Anterior Surgical Crown Lengthening by Dr. Davinder Singh Kalsi

Introduction
The following case was presented to me in my vocational training year, a multidisciplinary case where all anterior units indirectly restored were defective.

Before treatment
In cases like this, where you’re going to remove anterior units, it’s important to consent for the possibility that the anterior units may be unsuitable for restoration after removal of the crown units. The second is to consent for the alternative plan, if they are unable to be restored, with what you’ll do immediately to temporise, especially anteriorly. For example, in this case shown.

This particular patient gave me consent for removal and replacement of the existing, failing crowns with another root canal treatment, new post cores and surgical crown lengthening.

The patient understood that her alternative option (in the event that I was unable to restore the anterior teeth) would be having an acrylic Essex retainer fitted until an immediate denture could be provided.

The preoperative radiographic assessment indicated that the posts in situ at UR2 (12) and UR3 (13) were unsatisfactory, because of their short length. It was also assessed that there would likely be a limited amount of supragingival tooth structure remaining after preparation. Surgical crown lengthening would result in a more favourable aesthetic and clinical result.

Summary of treatment sequence

1. Removal of existing crowns. This photograph indicates how little supragingival tooth structure remained. In an ideal situation, at least 1.5–2mm would be available. When placing post crown units, the survival rate is considered to be similar to when there is an adequate ferrule.

Crown and caries / postremoval

2. Re-root canal treatment. H file guide path size 20. NaOCl oil of eucalyptus and EDTA. Protaper x2. Cold lateral compaction. Epoxy resin sealer. GP subsequently trimmed to 10mm.

3. Surgical crown lengthening by the raising of a three-sided flap, contouring of the bone (using a surgical handpiece to establish the new position of the bone and allowing periodontal attachment to take place) and re-establishing the biologic width with the aim for correct gingival contour and biologic width.

4. 3M fibre posts size 20 cemented with RelyX Ultimate after 37 percent phosphoric acid etch and Scotchbond. Core build-ups constructed with Venus Charisma A1.

5. Immediate temporary crowns were provided.

6. Luxatemp chairside temporary crowns placed one week later to manipulate the gingival contour and positioning.

7. Final sutures removed after 6 weeks.

8. E.max crowns placed after 6 months.

Dr. Davinder Singh Kalsi studied dental materials (BEng) 2008–2011 before studying dentistry at Aberdeen University, from which he graduated in 2016. He works with principal GDP Dr. Usman Ullah at the Merrylee Dental Practice in Glasgow.