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7/30/2019 Esthetic Surgical Procedures
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TARRSON FAMILY ENDOWED
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UCLA SCHOOL OF DENTISTR
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PresentsPresents
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E. Ba
Tarrs
Prof
UCL
ESTHETIC SURGICAL PROCEDURES FORCROWN LENGTHENING
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1. Gingivectomy
2. Flap surgery for osseousrecontouring
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Need minimum of one millimeter connectivetissue coronal to bone margin
Gingival margin will be two millimeterscoronal to this with 2 mm crevice depth.
Red line- Gingival margin.Pink area connective tissue.Black line probe to depth of crevice.
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Distance of gingival margin to bone on labial is 3mm.Two mmof this is crevice depth, and 1mm. is for connective tissue
between probable depth and crest of bone.
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Five millimeters of crevice depth withadequate band of Keratinized tissue
Gingivectomy can be used to increasecrown length by up to 3 mm
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Advantages of Gingivectomy
Precise control of gingival contours
Low risk of inadvertent necrosis of tissueduring healing
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Crevice depth of five millimeters will allowthree millimeters of crown lengthening byGingivectomy
If more than three millimeters needed useFlap Surgery
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Gingivectomy Techniques
This patient requires 3 mm of crownlengthening
Sufficient crevice depth and Keratinizedtissue
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Gingivectomy completed with surgicalscalpels and knives
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Healing at three weeks
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Crowns placed twelve weeks afterGingivectomy
Next slide Before and After
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Gingivectomy to correct lack of symmetryand short crowns
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Sufficient crevice depth and Keratinizedgingiva
Frenum correction also needed
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Scalpel used to establish 10 mm crownlength on central incisor
Height of contour of gingiva is distalized
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Kirkland Knife used to refine gingivalcontours by gentle scraping
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Length of central incisor serves asbasis for lateral incisor and cuspid
Lateral incisor gingival margin 1 mmcoronal to central
Cuspid gingival margin at same levelas central
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The lateral incisor also has distalizedgingival margin
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Left central incisor gingival margin
shaped for symmetry with right central
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Gingivectomy completed with bilateralsymmetry
Right central incisor edge will needshortening
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Initial incision for Frenectomy
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Removal of wedge of tissue fromfrenum
Interdental papilla is untouched
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Incision made through periosteumto expose bone
This ensures no muscle pull existsto interdental papilla
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Wound closed tightly with 5.0 gut sutures
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Healing at twelve weeks
Next Slide Before and After
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Crown Lengthening requires Flap
Surgery and osseous correction
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Initial Incisions
Central incisor and cuspid newgingival margins at same level
Sulcular incision used on lateralincisor to make it harmonious withcentral and cuspid
Interproximal incisions preservepapillae
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Incisions on left symmetricalwith right
Use new blade for each two teethto minimize tissue trauma
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Flap carefully dissected with sharpscalpels
3 mm of bone crest exposed
Bone recontouring needed to provideadequate connective tissue apical tocrevice depth
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Bone Margin has been moved apically
of central incisor and cuspid
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Flap sutured with apical positioningof gingival margins on central
incisors and cuspids
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Final Result at Twelve Weeks
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Short clinical crowns with largegingival display on smiling
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Insufficient gingival crevicedepth for Gingivectomy
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Premolars are included because ofexposure with smiling
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15 c scalpel used to distalizegingival margin equally on
central incisors
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12 B scalpel begins sharp dissectionof full thickness flap with
preservation of interdental papillae
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Incised gingiva gently removed
with sharp back action hoe
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Flap elevated and bone recontoured
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Flaps sutured with simple 5.0 gutinterproximal sutures
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Central incisors lengthening to 11 mm
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Firm pressure applied to flap for 5 minutes
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Healing at one week
No post surgical brushing orflossing
Chlorhexidine mouth washes threetimes per day
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Healing at twelve weeks
Gingival margins now stable
Gentle brushing with soft brush and
chlorhexidine from second week postoperative
Gentle flossing after four weekshealing
Next slide Before and After
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Short clinical crowns and excessivegingival display following
orthodontic treatment
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Level of Incisal edge is established
Central incisor and cuspid incisal edgesat same level
Lateral incisal edge 1 mm apical tocentral incisor
Incisal plane parallels lower lip
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Gingival crevice too shallow forGingivectomy
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New gingival margins established with
incisions
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Central incisor length at 10.50 mm
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Flap elevated to expose bone margin
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Bone recontoured to provide sufficient
connective tissue for Biologic width
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Flaps sutured in final position
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Healing at twelve weeks
Next slide Before and After
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Upper and lower incisors, cuspids, andpremolars with asymmetry and small
clinical crowns
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Size of clinical crowns too shortfor facial dimensions and smile
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Flap elevated to expose bone margins
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Osseous recontouring to movebone margins apical
Long anatomical crowns on centralincisors
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Flaps sutured with apical positionof gingival margins including
premolars
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Healing at twelve weeks
Cuspids elongated to give masculine
emphasisNext two slides Before and After
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Altered passive eruption
Short asymmetrical clinical
crowns
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Healing at one week
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Healing at 12 weeks
Next Slide Before and After
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Gingival and tooth estheticsunacceptable to patient
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Flaps and osseous recontouringcompleted
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Final Restorations completed after24 weeks of healing
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ONE WEEK POST SURGERY
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TEN WEEKS POST SURGERY
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Crown lengthening for esthetics and toprovide sufficient root volume for crownretention
Need to establish incisal edge asbaseline for gingival dimensions
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Provisional acrylic templateestablishes final crown
dimensions and incisal edge
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Patient can view template andsuggest any necessary
changes
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At time of Flap Surgery, gingivalmargins outline on tissues
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Flaps elevated to expose bonemargins
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Bone recontoured to mirror finalgingival margins
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Position of new gingival marginsconfirmed with stent
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Flap positioned withpolytetraflurethylene sutures
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Palatal view
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Healing at 6 weeks
Lower incisors also treated
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If amount of crown lenthening needed will result indepth of crevice being less than 1mm from bonemargin then flap sugery and bone removal is requiredto give adequate BIOLOGICAL WIDTH