Show Your Work: Aesthetic Crown Lengthening by Dr Abdullah Alkanan

Dr Abdullah Alkanan outlines the procedural approach and importance of planning and interdisciplinary communication in this aesthetic crown lengthening case

by Dr Abdullah Alkanan

Introduction
The following case presented as a referral from a prosthodontic colleague, Dr Hunter Dawson who practices in North Carolina. The patient’s presenting complaint was of ‘short teeth’ and he wished to improve his smile. Dawson wished to restore his teeth with full coverage crowns, and for that he needed aesthetic crown lengthening to be carried out. This case study describes the surgical intervention completed to facilitate the restoration of the anterior teeth without impinging on the biological width.

Diagnosis and treatment plan
Figs. 1 and 2 show the initial presentation. The restorative dentist made the diagnosis of ‘tooth wear’ and identified its aetiology and addressed its management before referral.

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  Fig. 1

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  Fig. 2

One of the first things to be done in this case was periodontal diagnosis, which drives and directs the treatment. It includes finding where the bone crest is in relation to the CEJ, how thick the osseous crest, where the restorative margin is anticipated, amount of keratinized tissue and tissue biotype.

This will determine if a flap will be raised or not, or if we will utilize an apical positioning flap approach or a gingivectomy. In this case, the osseous crest was thick, and the restorative margin was impinging on the biologic width. An internal bevel incision was indicated for this case.

Gingival margin positioning
The restorative dentist provided me with a clear stent with an anticipated gingival margin position (Figs. 3 and 4). This was to aid design of my internal bevel incisions through bleeding points as shown in Fig. 4.

The initial incisions re-created the anticipated gingival margin (Figs. 5 and 6).

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  Fig. 3

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  Fig. 4

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  Fig. 5

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  Fig. 6

Bone ostectomy and osteoplasty
After the initial outline was completed, a full-thickness flap was reflected to re-create the biologic width sustaining the future crowns as well as establishing proper bony architecture. By that, I mean the scalloped and parabolic form of bone as well as positive architecture. Figs. 7 and 8 demonstrate before and after the osseous recontouring.

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  Fig. 7

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  Fig. 8

Sutures
In this case, an everted vertical mattress suture was utilized to support the papillae (Fig. 9).

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  Fig. 9

Preparation and provisionalisation
The teeth were prepped 10 weeks after the procedure. Notice the excellent tissue color, consistency, counter, and texture at the time of teeth preparation (Fig. 10).

Fig. 11 shows the provisional restorations.

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  Fig. 10

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  Fig. 11

Conclusions
Aesthetic crown lengthening is a technique-sensitive procedure that requires careful planning.

Interdisciplinary communication among the restorative dentist, the surgeon and the patient is vital for treatment success. Fig. 12 shows ‘before’ and Fig. 13 shows ‘after’ treatment.

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  Fig. 12

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  Fig. 13

Dr Abdullah Alkanan BDS, MFDS RCS Ed, MSD. Diplomate of the American Board of Periodontology (the highest level attainable for the specialty in the United States) is a member of the American Academy of Periodontology and The Royal College of Surgeons of Edinburgh. He resides between Chicago and Kuwait City, where he practices implant dentistry and periodontology. Email: dralkanan@gmail.com