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Abstract
Sometimes, in order to properly restore teeth, surgical intervention in the form of a crown-lengthening procedure is required. Crown lengthening is a periodontal resective procedure, aimed at removing supporting periodontal structures to gain sound tooth structure above the alveolar crest level. Periodontal health is of paramount importance for all teeth, both sound and restored. For the restorative dentist to utilize crown lengthening, it is important to understand the concept of biologic width, indications, techniques and other principles. This article reviews these basic concepts of clinical crown lengthening and presents four clinical cases utilizing crown lengthening as an integral part of treatments, to restore teeth and their surrounding tissues to health.
PERIODONTAL HEALTH is a major factor in determining the prognosis of a restored tooth. Proper management of periodontal tissues during restorative procedures is an integral part of long-term success. It has been well established that surgical crown lengthening is a restorative-driven procedure. Crown lengthening will allow for placement of restorations above or at the gingival margins levels. Indeed, it is widely demonstrated and accepted that subgingival restorations may negatively affect not only the treated tooth, but also adjacent teeth.1
It is the responsibility of the restorative dentist to understand the periodontal procedures of clinical crown lengthening. The purpose of this article is to review the indications, contraindications, histological aspects and surgical techniques for crown lengthening that are needed for restorative and esthetic reasons.
indications
Before clinical crown lengthening is prescribed, the restorative dentist must carefully evaluate the restorability of the tooth. If the tooth is restorable, the crown-lengthening procedure is possible. Clinical crown lengthening is indicated for teeth with reduced clinical crowns. There are many causes of reduced crowns on teeth. They may result from: subgingival or subcrestal root fracture; perforations of the root at the coronal third; caries with subgingival extension; excessive wear of the dentition; or presence of previous subgingival margins of restoration.2 Clinical crown lengthening is indicated in these cases to gain additional tooth structures to meet the mechanical need of the restorative procedures.3
Crown lengthening can also be indicated for biologic reasons, to prevent violation of biologic width and future attachment breakdown around the restored tooth.'1 In addition to providing sufficient tooth structure for functionally and biologically healthy...