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Surgical Crown Lengthening 2
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    • 411PDS Surgical report
    Course director: Dr. Nahid Ashri
    Instructor: Dr.Fatin Awaratani
    Student Name: Jasmine
    Crown lengthening: is a surgical procedure performed on a healthy periodontium that requires exposure of adequate tooth structure (so, the amount of tooth exposed supragingivally is increased) for restorative purposes. This may be achieved by several techniques (either orthodontically or surgically) depending upon:
    • The proposed location of the restorative margin.
    • 2. The location of the alveolar crest and gingival margin.
    • 3. The width of the keratinized attached tissue.
    • 4. The amount of exposed tooth structure available.
    • 5. Biological width
    • 6. is a natural defense of the periodontium ,The concept of a minimum dimension of tissue from the alveolar crest to the bottom of the gingival sulcus. Consist of the average histological dimensions of the:
    • 7. connective tissue attachment
    • 8. the epithelial attachment
    • 9. the gingival sulcus.
    Understanding of the biological width and the level of the osseous crest is key to maintaining periodontal health in the presence of dental restorations. The location of a restorative margin relative to the crest of the alveolar bone is more critical for preserving gingival health than its distance below the free gingival margin.
    • The Goal and Location of periodontal surgery:
    The goal of the procedure is to increase the length of the clinical crown of 14, in order to make the crown margin in sound tooth structure without extending it deep into the periodontal tissue and jeopardizing the biological width.
    • Patient data:
    Patient name:
    File no. :
    Date: 27-12-09
    Age: 44years.
    • Chief Complaint: replacement of missing teeth , pt was referred from 431 SDS for crown lengthening.
    • 10. Medical History: Medically fit.
    • 11. Dental History:
    Endo tx for # 14 after caries exposure & temporarily build up (OD) with GIC.
    • extra oral examination:
    TMJ: no clicking, no tenderness, no deviation.
    Lymph Nodes: Not palpable, not movable, no tenderness.
    • Intra oral examination: NAD.
    Probing depth:MesialMidbuccalDistal Buccal311 Lingual311
    • Preoperative Radiographic examination
    • 12. There is no root proximity.
    • 13. The tooth is endodontically treated.
    • 14. There is no adequate space between the temporary restoration and the crestal bone (biological width is violated).
    • 15. INSTRUMENTS:
    • 16. Mirror.
    • 17. Periodontal prob.
    • 18. Disposable plastic Syringe+ Saline solution
    • 19. Metal syringe +Anesthetic solution (xylocain 2% + adrenalin 12,5 micrgm/ml)
    • 20. Sterile gauze
    • 21. Surgical kit :
    • 22. scalpel blades (no.15,12)
    • 23. Austin retractor
    • 24. periosteal elevator
    • 25. tissue forceps
    • 26. surgical curettes
    • 27. bone file (sugarman )
    • 28. surgical scissors
    • 29. high speed hand piece
    • 30. small round bur
    • 31. periodontal scalers
    Preoperative Photographs:
    There was no need for premedication because she is a medically fit.Local anesthesia
    2% xylocain with 1:100,000 epinephrine infiltration injection to anesthetize middle superior alveolar nerve buccally and Greater palatine nerve infiltration palatally, (2carpules).Incision
    lefttopUsing # 15 scalpel blade, the first incision (Internal bevel Incision) 1mm from gingival margin, followed by sulcular incision and finally interdental incision by orban knife
    Incisions have been done at Buccal & Lingual sides, extended from 13 to 15.
    Full thickness flap reflected buccally and palatally
    Using mucoperiosteal elevator.
    Open flap debridement, scaling and root planning eliminating the local factors,
    Then, tissue collar and granulation tissue removed by surgical curettes.
    Osseous correction:
    1mm of the tooth supporting bone was removed buccally, palatally, mesially and distally with a high speed # 4 round bur.Sutures
    • the flap repositioned and sutured.
    • 32. non resorbable silk suture size 3-0.
    • 33. 2 Simple interrupted suture was formed with the knot positioned buccally.
    Medication• Chlorohexidine mouth wash 2% for1 weeks • IBuprofen 400 mg tablets every 8 hoursPost operative instruction
    • 6737350512445Keep biting on the gauze for 30 min ,if bleeding persist bite on another gauze for another 30 min
    • 34. Keep your tongue and your fingers away from the surgical area so you don’t disturb the healing process.
    • 35. At the same day of the surgery :
    • 36. Eat soft food
    • 37. Don’t eat or drink hot food
    • 38. Follow your regular activities with no excessive exercise
    • 39. NO gargling is allowed .
    • 40. After one day of the surgery :
    • 41. Rinse with chlorhexidine 2% for 1 week twiceday
    • 42. Brush your teeth regularly except the area of surgery .
    • 43. If any complications occur as bleeding or sever pain contact the dental clinic.
    • 44. suture removal was schedule after two week .
    Prognosis: Good.
    Follow up visit:
    Removal of sutures was done, & irrigation with saline.