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Crown Lengthening Procedures for Functional and Esthetic Purposes

  • Clinical Periodontics (Y Stathopoulou, Section Editor)
  • Published:
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Abstract

Purpose of Review

The crown lengthening (CL) procedure is one of the most common procedures in daily dental practice. The purpose of this review is to examine the newer techniques along with parameters that need to be considered in the decision-making process for optimal functional and esthetic results.

Recent Findings

The parameters that need to be considered during the decision-making process for CL include the patient’s restorative needs and esthetic expectations, supracrestal attachment, level of bone, and gingival phenotype. While gingivectomy with or without osseous resection is the traditional approach, more recently less invasive procedures have been used including dental lasers, orthodontic extrusion, and lip repositioning.

Summary

Correct evaluation of the patient’s anatomical factors, restorative and esthetic needs should lead to the utilization of the most appropriate procedure. Adequate time for healing should be allowed prior to the final restoration for the most stable and predictable long-term result.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Academy of Periodontology. 2003 Practice profile survey: characteristics and trends in private periodontal practice. Chicago: American Academy of Periodontology, 2004.

  2. •• Marzadori M, Stefanini M, Sangiorgi M, Mounssif I, Monaco C, Zucchelli G. Crown lengthening and restorative procedures in the esthetic zone. Periodontology 2000. 2018;77:84–92 Recent review on crown lengthening in the esthetic zone with focus on classic surgical approaches and restorative considerations for the provisional and definitive rehabilitation.

    Article  PubMed  Google Scholar 

  3. •• Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1):S237–48 The consensus report on developmental and acquired periodontal conditions of the “2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions’ introduced new terminology: “supracrestal tissue attachment” that replaces the term “biologic width,” and “periodontal phenotype” that replaces “biotype” to describe more accurately the combined effect of the genotype and environmental factors on the gingival phenotype and bone morphotype.

    Article  PubMed  Google Scholar 

  4. • Ercoli C, Caton GJ. Dental prostheses and tooth-related factors. J Periodontol. 2018;89(Suppl 1):S223–36 Review of the current evidence about the role of the placement of the restorative margin in relation to the periodontium.

    Article  PubMed  Google Scholar 

  5. Cohen DW. Pathogenesis of periodontal disease and its treatment. Washington DC: Walter Reed Army Medical Center; 1962.

    Google Scholar 

  6. Bosshardt DD, Lang NP. The junctional epithelium: from health to disease. J Dent Res. 2005;84:9–20.

    Article  CAS  PubMed  Google Scholar 

  7. Gargiulo A, Wentz F, Orban B. Dimensions and relations of the dentogingival junction in humans. J Periodontol. 1961;32:261–7.

    Article  Google Scholar 

  8. •• Vacek JS, Gher ME, Assad DA, Richardson AC, Giambarresi LI. The dimensions of the human dentogingival junction. Int J Periodontics Restorative Dent. 1994;14:154–65 Classic histomorphometric study of the biologic width and gingival sulcus dimensions from 171 tooth surfaces and the surrounding periodontium from 10 human adult cadavers.

    CAS  PubMed  Google Scholar 

  9. Deas DE, Moritz AJ, McDonnell HT, Powell CA, Mealey BL. Osseous surgery for crown lengthening: a 6-month clinical study. J Periodontol. 2004;75:1288–94.

    Article  PubMed  Google Scholar 

  10. Ingber JS, Rose LF, Coslet JG. The “biologic width” –a concept in periodontics and restorative dentistry. Alpha Omegan. 1977;70:62–5.

    CAS  PubMed  Google Scholar 

  11. Nevins M, Skurow HM. The intracrevicular restorative margin, the biologic width, and maintenance of the restorative margin. Int J Periodontics Restorative Dent. 1984;4:30–49.

    CAS  PubMed  Google Scholar 

  12. Parsell DE, Streckfus CF, Stewart BM, Buchanan WT. The effect of amalgam overhangs on alveolar bone height as a function of patient age and overhang width. Oper Dent. 1998;23:94–9.

    CAS  PubMed  Google Scholar 

  13. Rosenberg ES, Garber DA, Evian CI. Tooth lengthening procedures. Compend Contin Ed Dent. 1980;1:161–72.

    CAS  Google Scholar 

  14. Becker W, Ochsenbein C, Becker BE. Crown lengthening: the periodontal-restorative connection. Compendium. 1998;19:239–54.

    CAS  PubMed  Google Scholar 

  15. Schmidt JC, Sahrmann P, Weiger R, Schmidlin PR, Walter C. Biologic width dimensions – a systematic review. J Clin Periodontol. 2013;40:493–504.

    Article  PubMed  Google Scholar 

  16. Novak MJ, Albather HM, Close JM. Redefining the biologic width in severe, generalized, chronic periodontitis: implications for therapy. J Periodontol. 2008;79:1864–9.

    Article  PubMed  Google Scholar 

  17. Perez JR, Smukler H, Nunn ME. Clinical evaluation of the supraosseous gingivae before and after crown lengthening. J Periodontol. 2007;78:1023–30.

