Than removal of the distal interproximal bone.
Measurement of the distance between the preparation margin and the bone crest after bone recontouring (4 mm). Suture of the double papilla flap.
Healing after 3 months.
Clinical and radiographic comparison before surgery (left pictures) and after 12 years.
When clinical crown lengthening is performed on a single tooth requiring prosthetic rehabilitation, the main problems to be addressed are the extent to which the periodontal support has to be removed both in relation to the tooth in question and to the adjacent teeth, and the imbalance between gingival levels that could occur at the completion of the treatment.
In such cases, it may be advisable to consider various therapeutic options such as extraction of the tooth and subsequent implant placement or orthodontic extrusion.
Knowles J, Burgett F, Nissle R, Shick R, Morrison E, Ramfjord S. Results of periodontal treatment related to pocket depth and attachment level. Eight years. J Periodontol. 1979;50:225–233.
Ochsenbein C. A primer for osseous surgery. Int J Periodontics Restorative Dent. 1986;6(1):8-47.
Lindhe J, Socransky SS, Nyman S, Westfelt E. Dimensional alteration of the periodontal tissues following therapy. Int J Periodontics Restorative Dent. 1987;7(2):9-21.
Kois JC, Vakay RT. Relationship of the periodontium to impression procedures. Compend Contin Educ Dent. 2000;21(8):684-6.
Van der Velden U. Regeneration of the interdental soft tissues following denudation procedures. J Clin Periodontol. 1982;9(6):455-9.
Levine HL. Periodontal ?ap surgery with gingival ?ber retention. J Periodontol. 1972 Feb; 43(2): 91-8.
Carnevale G. Fibre retention osseous resective surgery: a novel conservative approach for pocket elimination. J Clin Periodontol. 2007;34(2):182-7.
Donnenfeld OW, Hoag PM, Weissman DP. A clinical study on the effects of osteoplasty. J Periodontol. 1970;41(3):131-41.