Crown lengthening

Crown lengthening
Crown lengthening is a procedure to increase the amount
of supragingival tooth structure for aesthetic/restorative
purpose

Surgically by
Gingivectomy

or Apically positioned flap

or Apically positioned flap with osseous contouring

Orthodontically
Extrusion of tooth
 Functional crown lengthening

Indications
-Improve retention for prothesis (crowns , bridges ) in short clinical crown

-Inadequate prosthetic space

-Correction of violation of the biological width

Margins of restorations too close to the bone

-Subgingival caries or restorations

-Subgingival fructure
-Exposure of cervical resorption

-Unable to take final impression

-lack of ferrule
Improve retention for prothesis (crowns , bridges ) in short clinical
crown
Improve retention for prothesis (crowns , bridges ) in short
clinical crown

Functional crown lengthening

Correction of violation of the biological width
Margins of restorations too close to the bone
Badly destructive crowns
Inadequate prosthetic space
Subgingival fracture
Subgingival caries
Esthetic crown lengthening indications

Short clinical crowns:

Gingival enlargement or overgrowth

(Inflammatory ,Drugs etiology)

Delayed passive eruption

Excessive gingival display:

gummy smile
Esthetic crown lengthening
Gingival discrepancies
Correction gingival level
Contraindications for crown lengthening

Poor restorative prognosis

Poor esthetic outcome
Exposure of furcations ) Length of root trunk)
Requires extensive bone removal
 Crown-to-Root Ratio

Optimally a 1:2 ratio

1:1 ratio to be the absolute minimum required for restorability.
 Orthodontic techniques

Forced eruption, extrusion should be considered in cases where traditional crown

lengthening via ostectomy cannot be accomplished, like in the anterior area, as
ostectomy would lead to a negative architecture and also remove bone from the
adjacent teeth, which can compromise the function of these teeth. Some of the
contraindications to forced eruption are inadequate crown-to-root ratio, lack of
occlusal clearance for the required amount of eruption and any possible
periodontal complications
The biological width
Is the combined width of connective tissue and epithelial attachment
superior to crestal bone

2 mm Average biologic width

epithelial attachment (0.97 mm)
Connective tissue attachment (1.07 mm).
How to know bone level

Bone sounding
CATEGORIES OF BIOLOGIC WIDTH
Normal Crest
High Crest
Low Crest
 approximately 85 % of cases
Normal Crest
The mid-facial measurement from free gingiva to the crest is 3.0 mm
The proximal measurement from free gingiva to the crest is a range from 3.0
mm to 4.5 mm

Restorative considerations
The margin of a crown should generally be placed no closer than 2.5 mm from
alveolar bone.
crown margin which is placed 0.5 mm subgingivally tends to be well-tolerated by
the gingiva
High Crest Patient approximately 2% cases

In the High Crest patient:

the mid-facial measurement is less than 3.0 mm
the proximal measurement is also less than 3.0 mm

placing margin of restoration in sulcus will be too close to the alveolar bone,
resulting in a biologic width violation and chronic inflammation
Low Crest Patient approximately 13% of
cases

The mid-facial measurement is greater than 3.0 mm and the proximal

measurement is greater than 4.5 mm

Traditionally, the Low Crest patient has stable attachment

apparatus after placement margin of restoration subgingivally .
In order to diagnose a Low Crest patient as Stable or Unstable,
the dentist must perform sulcus probing in addition to sounding bone

Patient A Patient B
Bone sounding is 5.0 mm bone sounding is 5.0 mm
Sulcus depth 3mm Sulcus depth 1mm
2 mm attachment
4.0-mm attachment (epithelium and
(epithelium and connective
connective tissue).
tissue).
FUNCTIOAL CROWN LENGTHENING
Ferrule and crown lengthening
Ferrule effect reduces root fracture risk
Improve crown retention
Improving long term function

Ferrule effect

The rule established is that a 1.5-2 mm

ferrule height directly above the margin
improves long-term survival of endodontic
treated teeth with a post and core
Invading the biologic width during tooth
preparation can result in:
chronic inflammation
loss of alveolar bone
gingival recession
periodontal pocket formation

Biologic width invasion on the gingiva.

What I have to do to not violate biologic
width

1,5 mm 3 mm

3 mm at least must be between restorative margin and

crest of the bone
Surgical correction Biological width violations can be corrected by
removing bone away from proximity to the restoration margin
 Complications of crown lengthening

Possible poor aesthetic due to black triangle

Root sensitivity

Transient mobility of teeth

Gingival retraction –change of marginal gingival contour

Clinical tooth crown higher than adjacent teeth

Unfavorable crown root ration