New Crown Lengthening Techniques and Biologic Width?

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tannermck | Total Posts: 3 | Member Since: 08/03/05 | Location: Madison, WI | Posted: 6/19/2006 7:34:42 PM | Post: 1 of 41
Alright, I’ve got questions about perio crown lengthening [CL], now called “gum lifts,” with lasers. To sum it up, if one uses a soft-tissue laser to recontour the free gingival margin, and possibly ablate attached tissue also, what has been done about the osseous crest? The soft tissue may look great immediately, but if
any restorative is going to follow, won’t you be violating the biological width? Setting up multiple long-term problems? If so, it seems as though the soft-tissue laser is really no better than a good electrosurgery unit and not a true replacement for osseous crown lengthening. I am interested in opinions of operators doing various techniques. Periodontists and self-proclaimed cosmetic dentists are invited to weigh in.

Harry J. Jackson | Total Posts: 964 | Member Since: 03/07/05 | Location: Ft. Hood, TX | Posted: 6/19/2006 8:00:32 PM |
Post: 3 of 41
I don’t know who’s calling it “gum lifts,” I hope it’s not doctors! You need to understand the difference between a gingivectomy and crown lengthening. Crown lengthening involves osseous surgery. Some say that they can do this with an envelope-type flap, or even better, a sulcular flap without papilla release. I don’t see how it’s possible! The osseous surgery that is required is so delicate and exacting that I think you need to have x-ray vision to do it well.When CL has been treatment planned it doesn’t matter what you use to make that initial gingivectomy
incision; laser, electrosurge, or my preference, a blade. But, you have to make sure that a flap is reflected and the osseous is done properly. Please, I really hope we don’t start calling anterior esthetic crown lengthening “gum lifts.”

Matt Brink | Total Posts: 3589 | Member Since: 04/28/04 | Location: Wheaton, IL | Posted: 6/20/2006 4:39:59 AM |
Post: 7 of 41
Mike, these are my pictures. Thanks for mistaking them as Danny’s. It made my day. I did the RR [root reshaping] and CL with a bur and photographed the site prior to making bony corrections anywhere else. It shows what you would have to do with a laser. Could it be done closed flap? I sure don’t know how it would be possible.

tannermck | Total Posts: 3 | Member Since: 08/03/05 | Location: Madison, WI | Posted: 6/20/2006 6:02:26 AM |
Post: 12 of 41
Thanks for the comments. Your comments generally agree with my thoughts on the subject. I’d like to
share a few additional thoughts:
1) Many “cosmetic dentists” are using the term “gum lift” routinely now, especially in advertising in my area. I put cosmetic dentists in quotations because every dentist is a cosmetic dentist whether you realize it or not. Indeed, it is a sugar-coated term, but I feel it is misleading.
2) I recommend to all doing any type of osseous surgery using a surgical handpiece, such as an Impact Air. If you do enough using a traditional high-speed, you will have an episode of air emphysema. It’s only a matter of time.