The Principles and Techniques of Crownlengthening Procedures Hyundai

The Principles and Techniques of Crown-lengthening Procedures Hyundai Dental Clinic Yin Shik Hur, Periodontist, DDS, MSD Yin Shik Hur

The Purposes of Crown-lengthening • For the improvement of esthetics of anterior teeth (ex, Gummy smile, dissymmetric gingival level) • For prosthetic treatment • For restorative treatment Yin Shik Hur

The Techniques for Crown-lengthening • Gingivectomy & Gingivoplasty • Flap with osseous resective surgery • Apically positioned flap with osseous resective surgery • Flap with bone denudation Yin Shik Hur

Hyundai Dental Clinic Yin Shik Hur, Periodontist, DDS, MSD Yin Shik Hur

Hyundai Dental Clinic Yin Shik Hur, Periodontist, DDS, MSD Yin Shik Hur

Biologic Width : 2. 04 mm The zone of the root surface coronal to the alveolar crest to which the junctional epithelium (1 mm) and connective tissue(1 mm) are attached. Maynard & Wilson (JP, 1979) Yin Shik Hur

Biologic Width : Its Clinical Meaning ? A minimum of 3 mm for restoration 1 mm : Connective Tissue 1 mm : Junctional Epithelium 1 mm : Gingival Sulcus Newcomb (JP, 1974) Yin Shik Hur

Biotypes of Gingiva & Restoration Development of periodontal pocket(or infrabony pocket) in thick periodontium Yin Shik Hur

Biotypes of Gingiva & Periodontitis Development of marginal tissue recession in thin periodontium Yin Shik Hur

Periodontal Surgery for Biologic Width 1. 보철물 치관의 길이가 심미적으로나 기능적으로 적절하지만 biologic width를 침범한 경우 2. 술 후 치아가 더 이상 길어지지 않도록 주의 ! - Sulcular incision or Minimal Gingivoplasty Yin Shik Hur

Crown-lengthening Procedures - Case division - 1. 보철 술식과는 상관없이 자연치에 시행하는 경우 - Correction of Gummy Smile 2. 보철 지대치에 시행하는 경우 - Retention of Prosthesis , Biologic Width 3. 보철적 교정치료 (Prosthetic Orthodontics) Yin Shik Hur

Considering Factors in Crown-lengthening 1. Underlying bony contour 2. Thickness of periosteum 3. Intimacy of periosteum to underlying bone 4. Biotypes of gingiva ( Thickness & width of attached gingiva ) Yin Shik Hur

Periodontal Surgery vs Prosthesis 1. Biologic Width 2. Crown-lengthening 3. Mucogingival Surgery Yin Shik Hur

Mucogingival Surgery for Prosthesis 1. 부착치은의 부족, 소대부착(frenum attachment)의 이 상 등으로 보철물과 치주조직의 장기적인 건강이 위 협받을 때. 2. Free Gingival Graft, Vestibular Deepening Frenectomy, Other MG-surgeries Yin Shik Hur

The Situations Accommodated to the Following Treatments Hyundai Dental Clinic Yin Shik Hur, Periodontist, DDS, MSD Yin Shik Hur

Situation I Gingivectomy & Gingivoplasty • Deep pocket on probing • Horizontal bone loss on x-ray radiographs • Wide attached gingiva • Mainly, palatal side gingiva Yin Shik Hur

Situation II Unrepositioned flap with osseous resective surgery • Shallow pockets on probing • Wide attached gingiva • Mainly, anterior teeth and 1 st. premolar of mandible, all teeth of maxilla • Gummy smile • Prosthetic orthodontics Yin Shik Hur

Situation III Apically positioned flap with osseous resective surgery • Shallow or deep pockets • Narrow attached gingiva • Mainly, mandibular 2 nd. premolar & molars • Forced eruption case Yin Shik Hur

Situation IV Unrepositioned flap with osseous resective surgery followed by gingivectomy • Absence of attached gingiva • Mainly, distomolar areas • Electrosurgery Yin Shik Hur

Situation V Bone denudation procedure • Absence of attached gingiva • Mainly, posterior teeth & distomolar area Yin Shik Hur

Periodontal Surgery for Prosthetic Orthodontics Hyundai Dental Clinic Yin Shik Hur, Periodontist, DDS, MSD Yin Shik Hur

Procedures 1. Diagnostic wax-up & consult 2. Preparation & temporary crown 3. Determination of the standard position 4. Gingivectomy for the ideal gingival harmony 5. Extension of preparation margin & adjustment of temporary crown 6. Flap reflection & osseous resective surgery 7. Suture Yin Shik Hur

3 Types of Initial Incision 1. Buccal incision 2. Crestal incision 3. Sulcular incision Yin Shik Hur

Decision Making for Initial Incision 1. Amount of keratinized gingiva 2. Gingival thickness 3. Amount of ostectomy 4. Buccal side or Palatal side Yin Shik Hur

Crown-lengthening of Palatal Side 1. Flap after internally beveled gingivectomy 2. Flap after externally beveled gingivectomy 3. Gingivetomy (deep pocket) Yin Shik Hur

Flap after Internally Beveled Gingivectomy 1. More clean operation field 2. More fast healing 3. Less pain & discomfort Yin Shik Hur

Flap after Externally Beveled Gingivectomy 1. More easy to perform surgery. 2. Possible to anticipate the healing result. Yin Shik Hur

Classification for Initial Incision : Class I • Keratinized gingiva is more than adequate. • Buccal incision is placed 1 to 3 mm from the crest of gingiva. • Flap is positioned apically. Friedman & Levine (JP, 1964) Yin Shik Hur

Classification for Initial Incision : Class II • Keratinized gingiva is adequate. • Crestal incision • Flap is positioned apically to the crest. Friedman & Levine (JP, 1964) Yin Shik Hur

Classification for Initial Incision : Class III • Keratinized gingiva is inadequate. • Sulcular incision • Flap is positioned apically 1 to 2 mm below crest of bone. Friedman & Levine (JP, 1964) Yin Shik Hur

Ostectomy for Crown-lengthening 1. High-speed diamond chamfer bur 2. Straight low-speed handpiece & round bur 2. Universal curette & mini file 3. # 15 blade Yin Shik Hur

Ostectomy for Crown-lengthening 1. Non-supporting bone : using the high & low speed bur 2. Supporting bone : using #15 blade & universal curette Yin Shik Hur

Climbing a mountain named by ‘Perio-Prosthesis’ Esthetics Prosthetic Design Occlusion Biologic Width Yin Shik Hur