Dentaltown February 2018 - 79
the margin ends in the sulcus, we're going
to be safe most of the time-85 percent of
the time, according to Kois.² Violate this
principle by having your margin end in the
2mm of tissue attachment, however, and you'll
face an untimely death. OK, maybe that was
an exaggeration, but you risk having chronic
inflammation, bleeding and discomfort, as
well as possible gingival recession.
The best course of treatment is to prep
the tooth for the ideal location of your
margin and then crown-lengthen from the
anticipated margin location.
There are also some less common reasons
for crown lengthening teeth, such as to aid
in placement of a rubber dam or for those
with excess tissue that creates pseudo-pockets.
(This may be more of a gingivectomy, though,
if bone removal is not required.)
Healing on these cases is usually only
six to eight weeks. Studies have shown that
the tissues are stable as early as six weeks.
That said, I will wait longer to be on the
safe side, if the case is aesthetic in nature
(Bragger³, et al).
When should I not
crown-lengthen?
As dental implants have become routine
and predictable treatment options, there are
instances when crown lengthening may not
be worthwhile, in my opinion:
* If the aesthetics in the smile zone
would be sacrificed.
* If we may have to expose (or further
expose) the furcation opening of the
affected or adjacent tooth.
* If the tooth would need endodontic
therapy in addition to osseous crown
lengthening.
* Patients with high caries rates are not
good candidates for osseous crown
lengthening, because this makes them
even more susceptible to caries. ■
References
1.
Gargiulo, AW, Wentz FM, Orban B. Dimensions and
relations of the dentogingival junction in humans. J Perio
1961;32:261-267.
2.
Kois J. Altering gingival levels: The restorative connection,
Part 1: Biologic variables. J Esthet Dent. 1994;6:3-9.
3.
Bragger U, Lauchenauer D, and Lang NP: Surgical lengthening of the clinical crown. J Clin Perio 19: 58-63, 1992
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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
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