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Periodontics 2 > Crown lengthening > Flashcards

Crown lengthening Flashcards

1
Q

Indications for Crown Lengthening
Functional
(4)

A
  • Subgingival restorative margins
  • Tooth fracture
  • Endodontic perforations
  • Cervical root resorption
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2
Q

Indications for Crown Lengthening
Esthetic
(3)

A
  • Excessive gingival display
  • Gingival overgrowth (meds)
  • Altered passive eruption
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3
Q

Components of
Supracrestal Attached
Tissue (formerly Biologic
Width)
Connective Tissue Attachment
(2)
Junctional Epithelium
(2)
Added together =

A
  • Most consistent dimension
  • avg., 1.07 mm
  • Most variable dimension
  • avg., 0.97 mm

2.04 mm

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4
Q

Crown Lengthening Indications
* To allow for —
* Increasing crown length for —
* Restoration of tooth in harmony with —
* Esthetics via alteration of the —

A

restoration of tooth (Caries removal, clamp placement)
retention of restoration (adequate ferrule)
supracrestal attached tissue (biologic width)
gingival labial profile

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5
Q

What is Ferrule?

A
  • It is the vertical axial wall that
    surrounds the tooth
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6
Q

Ferrule
* Desired every time a crown is
fabricated to help —
* Need at least – mm of ferrule
(natural tooth structure)
circumferentially, beyond the
core

A

resist
fracture &/or crown
displacement
2

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7
Q

Considerations and Limitations
* Is tooth actually restorable?
* May need — to determine
* PLEASE ensure …

A

O&R
caries free before crown lengthening consult as may not be restorable

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8
Q

Considerations and Limitations
Is tooth strategically important?
(2)

A
  • Opposing tooth
  • Position in arch
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9
Q

Considerations and Limitations
Prognosis
(5)

A
  • Amount of tooth remaining in supporting bone
  • Furcations
  • Mobility
  • Esthetic concerns
  • Thick or Thin Phenotype (or needs conversion?)
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10
Q

**At end of
procedure
place well
fitting
temporary
back on
tooth to
prevent
–

A

tooth
migration

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11
Q

Final Restoration placement
* Variations between (time), but NOT —
* Bragger and Sonick - 6 weeks
* Bragger, Lanning - 3-6 months
* Lee - 3-6 months
* Pontoriero - 6 months

A

6 weeks and 6 months
sooner

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12
Q

If in doubt, provisionalize (well) and hold for — before final
restoration

A

3-6 months

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13
Q

IDEAL scenario
In Health
* CEJ should be approximately – mm from osseous crest
* Gingival margin should be – mm coronal to the CEJ (i.e.,
covering anatomic crown)

A

2
0.5-2.0

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14
Q

Active eruption
(3)

A
  • As tooth breaks through gingiva
  • Erupts until it meets its antagonist and occludes, then eruption
    ceases/slows
  • Eruption POTENTIAL continues throughout life (think supraeruption
    of tooth that has no opposing tooth)
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15
Q

Passive eruption (Ainamo and Loe 1966)
* Apical shift of Dentinogingival junction
(2)

A
  • Occurs during and after active eruption
  • Tooth does not move, gingiva does (apically)
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16
Q

Passive eruption (Ainamo and Loe 1966)
Stages
(4)

A
  1. Junctional epithelium (JE) rests on enamel surface
  2. JE rests on enamel and cemental surface apical to CEJ
  3. Epithelial attachment rests on cementum
  4. Epithelial attachment migrates apically
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17
Q

Normally concludes when sulcus base is at level of CEJ placing the gingival
margin – mm coronal to the CEJ

A

1-2

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18
Q

Altered Passive Eruption
* When …
* Frequency is about –% in adult population

A

eruption does not progress past Stage 1 or 2 it is termed Altered
Passive Eruption.
12

19
Q

Altered Eruption (diagnosis)
includes Excessive Gingival Display aka ‘the Gummy Smile’
Altered Active
(2)

A
  • Morphologic variant where CEJ
    is less than 2mm from osseous
    crest
  • Can be exacerbated by
    orthodontic brackets
20
Q

Altered Eruption (diagnosis)
includes Excessive Gingival Display aka ‘the Gummy Smile’
Altered Passive
(2)

