Sufferers might provide with over-retained deciduous anterior tooth and a want to give a boost to the aesthetics in their smiles. Even in circumstances wherein a dental implant is the most productive remedy possibility, the sufferers might not be in a position for implant placement for a number of causes, which might come with age and fiscal instances. Moreover, the sufferers might object to making ready adjoining tooth (conventional mounted bridges) or connecting them with resin-bonded wings. When the ones tooth are solid (no mobility) and feature root construction within the bone, a substitute for extraction and substitute is also indicated. Aesthetics is also progressed through restoring the deciduous tooth to lead them to mix higher with the adjoining tooth. This continuously calls for changing the coronal peak by means of crown lengthening to place the gingival margin in cohesion with the adjoining tooth, offering a natural-appearing smile.
A 27-year-old male affected person offered after the final touch of orthodontic remedy, complaining of dissatisfaction along with his smile associated with over-retained maxillary deciduous dogs bilaterally (tooth C and H). Exam famous standard mobility on tooth C and H, and the probing intensity used to be WNL with wholesome related periodontal tissue. Composite used to be provide protecting the facial surfaces of each tooth that have been positioned previous to his orthodontic remedy in an try to give a boost to the aesthetics of the ones 2 tooth. A diastema used to be provide on each tooth at the mesial interproximal contacts, and the coronal peak equaled the width of the enamel with a gingival margin extra incisal than the adjoining tooth, leading to a detrimental aesthetic impact (Figures 1 and a couple of). Periapical radiographs have been taken. Research of the radiograph of enamel C famous a brief root within the alveolous and the CEJ situated a number of millimeters coronal to the alveolar crest, which could have resulted from hyper-eruption as the encircling everlasting dentition erupted into place (Determine 3). A identical discovering used to be famous at the radiograph of enamel H (Determine 4).
Remedy choices have been mentioned with the affected person. One possibility used to be to extract the deciduous maxillary dogs and right away substitute them with implants. A 2d possibility used to be to revive the deciduous tooth contours to imitate the ones of everlasting dog tooth through striking full-coverage restorations. This feature will permit a prolong of the implant treatment possibility so long as the deciduous tooth closing. A crown-lengthening process can be wanted if the deciduous dogs have been retained to reposition the gingival margin extra apically to higher mix with the adjoining tooth and yield a greater length-to-width ratio aesthetically. The professionals and cons of each choices have been reviewed and mentioned with the affected person. The affected person indicated that he used to be no longer in a position for implant remedy at the moment and needed to check out to deal with the dogs longer whilst making improvements to the aesthetics of his smile. Impressions have been taken of each arches, and he used to be scheduled for remedy.
The impressions have been poured in dental stone, and a diagnostic wax-up used to be carried out to manufacture a surgical stent that will be used throughout the crown-lengthening process. A vacuum-formed stent used to be additionally fabricated, which might be used to create provisional crowns (Determine 5). Then the stent used to be trimmed to signify the best gumline at the deciduous dogs after receiving full-coverage restorations.
The affected person offered for remedy and showed a want to continue with the restorative remedy at the deciduous dogs and crown lengthening. Native anesthetic used to be administered by means of infiltration within the buccal vestibule above the dogs. The previous, present composite used to be stripped off of the dogs with a diamond bur, and the surgical stent used to be seated on maxillary tooth to visualise the best gumline at the deciduous dogs. The usage of a #15c scalpel blade, the best gumline used to be scored within the gingiva. After the best gumline location used to be marked without delay at the gingiva, a diamond bur used to be used to prep the gingiva, alveolar bone, and tooth all in combination (Figures 6 to eight).
A sulcular incision used to be made out of the distal papilla at No. 10 to the mesial papilla at No. 12 at the facial, and an envelope flap used to be raised to visualise the crestal bone at enamel H to permit amendment of the bone to succeed in right kind organic width for the deliberate crown (Determine 9). Organic width used to be checked with a periodontal probe on enamel H (Determine 10). The flap used to be repositioned, and sutures have been positioned on the papilla at the mesial and distal of enamel H with chromic intestine sutures (Determine 11). A identical method used to be carried out at enamel C (Determine 12). Provisional crowns have been fabricated the usage of the stent as a mould, filling it with Protemp II (3M) and reinserting it to create provisional crowns. The stent and provisional crowns have been got rid of intraorally and trimmed and polished. The provisional crowns have been then cemented with Temp-Bond (Kerr Dental), and the affected person used to be scheduled for a postoperative appointment 10 days later (Figures 13 and 14).
Following a therapeutic duration of three months, the affected person offered for initiation of the general crowns. The provisional crowns have been got rid of, and the gingival tissue used to be famous to be wholesome without a irritation (Determine 15). A full-arch affect used to be interested in light- and medium-viscosity VPS (Aquasil [Dentsply Sirona]), and the provisional crowns have been recemented with Temp-Bond. Customized sunglasses have been asked from the dental laboratory through taking footage with colour tabs and forwarding them to the lab. The case used to be despatched to the lab with a prescription for PFM crowns.
The crowns have been returned from the lab and tested at the solid to ensure the aesthetics combined with the dentition, and a natural-looking smile used to be accomplished (Determine 16). The provisional crowns have been got rid of, and any residual transient cement used to be wiped clean off of the arrangements. The crowns have been attempted in, and the affected person used to be given a replicate to ensure that he used to be pleased with the cultured consequence. Upon his approval, the PFM crowns have been luted with GC Fuji PLUS (GC The united states). Following the environment of the cement, marginal extra used to be got rid of with a scaler, and the occlusion used to be checked to verify mild touch at the crowns. A pure smile used to be accomplished, and the objectives of remedy have been finished (Figures 17 and 18). The affected person used to be adopted up for a number of years for regimen recare earlier than relocating to town. Right through the recare on the apply, the deciduous dogs remained periodontally solid, and no ordinary mobility used to be famous.
Upkeep of over-retained deciduous tooth which can be periodontally solid with the absence of mobility is also regarded as within the maxillary anterior to give a boost to aesthetics. The method described is a novel method to crown lengthening in that a couple of constructions are ready in combination: gingival tissue, crestal bone, teeth, and dentin. This permits correct relief of alveolar bone to be able to re-establish ok biologic width.
ABOUT THE AUTHORS
Dr. Kim won his DDS level and certificates in complex prosthodontics from the College of California, Los Angeles College of Dentistry. He maintains a non-public apply restricted to implant dentistry in Buena Park, Calif. He may also be reached at [email protected]
Dr. Kurtzman is in non-public normal dental apply in Silver Spring, Md; a former assistant medical professor on the College of Maryland within the division of Restorative Dentistry and Endodontics; and a former American Academy of Implant Dentistry Implant Maxi-Direction assistant program director at Howard College School of Dentistry. He has lectured across the world at the subjects of restorative dentistry, endodontics, implant surgical treatment, detachable and glued prosthetics, and periodontics and has printed greater than 780 articles globally, in addition to a number of ebooks and textbook chapters. Dr. Kurtzman has earned Fellowship within the AGD, the American School of Dentists, the Global Congress of Oral Implantology (ICOI), the Pierre Fauchard Academy, and the Academy of Dentistry Global. He has additionally earned Mastership within the AGD, the ICOI and Global Academy of Dental Facial Esthetics and Diplomate standing within the ICOI, the American Dental Implant Affiliation, and the Global Dental Implant Affiliation. He’s a expert and an evaluator for a couple of dental corporations. He may also be reached at [email protected]
Disclosures: The authors document no disclosures.