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ePaper created 2014-12-05, 14:13:04 | version 1.33.01
Editor - Online Haseeb Uddin CLINICAL PRACTICE4 DENTAL TRIBUNE Pakistan Edition September 2014 his article describes and demonstrates the use of the Erbium:YAG 2940nm laser system (LiteTouch, Syneron Medical Ltd.) as a central tool in the treatment of osseous crown lengthening, and the advantages this wavelength offers versus the use of conventional methods. Objectives and methods Crown lengthening is a surgical procedure employed for the removal of periodontal tissue, in order to increase the clinical crown height. It is the most frequently used and valuable periodontal surgical procedure related to restorative treatment.(1-4) The objectives of clinical crown lengthening include 8Removal of subgingival caries 8Preservation and maintenance of restorations 8Cosmetic improvement 8Enabling restorative treatment without impinging on biologic width 8Correction of the occlusal plane 8Facilitation of improved oral hygiene There are two methods of crown lengthening 8Orthodontic - coronal extension 8Surgical - apical extension Clinical considerations 8Importance of the tooth 8Subgingival caries 8Clinical crown/root ratio 8Root length and morphology 8Residual amount of bone support 8Furcation involvement 8Tooth mobility 8Aesthetic demands 8Post-op maintenance and plaque control Biologic width and aesthetic dentistry The clinician must create a symmetrical and harmonious relationship between lips, gingival architecture and positions of the natural dentate forms. Spear et al.(5) have referred to this diagnostic methodology as facially generated treatment planning, where the maxillary central incisal edges determine where the soft tissue, i.e., gingiva, and bone should be positioned.(6) To utilize crown lengthening, it is important for the restorative dentist to understand the concept of biologic width, indications, technique and other principles.(7-9) To maintain healthy periodontal tissue, the attached gingival and biologic width must be considered. Biologic width is measured from the bottom of the gingival sulcus to the alveolar crest and is maintained by homeostasis.(10,11) This width consists of the epithelial attachment to the tooth surface and its connective tissue. The average width is 2.04 mm. Impinging biologic width may cause periodontal tissue destruction; therefore, in crown lengthening, the position of the margin is important. Methods of clinical crown lengthening As mentioned above, there are two methods to lengthen a crown: coronal extension and apical extension. Apical extension of the crown is achieved by surgery, with or without osseous resection. In apical extension there are two methods: 8Open technique: patients who exhibit asymmetrical gingival levels, those with greater than 3 to 5mm of maxillary gingival display, or both may be candidates for surgical gingival and/or alveolar bone repositioning to improve their aesthetics. 8Closed technique - for minor localized biologic width and/or aesthetic gingival zenith corrections. Can be used in lieu of a flap procedure to make the correction and complete the restorative process without the necessary healing time required for open crown lengthening surgeries.( 1 2 ) Case presentation This clinical report describes a situation in which a crown lengthening procedure was successfully performed with the Er:YAG laser (LiteTouch, Syneron Medical Ltd.) as a principal auxiliary tool, and the advantages of the 2940 nm wavelength versus conventional methods. Examination Clinical examination of a 57-year-old male revealed missing teeth at the locations #17, 36, 44, 45 and 46 with overeruption of teeth # 14 and 15 (Fig. 1). Radiographic examination of the area showed overeruption of teeth 14 and 15 with the alveolar bone. Treatment options The treatment options available in this case were: 8Insertion of implants and metal-ceramic crowns at the locations of teeth #17, 36, 44, 45 and 46. Er:YAG Garnet in laser-assisted crown lengthening Fig. 1: Patient presentation. Fig. 2: Insertion of five implants. Fig. 3: Teeth #14 and 15 in occlusion. Fig. 4: Use of the diode laser to mark the border for incision of the soft tissue. Fig. 5: Incision border Fig.1 Fig.2 Fig.3 Fig.4 Fig.5 T open crown lengthening surgeries.( 12 )