Dentaltown February 2018 - 78

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 1: A preoperative photo of the patient in forced smile reveals how he shows almost no teeth.
Figs. 2 and 3: Occlusal views of patient's worn-down teeth and evidence of endodontic access holes.
Figs. 4-6: Postoperative views, taken six weeks after crown-lengthening 360 degrees on all maxillary teeth.

maybe only a portion of the tooth requires
crown lengthening. Those situations might
include:
* A fractured portion of the tooth
offers minimal crown height or even
extends subgingivally.
* Decay extending to minimal crown
height or even subgingivally.
* Removal of an older crown, only
to find that any of the previously
mentioned situations exist.

*

Placement of a subgingival root
restoration.
* A resorptive lesion that extends
subgingivally.
It goes without saying that prepping margins subgingivally is challenging because of
lessened visibility, increased bleeding (which
will also make getting a good impression
tougher), and more difficulty in packing
cord and having a readable margin.

Discover when to refer cases
to a perio specialist
In which situations should clinicians refer cases
to a periodontist? Dr. Brian S. Gurinsky's article for
Dentaltown discusses some of the factors and flags
where it makes sense to refer out. To read it, go to
dentaltown.com/gurinsky-on-perio.

78

FEBRUARY 2018 // dentaltown.com

Space invaders
The second main reason to lengthen a
tooth's crown is to avoid invading the biologic
width. Harken back to your dental school
days and you'll most certainly remember
hearing about the holy biologic width; in
general terms, this refers to the space from
the free gingival margin to the crestal bone.
Sulcus depth varies, depending on
which tooth you're probing and where you're
probing it. Assuming that we're dealing
with a periodontally healthy situation,
normal limits for a sulcus depth would
be 1-3mm. We then would assume the
epithelial attachment to be about 1mm,
and the connective tissue attachment to
be about 1mm as well. According to the
original biologic width studies by Gargiulo,¹
this 2mm of tissue is where we want to avoid
having a preparation end.
As a periodontist, my preference is to
not have preps end subgingivally, but that's
not realistic in 100 percent of the cases. If



http://www.dentaltown.com/gurinsky-on-perio http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown February 2018

Dentaltown February 2018 - Intro
Dentaltown February 2018 - Cover1
Dentaltown February 2018 - Cover2
Dentaltown February 2018 - 1
Dentaltown February 2018 - 2
Dentaltown February 2018 - 3
Dentaltown February 2018 - 4
Dentaltown February 2018 - 5
Dentaltown February 2018 - 6
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Dentaltown February 2018 - Cover3
Dentaltown February 2018 - Cover4
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