When we think of an attractive smile, we are referring to one that lines up smoothly with the lower lip and displays even gingival levels. When a patient is unhappy with the display of their teeth and gingiva, the use of facial crown lengthening surgery can be a great adjunct to enhance the final result of the smile. When performing this surgery there are necessary steps that you need to take in order to achieve an ideal look and biologically stable and healthy result.
Step 1: Determine where the tooth position and gingival levels should be. The use of a removable composite mock-up can be very helpful at visualizing both incisal edge position and gingival levels.
Step 2: Evaluate sulcus depth, sounding depth to bone, and the amount of attached gingiva. If the surgery will not leave 3mm of attached gingiva it will be necessary to use an apically positioned flap rather then an excisional approach.
Step 3: Using the mock-up to guide you, perform a gingivectomy to correct the gingival height using a laser, electrosurg, or scalpel.
Step 4: Following the gingivectomy reevaluate the sulcus depth and sounding depth. If there is more then 1mm of sulcus remaining and the sounding depth to bone is 3mm or more, the surgery is complete, although some rebound can be expected. If the sulcus has been eliminated or the sounding depth is less then 3mm it will be necessary to remove facial bone to recreate at least 3mm of space from the desired gingival level to the bone. This can be done with a flap or flapless depending upon the case and amount of bone removal needed.