Esthetic Surgical Procedures

7/30/2019 Esthetic Surgical Procedures

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TARRSON FAMILY ENDOWED


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UCLA SCHOOL OF DENTISTR


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PresentsPresents


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E. Ba

Tarrs

Prof

UCL

ESTHETIC SURGICAL PROCEDURES FORCROWN LENGTHENING


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1. Gingivectomy

2. Flap surgery for osseousrecontouring


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Need minimum of one millimeter connectivetissue coronal to bone margin

Gingival margin will be two millimeterscoronal to this with 2 mm crevice depth.

Red line- Gingival margin.Pink area connective tissue.Black line probe to depth of crevice.


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Distance of gingival margin to bone on labial is 3mm.Two mmof this is crevice depth, and 1mm. is for connective tissue

between probable depth and crest of bone.


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Five millimeters of crevice depth withadequate band of Keratinized tissue

Gingivectomy can be used to increasecrown length by up to 3 mm


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Advantages of Gingivectomy

Precise control of gingival contours

Low risk of inadvertent necrosis of tissueduring healing


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Crevice depth of five millimeters will allowthree millimeters of crown lengthening byGingivectomy

If more than three millimeters needed useFlap Surgery


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Gingivectomy Techniques

This patient requires 3 mm of crownlengthening

Sufficient crevice depth and Keratinizedtissue


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Gingivectomy completed with surgicalscalpels and knives


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Healing at three weeks


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Crowns placed twelve weeks afterGingivectomy

Next slide Before and After


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Gingivectomy to correct lack of symmetryand short crowns


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Sufficient crevice depth and Keratinizedgingiva

Frenum correction also needed


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Scalpel used to establish 10 mm crownlength on central incisor

Height of contour of gingiva is distalized


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Kirkland Knife used to refine gingivalcontours by gentle scraping


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Length of central incisor serves asbasis for lateral incisor and cuspid

Lateral incisor gingival margin 1 mmcoronal to central

Cuspid gingival margin at same levelas central


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The lateral incisor also has distalizedgingival margin


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Left central incisor gingival margin

shaped for symmetry with right central


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Gingivectomy completed with bilateralsymmetry

Right central incisor edge will needshortening


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Initial incision for Frenectomy


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Removal of wedge of tissue fromfrenum

Interdental papilla is untouched


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Incision made through periosteumto expose bone

This ensures no muscle pull existsto interdental papilla


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Wound closed tightly with 5.0 gut sutures


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Healing at twelve weeks

Next Slide Before and After


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Crown Lengthening requires Flap

Surgery and osseous correction


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Initial Incisions

Central incisor and cuspid newgingival margins at same level

Sulcular incision used on lateralincisor to make it harmonious withcentral and cuspid

Interproximal incisions preservepapillae


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Incisions on left symmetricalwith right

Use new blade for each two teethto minimize tissue trauma


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Flap carefully dissected with sharpscalpels

3 mm of bone crest exposed

Bone recontouring needed to provideadequate connective tissue apical tocrevice depth


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Bone Margin has been moved apically

of central incisor and cuspid


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Flap sutured with apical positioningof gingival margins on central

incisors and cuspids


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Final Result at Twelve Weeks



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Short clinical crowns with largegingival display on smiling


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Insufficient gingival crevicedepth for Gingivectomy


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Premolars are included because ofexposure with smiling


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15 c scalpel used to distalizegingival margin equally on

central incisors


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12 B scalpel begins sharp dissectionof full thickness flap with

preservation of interdental papillae


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Incised gingiva gently removed

with sharp back action hoe


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Flap elevated and bone recontoured


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Flaps sutured with simple 5.0 gutinterproximal sutures


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Central incisors lengthening to 11 mm


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Firm pressure applied to flap for 5 minutes


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Healing at one week

No post surgical brushing orflossing

Chlorhexidine mouth washes threetimes per day


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Gingival margins now stable

Gentle brushing with soft brush and

chlorhexidine from second week postoperative

Gentle flossing after four weekshealing



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Short clinical crowns and excessivegingival display following

orthodontic treatment


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Level of Incisal edge is established

Central incisor and cuspid incisal edgesat same level

Lateral incisal edge 1 mm apical tocentral incisor

Incisal plane parallels lower lip


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Gingival crevice too shallow forGingivectomy


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New gingival margins established with

incisions


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Central incisor length at 10.50 mm


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Flap elevated to expose bone margin


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Bone recontoured to provide sufficient

connective tissue for Biologic width


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Flaps sutured in final position


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Upper and lower incisors, cuspids, andpremolars with asymmetry and small

clinical crowns


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Size of clinical crowns too shortfor facial dimensions and smile


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Flap elevated to expose bone margins


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Osseous recontouring to movebone margins apical

Long anatomical crowns on centralincisors


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Flaps sutured with apical positionof gingival margins including

premolars


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Cuspids elongated to give masculine

emphasisNext two slides Before and After


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Altered passive eruption

Short asymmetrical clinical

crowns


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Healing at one week


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Healing at 12 weeks



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Gingival and tooth estheticsunacceptable to patient


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Flaps and osseous recontouringcompleted


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Final Restorations completed after24 weeks of healing



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ONE WEEK POST SURGERY


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TEN WEEKS POST SURGERY


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Crown lengthening for esthetics and toprovide sufficient root volume for crownretention

Need to establish incisal edge asbaseline for gingival dimensions


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Provisional acrylic templateestablishes final crown

dimensions and incisal edge


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Patient can view template andsuggest any necessary

changes


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At time of Flap Surgery, gingivalmargins outline on tissues


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Flaps elevated to expose bonemargins


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Bone recontoured to mirror finalgingival margins


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Position of new gingival marginsconfirmed with stent


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Flap positioned withpolytetraflurethylene sutures


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Palatal view


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Healing at 6 weeks

Lower incisors also treated



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If amount of crown lenthening needed will result indepth of crevice being less than 1mm from bonemargin then flap sugery and bone removal is requiredto give adequate BIOLOGICAL WIDTH

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Esthetic Surgical Procedures

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