Clinical Considerations in Orthodontically Forced Eruption for Restorative Purposes

For restorations on teeth involving invasion of the supracrestal tissue attachment (biological width), as well as for lack of ferrule effect, crown lengthening is required for long-term periodontal health and success of the restoration. In the same fashion, site development is often necessary prior to implant placement in order to provide optimal peri-implant soft and hard tissue architecture conducive to future esthetics and function. Orthodontic extrusion, also known as forced eruption, has been developed and employed clinically to serve the purposes of increasing the clinical crown length, correcting the periodontal defect, and developing the implant site. In order to provide comprehensive guidance on the clinical usage of this technique and maximize the outcome for patients who receive the dental restoration, the currently available literatures were summarized and discussed in the current review. Compared to traditional crown lengthening surgery, forced eruption holds advantages of preserving supporting bone, providing improved esthetics, limiting the involvement of adjacent teeth, and decreasing the negative impact on crown-to-root ratio compared to the traditional resective approach. As a non-invasive and natural technique capable of increasing the available volume of bone and soft tissue, forced eruption is also an attractive and promising option for implant site development. Both fixed and removable appliances can be used to achieve the desired extrusion, but patient compliance is a primary limiting factor for the utilization of removable appliances. In summary, forced eruption is a valuable treatment adjunct for patients requiring crown lengthening or implant restorations. Nonetheless, comprehensive evaluation and treatment planning are required for appropriate case selection based upon the known indications and contraindications for each purpose; major contraindications include inflammation, ankylosis, hypercementosis, vertical root fracture, and root proximity. Further studies are necessary to elucidate the long-term stability of orthodontically extruded teeth and the supporting bone and soft tissue that followed them.

Gummy Smile Treatment by Aesthetic Crown Lengthening on Altered Passive Eruption Case

An attractive smile enhances the appearance and acceptance of an individual in society. Gum exposure more than 3 mm is generally considered unattractive and known as a gummy smile, which is usually considered an aesthetic problem. At present, patients have a greater desire for more aesthetic results that may influence the planning of dental treatments. This case report aimed to describe the surgical sequence of aesthetic crown lengthening to improve smile profile and eliminate gummy smile. We reported a 21-year-old non-smoking woman with no pertinent medical history who presented with a chief complaint of an unattractive smile due to excessive gingival display. The gingival display in the smile was 5 mm, and the width to height ratio of the central incisor was 121%. Neither periodontal problems nor teeth mobility was detected. Assessment for the condition was excessive gingival display due to altered passive eruption. The overall prognosis for this case was good. The primary treatment plan proposed to the patient was an aesthetic crown lengthening. Altered passive eruption class I subtype A was a case conclusion, and aesthetic crown lengthening with gingivectomy without osseous reduction was the selected treatment. In conclusion, aesthetic crown lengthening should be considered as a surgical component of aesthetic therapy to improve smile profile and eliminate gummy smile.

CROWN LENGTHENING DAN FRENEKTOMI PADA DAERAH ESTETIK (LAPORAN KASUS)

Arsitektur gingiva berperan penting dalam masalah ukuran, bentuk, dan proporsi gigi yang tepat. Crown lengthening adalah prosedur bedah pemanjangan mahkota gigi dengan tujuan untuk restoratif serta pencapaian estetika baik, yang secara aplikatif menempatkan margin gingiva dengan atau tanpa mengurangi tulang pendukung di bawahnya. Frenulum adalah lipatan selaput lendir yang melekatkan bibir dan pipi ke mukosa alveolar, gingiva, dan periosteum yang mendasarinya. Perawatan frenulum dilakukan dengan bedah frenektomi. Pasien wanita usia 22 tahun dirujuk dari departemen konservasi gigi untuk perawatan yang tepat pada gigi anterior atas dengan perlekatan frenulum tinggi. Pada pemeriksaan intraoral ditemukan fraktur pada gigi 21 sudah dengan perubahan warna. Radiografi periapikal menunjukkan obturasi non-hermetis. Perawatan ulang dilakukan oleh dokter gigi konservasi. Setelah itu crown lengthening dan frenektomi dilakukan untuk mendapatkan lebar biologis serta untuk memerbaiki perlekatan frenulum. Bedah periodontal direkomendasikan untuk mendukung kedokteran gigi restoratif serta untuk meningkatkan prognosis jangka panjang. Pendekatan multidisiplin sering diperlukan untuk mendapatkan hasil estetika yang baik. Bedah crown lengthening dan koreksi frenulum dapat menjadi pilihan yang tepat untuk memfasilitasi terapi restoratif dan meningkatkan penampilan estetis.

Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review

Crown lengthening surgery and deep margin elevation are two distinct approaches used to manage decayed teeth. This systematic review examined the survival rate of badly decayed teeth when restored using the crown lengthening technique and compared it to the deep margin elevation technique. The search was conducted during July 2020 and then again updated at the end of July 2021, and no restriction concerning publication status and time was applied during the search. Cochrane Database, EBSCO, Scopus, and Medline databases were searched electronically for relevant literature. Google Scholar was used as a secondary source. Predefined inclusion and exclusion criteria were used to select the relevant articles. PRISMA guidelines were followed. The focused PICO question was: ‘Does the crown lengthening technique (I) provide a better survival rate (O) than deep margin elevation technique (C) following the restoration of badly decayed teeth (P).’ A total of six articles were included after performing screening based on the eligibility criteria. Four studies focused on crown lengthening while two focused on deep margin elevation technique. A majority of the studies showed a high risk of bias owing to methodological insufficiencies. Crown lengthening (CL) treated cases showed a change in the free gingival margin at six months post-surgery. A tissue rebound was seen that was correlated to the periodontal biotype. Teeth treated with the deep margin elevation (DME) technique showed high survivability. There is a lack of high-quality trials examining surgical comparisons between CL and DME with long-term follow-up. Patient- and dentist-reported outcomes have not been given adequate consideration in the literature. Based on the limited evidence, it can be concluded that for restorative purposes, crown lengthening surgery can be successful in long-term retention of restored teeth. However, the deep margin elevation technique has a better survival ratio. Future well-designed and executed research will have an effect on the evidence and level of certainty for the best approach to treating severely decayed teeth.

Deep margin elevation: a systematic review

Deep margin elevation (DME) is a nonsurgical, alternative technique of dental crown lengthening. Portion of direct restoration placed only at the deep apical part of the cavity to elevate the margin to a more coronal and more adequate position for final cementation of indirect restoration.Materials and methods. In this systematic review, we were looking for in vitro studies in which deep margin elevation (DME) technique were used. The electronic databases PubMed and EMBASE were used for the search. The search began on July 29, 2021 and ended on August 10, 2021. We have analyzed the materials and methods of each research and entered them in the appropriate tables to give a clearer assessment of the obtained results.Results. Analysis of marginal quality showed the best results when indirect restorations luted to dentin directly and with DME technique with three consecutive layers of resin composite. In groups without DME there were fewer microleakage. DME did not statistically significantly influence the fracture strength.Conclusions. We conducted a systematic review that included 12 in vitro studies. Even though samples without DME showed better results in in vitro studies, the difference between samples with and without DME was not statistically significant. However, in clinical practice, DME facilitates the insertion of indirect restorations. Therefore, further studies and clinical observations are necessary.

Management of a fractured endodontically treated tooth with crown lengthening and glass fibre post: A case report

Purpose: This clinical case discusses the step-by-step implementation of a core and a post system that uses a single resin composite material for cementation of a glass fibre post and core build up of a fracture endodontically treated maxillary left first premolar with gingivectomy as a crown lengthening procedure. Clinical considerations: Several materials and methods has been discussed in the literatures regarding restoration of endodontically treated teeth with minimal tooth structure left which require fibre post and core build up. Gingivectomy as a crown lengthening is also a common procedure that facilitates restorative dentistry. This case presents a restoration of a tooth with a short clinical crown by gingivectomy and post core build up by glass fibre post with a mono-block technique or core-and-post technique with dual cure composite resin as a luting and core build up material. Conclusion:Post and core is needed to restored tooth with little tooth structure remaining.Glass fibre post are prefabricated posts which makes it easy to manipulate and reduces chairs side time among other advantages. Use of single material system for post-and-core reduces the steps of manipulation and chair side time compared to conventional techniques. Clinical significance: More measures are required when different materials are used for post-cementation and core build-up, increasing the chair time and the number of interfaces between the materials. However, these shortcomings can be overcome by the mono-block technique where only one material is used for both cementation and core build up. Update Dent. Coll. j: 2021; 11(2): 38-42