Crown Lengthening without Osseous Reduction: Gingivectomy and Lasers

Crown Lengthening without Osseous Reduction: Gingivectomy and Lasers

Jorge André Cardoso

Principles

Aesthetic situations that can benefit from crown lengthening are very common. Any gingival margin that could aesthetically benefit from being in a more apical position can be considered for crown lengthening after a correct diagnosis of the cause has been carried out. Many of these situations, where the gingiva has excessive aesthetic exposure, are commonly described as a ‘gummy smile’, especially when it is evident in anterior teeth (Figure 4.2.1). Table 4.2.1 describes the common causes of excessive gingival display.

Table 4.2.1 Common causes of excessive gingival display and main treatments to be considered for aesthetic improvements

Causes Main treatments to be considered (may not be exclusive and different or combined approaches may be considered)
Altered active eruption (bone level coronally positioned, causing excessive coverage of crown) Crown lengthening with osseous reduction
Altered passive eruption (bone levels correct, but soft tissue coronally positioned, causing excessive coverage of the crown) Crown lengthening without osseous reduction
Gingival overgrowth Crown lengthening without osseous reduction and treat underlying cause
Maxillary vertical excess Orthodontics and orthognathic surgery
Wear and secondary eruption Intrusion with orthodontics and/or Dahl concept

Restorations

A new occlusal vertical dimension may be needed

Overjet during growth causing overbite Orthodontics
Proclined anterior teeth causing excessive lip displacement during smile Orthodontics
Short teeth Orthodontics and/or restorations

A new occlusal vertical dimension may be needed

Short upper lip Referral to plastic surgery may be considered
Hypermobile upper lip Referral to plastic surgery may be considered
images

Figure 4.2.1 Examples of gummy smiles where the main causes are maxillary vertical excess (upper left), altered eruption (upper right), short lateral incisor teeth (lower left) and secondary eruption due to wear (lower right)

Variation in the normal morphology of the dentogingival complex where the periodontum is comprised of a different configuration being located at a more coronal zone has been described as altered eruption, making reference to a possible alteration during the tooth eruption process.1 Table 4.2.2 describes the differential diagnosis and treatment of altered eruption.

Table 4.2.2 Altered eruption: Differential diagnosis and treatment

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Diagnosis Amount of keratinised tissue Treatment
Altered passive eruption Bone level in normal position, 2 mm or more to the CEJ More than 2 mm of keratinised tissue band Gingivectomy leaving at least 2 mm of keratinised tissue band in place
2 mm or less of keratinised tissue band Apically repositioned flap
Altered active eruption Bone too close to the CEJ, 1 mm or less More than 2 mm of keratinised tissue band
Feb 16, 2017 | Posted by in Esthetic Dentristry | Comments Off on Crown Lengthening without Osseous Reduction: Gingivectomy and Lasers
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