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Hard tissue crown lengthening
Hard tissue crown lengthening is the procedure done if there is no enough structure which exists over the gumline. In order to attach the prosthetic device like a crown, a dentist may suggest that you get crown lengthening procedure. Even though the word lengthening is used, there will be no actual stretching of the tooth, but the cosmetic results will give the illusion of the lengthened crown as the foundation of the bone around the tooth is adjusted.
With this procedure, the dentist makes incision within the gum tissue and will create the flap which may be folded downward to expose more bone which encases the tooth. The portion of the bone can be adjusted down a specific amount of millimeters and the gum flap will be sutured back in its place. With the surgery, the bone height is going to be lower compared to how it was before and the gum tissue can rest at the lower height, which leaves the crown more visible when someone smiles.
Why is hard tissue crown lengthening required?
To be able to understand what hard tissue crown lengthening is all about it is good to understand more about the gingival crest contour, crown retention, and biological width.
Biological width is dimension found at the crest of the alveolar bone and at the base of the sulcus. It does include the connective tissue and the epithelial attachment. The biological width is measured as 2.73 mm. If the restoration requires the full crown, then it will require biological width which is around 1 mm from the structure of the tooth to use for connective tissue and 1 mmm of the structure of the tooth to use with junctional epithelium. There is also a need of 1 up to 2 mm for the tooth structure and the crown margin placement with termination. This is 3 up to 4 mm of the tooth surface that have to be used for crown; it has to be exposed through the use of this hard tissue crowning. When there is no enough biological width, it may lead to restoration infringement of connective tissue and junctional epithelium and it will lead to bone loss or soft tissue complex’s apical migration. This is may be the reason why, people who have the right oral hygiene can experience gingival inflammation, bleeding or gingival redness on regular basis even if the new crown have close and good margin.
Dental crown retention is a concept which is related directly to the long term function of the crown. The crown retention may be defined like the resistance that prevents the dislodgment and restoration movement and this is mostly when the restoration has been subjected to force which is used in lateral or oblique direction. There is no cement that can be good enough to work on a living tooth structure while biologic environment of oral cavity has adhesive properties that are required in order to withstand oblique or lateral force in mastication. The resistance may be achieved through getting 2-3 mm of the lateral walls up to 6 degree taper. Even with the use of the advance resin bonding cement which offers better restoration, the wall for the ceramic dental crown has to be 2 mm at least. In the circumstances of the crown had fractured, the crown lengthening procedure may be done in order to move the margin of the tooth and to increase the lateral wall.
The gingival crest contour in the height and width has to be restored in order to help with the food deflection away of the dentogingival junction and it also facilitates the oral hygiene effort. If a person has uneven gingival height, it can lead to the problems through brushing since a patient may forget to move his tooth brush after dentogingival contour. When there is uneven gingival width, it will cause the food impaction since it prevents the food or the chew from deflecting away of the dentogingical junction. The phenomena may be achieved by the use a crown lengthening laser or standard methods using oral surgery tools.
What happens during hard tissue crown lengthening?
The treatment technique is different depending on the method that the tissue will be removed. The tools required are laser, electro surgery and the gold standard which includes a regular blade and bone file.
The right way of doing the crown lengthening, is to ensure that the crown had been prepared and that the new crown margin had been visualized. The patient may undergo the crown lengthening afterwards. The use of regular blade offers the speed with a clean sterile cut. Electrosurgery offers hemostatis and it maintains speed and efficiency. Laser offers the best hemostasis, better post operative healing with the best tissue control when it comes to contouring and thinning. However, with laser cutting may be too slow and also time consuming. The doctor may use any of these three tools according to the level of tissue to be removed and how many teeth that are involved.
After the tissue had been trimmed and then removed to reach to the level of where the future crown can be installed, the doctor will reflect the flap and make the recontour of the bone crest. A bone has to be removed up to the level that the bone crest is found at least in 3 to 4 mm away of new crown margin. This is to satisfy requirements of the biological width. The flap will then be repositioned to allow the adaptation of new gingival crest. Gingival crest will not show any pulling movement. In doing this, the flap has to be released and then re-adapted before the suture.
At the end, the dentist will then suture the remaining tissue to heal. In 14 days, the tissue will heal clinically and in 28 days, the tissue will heal microscopically. In 28 days, the impression of a new crown is made.
Is it possible for the tissue to grow back?
The bone will not grow back, however, the tissue will heal in the new position making sure all is healthy and safe with the medical parameters needed. The removal of the tissue and the bone crest will ensure that the biological width has not been violated and this means that gingival crest can stay in place if there is no other process like periodontal disease or margin overhang that takes place. The patient is only required to maintain good oral hygiene and to get professional dental cleaning after each six months.
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