A
  • Morphological variant where
    gingiva is more than 2mm
    coronal to CEJ
  • Can be exacerbated by
    inflammation, medications
21
Q

Skipped
Classification and Treatment
Type 1 A: Adequate KG; MGJ apical to osseous crest; adequate
distance from CEJ to bone crest

A

Gingivectomy

22
Q

Skipped
Classification and Treatment
Type 1 B: Adequate KG; MGJ apical to osseous crest BUT
osseous crest at CEJ

A

Gingival scallop with Internal bevel then ostectomy
with unchanged flap position

23
Q

Skipped
Classification and Treatment
Type II A: Inadequate KG; MGJ at or coronal to osseous crest

A

Apically Positioned flap (don’t want to remove any KG)

24
Q

Skipped
Classification and Treatment
Type II B: Inadequate KG; MGJ at or coronal to osseous crest
AND osseous crest at CEJ

A

Apically Positioned Flap with Ostectomy

25
Q

What are the components of an appealing
smile? (What is the ‘perfect’ smile??)
(5)

A
  • Teeth
  • Gingival scaffold
  • Lip framework
  • Skeletal profile
  • The eyes
26
Q
  • Teeth
A
  • Size, shape and position
27
Q
  • Gingival scaffold
A
  • Health and contour
28
Q
  • Lip framework
A
  • Shape, length and mobility
29
Q
  • Skeletal profile
A
  • Maxillary excess (may require oral surgery intervention)
30
Q

Clinically
* Show —% of crowns
and interproximal gingiva
* Symmetrical display and
harmony between the
(2)
* Lower lip parallel to the
…

A

75%-100
maxillary gingival line and
the upper lip
incisal edges of maxillary
teeth and in close
approximation

31
Q

Smile Line

A
  • Position of the upper lip relative to the maxillary incisors and gingiva
    during a natural full smile
32
Q

Normal Anterior Tooth Length*
Tooth Normal variation (mm) Minimum ‘normal’ (mm)
Central
Lateral
Canine

A

11-13 10
10 9
11-13 10

33
Q

Preferred anatomical crown width to height ratio is –%
* Acceptable range –%
* Regardless of (2)

A

78
66%-80
race or gender

34
Q
  • Central Incisor Width—% wider than the lateral incisor
  • Lateral incisor Width- –% wider than the mesial portion of the canine
A

60
60

35
Q

If assign a value of – to lateral incisor, then in anterior view
* Central incisor would be – x width of lateral incisor
* Canine would be – x width of lateral incisor

A

1.0
1.6
0.6

36
Q

Esthetic Smile
Gingival Zenith
* Centrals- — mm distal to midline
* Laterals- — mm distal to midline
* Canines- centered –

A

1
0.3
M-D

37
Q

Gingival Margin
* Central and canine ON —
* Lateral – mm CORONAL to central and
canine

A

SAME LINE
0.5

38
Q

To help determine
classification and
treatment
* Perform detailed —
* Look at amount and location of —
* Evaluate location of supporting bone using
(2)
* Understand where the — is located
* Understand the Clinical vs Anatomic — of
the teeth (radiographs)

A

Smile Analysis (Esthetic
Analysis Form available on AxiUm)
keratinized
tissue
* radiographs &/or
* bone sounding (under LA)
CEJ
size

39
Q

To determine treatment
* Diagnostic radiographs
(3)

A
  • Anatomic vs. clinical crowns
  • Location of CEJ
  • Location of osseous crest
40
Q

To determine treatment
* Assess probing depths
(2)

A
  • Location of CEJ
  • Location of osseous crest
41
Q

To determine treatment
* Keratinized tissue
* Assess quantity
(2)

A
  • Thick, normal or thin
  • Narrow or wide
42
Q

Skipped
Smile Analysis for DDS
(3)

A
  • Refer to Operative III Course this semester specifically Sept 9th lecture
    (Dr. Seabaugh)
  • Additional Info-Lecture on Elements of Smile Design (Dr. Leal in
    Advanced Pros)
  • Esthetic Analysis Form and Instructions on AxiUm (updated Sept 2022
    )
43
Q
A

Periodontics 2 (13 decks)

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