Orthotown April 2021 - 52

Taking some measurements
The best way to describe how this process
is accomplished is to begin with the end in
mind. Just like a sculptor imagines what's
under the clay, we too must have an artistic
vision of what we want to create.
For this, we can lean on many great
orthodontists who have provided us a
model of these principles. (For example,
Dr. David Sarver discusses macro-, miniand microaesthetic models and how these
principles can produce superior outcomes.
Figs. 2 and 3 show miniaesthetics and
microaesthetics, respectively, as presented
by Sarver.2)
From this, we can take a close-up smiling
photograph of the patient to plan our
procedure using the principles of both miniand microaesthetics. We encourage doctors
who are just beginning this process to print
out the close-up smiling photograph of the
patient and draw the appropriate gingival
margins to practice the clinical procedure.
If clinicians are looking for additional
guides on gingival recontouring and how
tissue should be managed, it can also be
evaluated through measurement of the
clinical crown. Fig. 4 demonstrates studies
performed by Sterrett, et al.,3 that show
average clinical crown length and height as
well as relation between width and height
of central and lateral incisors.
The gingival contour with the lateral
incisor should be 1 millimeter below the
apical limit of the central incisor and the
canine4 (Fig. 5).
The gingival zenith is the highest, or
tallest, point of the gingival margin curvature.
Sarver4 suggests that the ideal position of
the apex of the contour of the lateral is the
center of the crown, and distally displaced
on the central and the canine (Fig. 6).
Finally, it's important to know the
depths of the pockets to determine how
much tissue can be removed, and if crown
lengthening might be necessary. We will
normally attempt a gingivectomy even in
cases where crown lengthening might be
necessary: We inform the patient that if
the tissues rebound, we will send him or
her to a periodontist or oral surgeon for a
crown-lengthening procedure.

52

Fig. 2: Courtesy Dr. David Sarver.

Fig. 3: Courtesy Dr. David Sarver.

Fig. 4

90%
of CI

87%
of UC
78%
of CI

10.4 to
11.2mm
1

1

0.82

8.73 to
80%
9.3mm H=W x 1.25

Fig. 5

1mm

Fig. 6

Zenith
50%

APRIL 2021 // orthotown.com

OT0421_Nichols_Frost_Gingivectomy_MM.indd 52

3/24/21 9:11 AM



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Orthotown April 2021

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