Crown lengthening and restorative procedures in the esthetic zone

Influence of crown-lengthening surgery on teeth rehabilitated with ceramic single crowns: A 12-month prospective clinical study

OBJECTIVE

To compare the clinical periodontal parameters of teeth restored with a single ceramic crown, with and without crown lengthening procedure.

METHODS

This prospective, longitudinal, controlled, and single-blinded clinical trial involved 22 patients with a total of forty-one teeth with ceramic crowns. The teeth were divided into two groups: test (n = 21), comprising teeth rehabilitated post crown-lengthening surgery, and control (n = 20), comprising teeth rehabilitated without crown-lengthening surgery. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL) were compared between groups (surgically treated and non-surgically treated) and within each group for each type of site (treated -tt; adjacent - ad; and nonadjacent - nad). Additionally, gingival phenotype (GP), gingival recession (GR), and keratinized tissue width (KTW) were also assessed post- restoration. Statistical analyses used a significance level set at 5 %.

RESULTS

PI, GI, and BoP were reduced, but no statistically significant differences were observed within each group or between groups for most follow-up periods. CAL of the TT sites was consistently higher in the test group, and PD was also higher in the test group (p < 0.05), except at T3. adPD, nadPD, adCAL, and nadCAL demonstrated no significant differences between groups and periods. A significant association was identified between GP and the occurrence of GR, with the thick-flat phenotype demonstrating less association with GR, regardless of whether crown lengthening was performed or not.

CONCLUSION

Crown-lengthening surgery in rehabilitated teeth does not significantly affect PI and GI after 12 months. Although crown-lengthening surgery affected PD and CAL in TT sites, it did not affect adjacent and non-adjacent sites.

CLINICAL RELEVANCE

These findings emphasize the importance of considering individual patient factors and the potential impact on periodontal tissues when planning crown-lengthening surgery. Clinicians must have a comprehensive understanding of the dynamics of the periodontal tissues involved in restorative treatments to optimize the procedure, increase success rates, and minimize potential complications.

Deep margin elevation in restorative dentistry: A scoping review

OBJECTIVES

Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web.

DATA

Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening.

SOURCES

This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information.

STUDY SELECTION

The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources.

CONCLUSIONS

DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to.

CLINICAL SIGNIFICANCE

With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.

Biologic Width Following Different Crown Lengthening Procedures: A Six-Month Follow-Up Study

BACKGROUND

One of the important things to preserve during crown lengthening is the biologic width (BW), recently called supracrestal tissue attachment. A healthy periodontium with adequate BW is very essential for the success of restored teeth. There are various techniques to perform crown lengthening procedures. Most of the studies have focused on assessing the changes in the position of the marginal gingiva and bone as outcome parameters rather than BW. Also, most of the research was done on animal models.

AIM

The purpose of this study was to assess the periodontal tissue changes at three months and six months following two different surgical crown lengthening procedures.

MATERIALS AND METHODS

Sixty mandibular first molars among 60 patients that required surgical crown lengthening were enrolled in the study and subjected to two different procedures, gingivectomy (Group I; n=30) and apically positioned flap with ostectomy (Group II; n=30). The following parameters were recorded at baseline, three months, and six months, position of free gingival margin (FGM), probing depth (PD), relative attachment level (RAL), bone level (BL), and BW. These measurements were made at three sites in every patient: treated tooth sites (TT), adjacent tooth's adjacent sites (AD), and adjacent tooth's non-adjacent sites (NAD). The data was then subjected to statistical analysis using SPSS software (Version 20.0). Statistical significance was set to p<0.05.

RESULTS

When groups I and II were compared at three and six months, there was no statistical difference in terms of position of FGM, PD, and RAL (p>0.05). When BW was compared between the two groups at three and six months, group II showed better reestablishment of BW at any given time period and was statistically significant (p<0.05).

CONCLUSION

 Following surgical crown lengthening, the bone level was shifted apically and allowed for the reestablishment of BW. At six months of follow-up, the apically positioned flap with ostectomy was superior in restoring the BW compared to gingivectomy.