    Article  PubMed  Google Scholar 

  18. Cairo F, Graziani F, Franchi L, Defraia E, Pini Prato GP. Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. Int J Dent. 2012;837658.

  19. Goldman HD, Cohen D. Periodontal therapy. 4th ed. St. Louis: C.V. Mosby; 1968. p. 773–1005.

    Google Scholar 

  20. • Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan. 1977;70:24–8 Diagnosis and classification of altered passive eruption with treatment recommendations.

    CAS  PubMed  Google Scholar 

  21. Zangrando M, Veronesi G, Cardoso M, Michel R, Damante C, Sant’Ana A, et al. Active and passive eruption : a modified classification. Clin Adv Periodontics. 2017;7:51–6.

    Article  Google Scholar 

  22. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod. 1992;62:91–100.

    CAS  PubMed  Google Scholar 

  23. Tjan AH, Miller GD, The JG. Some esthetic factors in a smile. J Prosthet Dent. 1984;51:24–8.

    Article  CAS  PubMed  Google Scholar 

  24. Vig RG, Brundo GC. The kinetics of anterior tooth display. J Prosthet Dent. 1978;39:502–4.

    Article  CAS  PubMed  Google Scholar 

  25. Silberberg N, Goldstein M, Smidt A. Excessive gingival display - etiology, diagnosis, and treatment modalities. Quintessence Int. 2009;40:809–18.

    PubMed  Google Scholar 

  26. • Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification. J Periodontol. 2018;89(Suppl 1):S1–8 Overview of the changes in the periodontal classification and terminology from the “2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions.”.

    PubMed  Google Scholar 

  27. •• Cortellini R, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S204–13 Excellent review on the mucogingival conditions and the definitions and anatomic characteristics of the various periodontal biotypes, from the “2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions.”.

    Article  PubMed  Google Scholar 

  28. Ronay V, Sahrmann P, Bindl A, Attin T, Schmidlin PR. Current status and perspectives of mucogingival soft tissue measurement methods. J Esthet Restor Dent. 2011;23:146–56.

    Article  PubMed  Google Scholar 

  29. Eger T, Muller HP, Heinecke A. Ultrasonic determination of gingival thickness. Subject variation and influence of tooth type and clinical features. J Clin Periodontol. 1996;23:839–45.

    Article  CAS  PubMed  Google Scholar 

  30. Kan JY, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent. 2010;30:237–43.

    PubMed  Google Scholar 

  31. • Zweers J, Thomas RZ, Slot DE, Weisgold AS, van der Weijden FGA. Characteristics of periodontal biotype, its dimensions associations and prevalence: a systematic review. J Clin Periodontol. 2014;41:958–71 Systematic review on the characteristics and dimensions of the periodontal biotypes.

    Article  PubMed  Google Scholar 

  32. • Chambrone L, Tatakis DN. Long-term outcomes of untreated buccal gingival recessions: a systematic review and meta-analysis. J Periodontol. 2016;87:796–808 Systematic review and meta-analysis showing that thin gingiva are associated with higher risk for gingival recessions.

    Article  PubMed  Google Scholar 

  33. Agudio G, Cortellini P, Buti J, Pini Prato G. Periodontal conditions of sites treated with gingival augmentation surgery compared with untreated contralateral homologous sites: an 18- to 35-year long-term study. J Periodontol. 2016;87:1371–8.

    Article  PubMed  Google Scholar 

  34. Lee E. Esthetic crown lengthening: contemporary guidelines for achieving ideal gingival architecture and stability. Curr Oral Health Rep. 2017;4:105–11.

    Article  Google Scholar 

  35. Lee EA. Laser-assisted gingival tissue procedures in esthetic dentistry. Pract Proced Aesthet Dent. 2006;18(9):2–6.

    Google Scholar 

  36. Cobb CM. Lasers in periodontics: a review of the literature. J Periodontol. 2006;77:545–64.

    Article  CAS  PubMed  Google Scholar 

  37. Mc Guire MK, Scheyer ET. Laser-assisted flapless crown lengthening: a case series. Int J Periodontics Restorative Dent. 2011;31:257–364.

    Google Scholar 

  38. Heithersay GS. Combined endodontic- orthodontic treatment of transverse root fractures in the region of the alveolar crest. Oral Surg Oral Med Oral Pathol. 1973;36:404–15.

    Article  CAS  PubMed  Google Scholar 

  39. Ingber JS. Forced eruption: part II. A method of treating nonrestorable teeth- -periodontal and restorative considerations. J Periodontol. 1976;47:203–16.

    Article  CAS  PubMed  Google Scholar 

  40. Graber TM, Vanarsdall RL. Orthodontics: current principles and techniques. St Louis: Mosby; 1994.

    Google Scholar 

  41. Pontoriero R, Celenza F Jr, Ricci G, Carnevale G. Rapid extrusion with fiber resection: a combined orthodontic- periodontic treatment modality. Int J Periodontics Restorative Dent. 1987;7:30–43.

    CAS  PubMed  Google Scholar 

  42. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. St Louis: Mosby; 2007.

