Stability of the gingival margin after an aesthetic crown lengthening procedure in the anterior region by means of a rep
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ORIGINAL ARTICLE
Stability of the gingival margin after an aesthetic crown lengthening procedure in the anterior region by means of a replaced flap and buccal osseous surgery: a prospective study Eduard Domínguez 1 & Andrés Pascual - La Rocca 1 Antonio Santos Alemany 1 & Jose Nart 1
&
Cristina Valles 1 & Neus Carrió 1 & Laura Montagut 1 &
Received: 19 September 2019 / Accepted: 11 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives The main objective of this study was to assess changes in the position of the gingival margin (GM) after performing an aesthetic crown lengthening (ACLP) by means of submarginal incisions, buccal osseous surgery, and a replaced flap after a healing period of 6 months. Methods Twenty-one patients who needed a surgical crown lengthening in the maxillary anterior teeth were included. An individual stent was fabricated to record changes in the position of the GM. Clinical measurements were recorded presurgically; immediately post-surgically (baseline); and at 42, 90, and 180 days. Results After the ACLP, the GM displacement did not change significantly after 42, 90, and 180 days (4.32 ± 1.17 mm, 4.29 ± 1.14 mm, and 4.26 ± 1.11 mm, respectively). Tissue rebound seems to be related to the distance from the GM to the alveolar bone (AB) at the time of suturing (GM-AB(X)). When GM-AB(X) was ≤ 2 mm, 3 mm, and ≥ 4 mm, the GM rebound at 6 months was 0.94 ± 0.53 mm, 0.10 ± 0.28 mm, and − 0.26 ± 0.40 mm, respectively. These differences were statistically significant (P < 0.001). Conclusions An ACLP releasing the flap up to the mucogingival junction, with a ≥ 3-mm distance from the bone crest to the gingival margin can lead to a stable GM position at 42, 90, and 180 days. Clinical relevance This article focuses on variables affecting the stability of the GM, which is a critical factor that may compromise the biological and aesthetic long-term outcomes. Keywords Crown lengthening . Gingiva . Alveolar process . Crowns . Aesthetics . Stents
Introduction The stability of the soft tissue margin following a crown lengthening procedure is a critical factor and may compromise the outcome of the operated areas [1]. A rebound of the gingival margin (GM) can lead to an aesthetics compromise as well as an alteration of the periodontal health [2]. A systematic review observed that tooth site, presence of restoration, healing time after crown lengthening procedure, and periodontal disease condition are factors that may affect the
* Andrés Pascual - La Rocca [email protected] 1
Department of Periodontology, Universitat Internacional de Catalunya (UIC), C/Josep Trueta s/n, 08195 Sant Cugat del Valles, Barcelona, Spain
dimension of the biologic width [3]. The influence of the periodontal phenotype has also been assessed. Thick phenotypes seemed to be associated with a greater GM rebound after aesthetic crown lengthening procedure (ACLP), when compared with thin phenotypes [4, 5]. Tooth type has also been studied as a possible influencing factor for tissue rebound [3, 5
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