We all know it’s a fact that crown lengthening is often beneficial, if not downright required, to achieve an optimal restorative result for our patients. When needed, there are two very different times during the patient's care it can be done - both with their own unique pros and cons. Additionally, it is important to realize there are things the restorative dentist can do to make the periodontists life much easier and the outcome of the case more predictable.
Crown Lengthening Choices
The first choice is to have the crown lengthening done prior to starting the restorative procedure. The great thing about this for the restorative dentist is that after the appropriate healing has taken place they can then go in and complete their treatment as they normally would. There are however some downsides to doing things this way. First of these downsides is that unless the periodontist removes the decay at the time of surgery, it continues to grow while waiting on healing. Second, unless the periodontist is given a surgical guide or template they have to guess as to where to put things. Third, if the crown lengthening to be done is in the esthetic zone and the result will be exposed roots the patient is going to look rather ugly during healing.
The other choice is for the restorative dentist to do their initial preparation, preparing into the tissue and violating the biologic width, and then provisionalizing the patient to the margin that was prepared into the tissue. Following this the patient then sees the periodontist within 30 days to complete the crown lengthening.
It is worth noting that the 30 day timeframe is critical as tissue will start to look inflamed and ugly if the surgery is not completed within this window. The great thing about doing things this way is if the restorative dentist trims the tissue back to where they need it and then places nice provisionals that replicate the desired outcome the periodontist can then use those margins as the surgical guide and they will know exactly whereto put things. The other upside to this method is that the patient will always look reasonably good and they won’t be walking around with exposed roots following their crown lengthening.
The big downside to doing things this way is that the restorative dentist will have to have a second appoint to refine their preparations and take impressions. That being said for me this is not a real concern at all when working in the esthetic zone as the benefits vastly outweigh the trouble of a second appointment.
If you are wondering how to go about making sure the margins of the provisionals get in the right place and trim away just there right amount of tissue stay tuned as I will discuss some methods for doing this in my next article.
John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author www.johncarsondds.com