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

    Next Slide Before and After

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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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    Healing at twelve weeks

    Gingival margins now stable

    Gentle brushing with soft brush and

    chlorhexidine from second week postoperative

    Gentle flossing after four weekshealing

    Next slide Before and After

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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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    Healing at twelve weeks

    Next slide Before and After

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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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    Hea