Assessment of the correlation between supracrestal gingival tissue dimensions and other periodontal phenotypes components via the digital registration method: a cross‑sectional study in a Chinese population

BACKGROUND

Supracrestal gingival tissue dimensions (SGTDs) has been considered to be an essential element of periodontal phenotype (PP) components. This study aimed to explore the relationship between SGTDs and other PP components by digital superposition method that integrated cone beam computed tomography (CBCT) with intraoral scanning.

METHODS

This cross-sectional study was conducted at the Stomatology Hospital of Fujian Medical University. Participants were recruited based on the inclusion and exclusion criteria. The data obtained from the digital scanner (TRIOS 3, 3Shape, Denmark) and CBCT images were imported into the TRIOS software (Implant Studio, 3Shape, Denmark) for computing relevant parameters. The significant level was set at 0.05.

RESULTS

A total of 83 participants with 498 maxillary anterior teeth were finally included. The mean values of supracrestal gingival height (SGH) and the distance from the cementoenamel junction (CEJ) to the crest of the alveolar ridge (CEJ-ABC) on the buccal site were significantly higher than palatal SGH (SGH-p) and palatal CEJ-ABC (CEJ-ABC-p). Men exhibited taller CEJ-ABC and SGH-p than women. Additionally, tooth type was significantly associated with the SGH, SGH-p and CEJ-ABC-p. Taller SGH was associated with wider crown, smaller papilla height (PH), flatter gingival margin, thicker bone thickness (BT) and gingival thickness (GT) at CEJ, the alveolar bone crest (ABC), and 2 mm apical to the ABC. Smaller SGH-p displayed thicker BT and GT at CEJ, the ABC, and 2 and 4 mm apical to the ABC. Higher CEJ-ABC showed lower interproximal bone height, smaller PH, flatter gingival margin, thinner GT and BT at CEJ, and 2 mm apical to the ABC. Smaller CEJ-ABC-p displayed thicker BT at CEJ and 2 and 4 mm apical to the ABC. On the buccal, thicker GT was correlated with thicker BT at 2 and 4 mm below the ABC.

CONCLUSION

SGTDs exhibited a correlation with other PP components, especially crown shape, gingival margin and interdental PH. The relationship between SGTDs and gingival and bone phenotypes depended on the apico-coronal level evaluated.

TRIAL REGISTRATION

This study was approved by the Biomedical Research Ethics Committee of Stomatology Hospital of Fujian Medical University (approval no. 2023-24).

Biological shaping as a conservative alternative for crown lengthening: A review

OBJECTIVES

The perio-restorative approach to maintaining supracrestal tissue attachment (STA; formerly known as biologic width) is a fundamental goal in modern dentistry. This article aims to review the clinical impact of biologic shaping (BS) as an innovative alternative to traditional crown lengthening procedures, reflecting over two decades of clinical experience.

MATERIAL AND METHODS

As a review paper, it is crucial to highlight that BS stands as a unique approach designed to optimize STA while emphasizing minimal to no removal of supporting bone. The review spans over two decades, consistently demonstrating clinical efficacy and predictability. Remarkably, BS focuses on addressing issues such as root concavities, developmental grooves, irregularities, furcation lips, and CEJ offering a remarkable level of clinical precision.

RESULTS

The reviewed literature underscores that BS has consistently achieved substantial clinical success in fulfilling its objectives. This method presents a biologically sound alternative to traditional crown lengthening, placing a strong emphasis on the preservation of essential bone tissue and the establishment of durable STA.

CONCLUSIONS

The results suggest that BS is a logical and biologically driven approach for maintaining STA, making it a promising alternative to traditional crown lengthening. The method offers a predictable and reproducible way to preserve bone tissue while achieving durable STA. This innovation holds great promise in the field of periodontal and restorative dentistry.

A combination crown lengthening and implant placement guide

Surgical procedures, including crown lengthening and implant placement, have become more predictable and less invasive because of the use of digital planning tools. A method combining a cone beam computed tomography and a digital scan with a virtual planning software program is described to fabricate a combination guide for both surgical esthetic crown lengthening and guided implant placement.

Accuracy of three types of digital guides for crown lengthening surgery: An in vitro study

Background/purpose

The guided protocols always yield a higher accuracy than freehand surgery. However, the accuracy of digital guides for crown lengthening surgery (CLS) is unknown. The purpose of this study was to evaluate the trueness of 3 types of digital guides for CLS.

