PubMed · 16463517
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Glenn Melenyk. 2005. Crown lengthening: a second look.. https://pubmed.ncbi.nlm.nih.gov/16463517/
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The aim of this review is to point out the pathological effects after placement of subgingival crown margins or insufficiently adapted margins of restaurations. The distance between the base of the gingival sulcus and the alveolar bone crest is relatively stable in the context of periodontal health. The term "biological width" refers to the histological dimensions of epithelial and connective tissue attachment. The "biologic width" is in average 2 mm. This distance has to be respected in the case of teeth in need for restorations. From a clinical point of view a distance of at least 3 mm between the margin of restoration and the limbus alveolaris is indispensable. Several pre-prosthetic possibilities are discussed in order to maintain periodontal health. Orthodontic or surgical procedures can be used to obtain of a sufficient distance of the margin of restoration to the alveolar bone crest.
Soft tissue lasers are increasing in popularity among clinicians in part due to their potential value in preprosthetic gingival procedures. The ability of soft tissue lasers to control moisture and facilitate hemostasis appears particularly promising for clinicians excising gingival tissues, performing esthetic crown lengthening, and using resective techniques for gingival troughing--and these applications will grow as practitioners become more familiar with such technologies. This presentation highlights the use of the 810 nm diode laser for perio-restorative procedures in the anterior maxilla.
To understand why the crown lengthening may be desirable, a review of periodontal anatomy is in order. The odontologists know, but often underestimate importance of periodontal tissues health to restoration of defected teeth or dental arches. In order to avoid pathological changes, to predict treatment results more precisely, it is necessary to keep gingival biological width unaltered during teeth restoration. If there are less than 2 mm from restoration's margin to marginal bone clinical crown lengthening possibility should be considered in dental treatment plan. The choice depends on relationship of crown-root-alveolar bone and esthetical expectations. In order to keep margins of restoration supragingivally the distance from marginal bone to margins of restoration should not be less than 3 mm. Ideally the margins of restoration should be supragingivally or in the same level as marginal gingiva. When the margins of restoration are prepared subgingivally, the distance from marginal gingiva to margins of restoration should not be more than 0.7 mm. To continue dental treatment in operated area is recommended not earlier than in 4 weeks, and making restorations in esthetical area--not earlier than in 6 weeks.