    Google Scholar 

  43. Schwimer CW, Rosenberg ES, Schwimer DH. Rapid extrusion with fiberotomy. J Esthet Dent. 1990;2:82–8.

    Article  CAS  PubMed  Google Scholar 

  44. Minsk L. Orthodontic tooth extrusion as an adjunct to periodontal therapy. Compend Contin Educ Dent. 2000;21:768–70 772, 774.

    CAS  PubMed  Google Scholar 

  45. Ainama J, Talari A. The increase with age of the width of attached gingiva. J Periodontal Res. 1976;11:182–8.

    Article  Google Scholar 

  46. Reitan K. Clinical and histological observations on tooth movement during and after orthodontic treatment. Am J Orthod. 1967;53:721–45.

    Article  CAS  PubMed  Google Scholar 

  47. Heithersay GS, Moule AJ. Anterior subgingival fractures: a review of treatment alternatives. Aust Dent J. 1982;27:368–76.

    Article  CAS  PubMed  Google Scholar 

  48. Bhola M, Fairbairn PJ, Kolhatkar S, Chu SJ, Morris T, de Campos M. LipStaT: The lip stabilization technique - indications and guidelines for case selection and classification of excessive gingival dis- play. Int J Periodontics Restorative Dent. 2015;35:549–59.

    Article  PubMed  Google Scholar 

  49. Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000. 1996;11:18–28.

    Article  CAS  PubMed  Google Scholar 

  50. Rosenblatt A, Simon Z. Lip repositioning for reduction of excessive gingival dis- play: a clinical report. Int J Periodontics Restorative Dent. 2006;26:433–7.

    PubMed  Google Scholar 

  51. Ishida LH, Ishida LC, Ishida J, Grynglas J, Alonso N, Ferreira MC. Myotomy of the levator labii superioris muscle and lip repositioning: a combined approach for the correction of gummy smile. Plast Reconstr Surg. 2010;126:1014–9.

    Article  CAS  PubMed  Google Scholar 

  52. Abdullah WA, Khalil HS, Alhindi MM, Marzook H. Modifying gummy smile: a minimally invasive approach. J Contemp Dent Pract. 2014;15:821–6.

    Article  PubMed  Google Scholar 

  53. Silva CO, Ribeiro-Júnior NV, Campos TV, Rodrigues JG, Tatakis DN. Excessive gingival display: treatment by a modified lip repositioning technique. J Clin Periodontol. 2013;40:260–5.

    Article  PubMed  Google Scholar 

  54. Herrero F, Scott JB, Maropis PS, Yukna RA. Clinical comparison of desired versus actual amount of surgical crown lengthening. J Periodontol. 1995;66:568–71.

    Article  CAS  PubMed  Google Scholar 

  55. de Waal H, Castellucci G. The importance of restorative margin placement to the biologic width and periodontal health. Part II. Int J Periodontics Restorative Dent. 1994;14:70–83.

    PubMed  Google Scholar 

  56. Wagenberg BD, Eskow RN, Langer B. Exposing adequate tooth structure for restorative dentistry. Int J Periodontics Restorative Dent. 1989;9:322–31.

    CAS  PubMed  Google Scholar 

  57. Lanning SK, Waldrop TC, Gunsolley JC, Maynard JG. Surgical crown lengthening: evaluation of the biological width. J Periodontol. 2003;74:468–74.

    Article  PubMed  Google Scholar 

  58. Brägger U, Lauchenauer D, Lang NP. Surgical lengthening of the clinical crown. J Clin Periodontol. 1992;19:58–63.

    Article  PubMed  Google Scholar 

  59. •• Pilalas I, Tsalikis L, Tatakis DN. Pre-restorative crown lengthening surgery outcomes: a systematic review. J Clin Periodontol. 2016;43:1094–108 Systematic review showed that gingival margin rebound after pre-restorative crown lengthening occurs during the first three post-operative months.

    Article  PubMed  Google Scholar 

  60. Arora R, Narula SC, Sharma RK, Tewari S. Evaluation of supracrestal gingival tissue after surgical crown lengthening: a 6-month clinical study. J Periodontol. 2013;84:934–40.

    Article  PubMed  Google Scholar 

  61. Amsterdam MA. Form and function of the masticatory system. Philadelphia: University of Pennsylvania; 1991.

    Google Scholar 

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Author notes

  1. Pinelopi Xenoudi and Anastasios Karydis contributed equally to this work.

Authors and Affiliations

  1. Division of Periodontology, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, 707 Parnassus Ave, Rm D3015, San Francisco, CA, 94143, USA

    Pinelopi Xenoudi

  2. Department of Periodontology, University of Tennessee Health Science Center, Memphis, TN, USA

    Anastasios Karydis

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  1. Pinelopi Xenoudi
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Correspondence to Pinelopi Xenoudi.

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Dr. Xenoudi reports non-financial support from Biohorizons, and personal fees from Millennium Dental Technologies, outside the submitted work.

Anastasios Karydis declares no conflicts of interest.

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Xenoudi, P., Karydis, A. Crown Lengthening Procedures for Functional and Esthetic Purposes. Curr Oral Health Rep 6, 230–236 (2019). https://doi.org/10.1007/s40496-019-00229-2

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