BDS11007 mucogingival management-2--done.pdf

Date : / / 20 Excessive gingival display Causes (1) short upper lip (2) hypermobile upper lip (3) vertical maxillary excess (4) anterior dento-alveolar extrusion (5) short clinical crown. Excessive gingival display high average Smile line High smile line Average smile line Low smile line low Excessi...

Date : / / 20 Excessive gingival display Causes (1) short upper lip (2) hypermobile upper lip (3) vertical maxillary excess (4) anterior dento-alveolar extrusion (5) short clinical crown. Excessive gingival display high average Smile line High smile line Average smile line Low smile line low Excessive gingival display Short clinical crowns Normally: gingival margin is about 1 mm coronal to the CEJ. some cases: free gingiva is >1 mm short clinical crown. full exposure of the anatomical crown can be accomplished by crown lengthening:  Gingivectomy (external or internal bevel)  Apically positioned flap procedure  Forced tooth eruption Excessive gingival display crown lengthening Choice of the crown lengthening surgical procedure The following should be considered: Clinical crown width and length Anatomic crown length Height of keratinized tissue Decision depends on: The need to leave a minimum of 3mm of keratinized marginal tissue (1mm CT, 1mm junctional epithelium, 1mm sulcus depth) The possible need for osseous surgery (normal thickness & 2mm apical to CEJ) Choice of the crown lengthening surgical procedure if 3mm keratinized marginal tissue will remain after anatomical crown exposure and no need for osseous contouring If < 3mm of keratinized marginal tissue will remain after excision Thick gingival phenotype/ alveolar crest is near the CEJ (3mm remains after excision No need for osseous contouring (no flap is raised) The need for removal of pigmentation to produce pink tissues Excessive gingival display crown lengthening Gingivectomy (internal bevel) Indications: Adequate zone of keratinized gingiva >3mm remains after excision flap needed for osseous contouring No need for depigmentation Thick gingival phenotype where thinning of the flap can be performed Excessive gingival display crown lengthening Apically positioned flap Indications: Inadequate keratinized tissue (< 3mm keratinized tissue will remain after excision) The need for osseous recontouring Crown lengthening for multiple teeth Contraindications: Crown lengthening of a single tooth in the esthetic zone Excessive gingival display crown lengthening Apically positioned flap Reverse bevel incision Vertical releasing incisions A full-thickness mucoperiosteal flap is raised The alveolar bone crest is recontoured. Flap is repositioned apically to the level of the newly contoured bone periosteal sutures Excessive gingival display crown lengthening Forced tooth eruption moderate eruptive forces the entire attachment apparatus will move with the tooth The tooth is extruded a distance equal to or slightly longer than the portion of sound tooth structure that will be exposed in the subsequent surgical treatment. tooth reaches the intended position & stabilized full-thickness flap & bone recontouring is performed to expose sound root structure. Excessive gingival display crown lengthening Forced tooth eruption with fiberotomy Fiberotomy scalpel at 7–10-day intervals to sever the supracrestal CT fibers prevent crestal bone from following the root in a coronal direction crestal bone & gingival margin are retained at their pretreatment locations The tooth–gingiva interface at adjacent teeth is unaltered. Excessive gingival display crown lengthening procedures Forced tooth eruption Indications: Bone & soft tissue level of adjacent teeth remains unchanged for esthetic reasons. For reducing pocket depth at sites with angular bony defects (forced tooth eruption without fiberotomy). To level and align gingival margins and the crowns of teeth to obtain esthetic harmony (forced eruption without fibrotomy) Summary Excessive gingival display Causes Smile line Normal proportions of anterior teeth Short clinical crowns Esthetic Crown lengthening procedures Choice of the proper surgical procedure 1.Gingivectomy external or internal bevel 2.Apically positioned flap 3.Forced tooth eruption (with or without fibrotomy) Refer to SDS 1. Interdental papilla reconstruction Classification for interdental papilla Surgeries for papillary reconstruction 2. Deformed edentulous ridge Prevention of post-extraction soft tissue collapse Ridge augmentation and correction of ridge defects using soft tissue grafts READING MATERIAL Carranza`s clinical periodontology, Newman, Takei, Klokkevold, Carranza (Chapter 58) Clinical periodontology and implant dentistry, Jan Lindhe and Niklaus P. Lang, volume 2 (chapter 46)