There are several indications for crown lengthening surgery: gaining access to subgingival margins, increasing tooth structure for improved retention, avoiding biologic width violation, and improving esthetics. Today’s case was primarily driven by esthetics. Our goal was to create ideal gingival contours, with #8 and 9 symmetric with each other and with #6 and 11. The tissue margins at #7 and 10 were placed 1-2 mm coronal to their neighbors.
Minor crown lengthening procedures can sometimes be limited to soft tissue. This can be achieved using a surgical flap or laser. The constraint is that restorative margins should be 2-3mm from the bony crest to maintain the biologic width. This can be assessed radiographically and by sounding to the bone with a periodontal probe once the area is anesthetized. Interproximal crown lengthening usually requires removal of bone. If margins will be closer to the bony crest than 2-3mm, soft tissue removal alone will not be sufficient. In today’s case, approximately 2mm of bone was resected to provide proper final gingival contours. Esthetic crown lengthening cases should heal for 6 months prior to fabrication of the final restorations.
Highly demanding esthetic cases are best approached using a diagnostic wax-up with model trimming to establish the ideal gingival and restorative margin positions followed by temporization to the desired final margin position. Alternatively, a vacuform surgical guide for the surgeon can be used in place of provisionals. This avoids guesswork during surgery, and leaves the responsibility for the final tissue and restorative contours in the hands of the restorative doctor and lab where it belongs.