Materials and methods

Twenty individually designed maxillary models were divided into 4 groups according to surgical guides: type I (T1), type II (T2), type III (T3), and free-hand. T1 comprised a planed gingival margin at the tissue level. T2 included both the planed gingival margin and alveolar crest at the tissue level. T3 consisted of a planed gingival margin at the tissue level and an alveolar crest at the bone level. CLS was performed under the indication of the guides. Trueness of the guides was evaluated through the deviation of the gingival zenith and alveolar crest height.

Results

The control group had higher vertical and horizontal distance deviations of gingival zenith compared to the 3 digital guide groups (P < 0.001). There were no significant differences among the 3 test groups in terms of gingival zenith deviations (P > 0.05). With regard to height deviation of alveolar crest, the control and T1 groups were higher than T2 group (P < 0.001), while T3 group had the lowest deviations among the 4 groups (P < 0.001).

Conclusion

The digital guides assisted CLS procedures are more accurate than free-hand method. The trueness of type III guide was better than type I and type II.

Aesthetic Management of Tooth Size Discrepancies

The aesthetic management of tooth size discrepancies is an essential component when dealing with simple and complex dental rehabilitation. Tooth size and shape is a crucial factor that strongly influences both the smile and the face in the treatment outcome. From an orthodontic perspective, evaluation of the ideal mesiodistal widths relating to both maxillary and mandibular arches is required to plan the correct occlusal, aesthetic, and functional result.The aim of this paper is to propose a safe and repeatable method to evaluate and correct tooth size discrepancy through the presentation of two case reports. Both cases were managed using a combination of clear aligner therapy and minimally invasive restorative procedures, as well as the use of digital tools.

Reattachment of Fractured Tooth Fragment by Multidisciplinary Treatment Approach

Dental anterior fractures are common injuries, especially in those who practice extreme sports. This report describes a 25-year-old Bolivian patient who attended our private dental clinic in La Paz, Bolivia after experiencing an accident during downhill mountain biking. An intraoral examination revealed a fracture line on the buccal side in the middle third of the coronal portion of the right central maxillary incisor which extended towards the proximal and lingual sides. Multidisciplinary treatment, including crown lengthening, osteotomy, root canal treatment, fiberglass post insertion, and reattachment of the fracture segment was performed. A follow-up examination at 10 months later revealed that the tooth was completely reestablished both functionally and esthetically and that there was no periapical pathosis or discomfort. This outcome suggests that if a patient seeks a dental consultation soon after a complex crown-root fracture has occurred, and if the broken tooth segment is available, then reattachment offers an economical and simple treatment option which will allow immediate restoration of functionality and esthetic standards. Continued follow-up should form part of such a treatment plan to allow long-term pulp vitality and periodontal health status to be monitored.

Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review

Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed.

Present status and future directions - Managing discoloured teeth

Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.

Diagnostic Mock-Up as a Surgical Reduction Guide for Crown Lengthening: Technique Description and Case Report

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.

Assessment of a developed pig cadaver model for teaching crown lengthening surgical procedures

Background

Information regarding using a pig cadaver model for teaching purposes in dentistry is limited, especially for periodontal surgery procedures. The aim of this study was to assess the feasibility and efficacy of teaching crown lengthening surgical procedures using a prepared pig cadaver model.

Methods

Mandibles of slaughtered pigs with subgingival crown fracture defects on two premolars and two molars on each side were prepared as periodontal surgery teaching cases. A resident group (n = 20) and an instructor group (n = 18) participated in assessing the efficacy of the model by completing questionnaires before and after training sessions. Data was either assessed descriptively or analyzed statistically with Wilcoxon signed-rank test with the significance level at α = 0.05.

Results

Results revealed that all the knowledge points showed statistically significant improvements (p < 0.05) except for the procedure to determine the quantity of bone removal during osteotomy procedures. Most residents rated the efficacy of the model obtained with 9.0 out of 10 scale. The data of effectiveness of the pig cadaver model from the instructor group ranged from 7.4 ± 1.4 to 9.0 ± 1.0.

Conclusion

Results of this study support feasibility in using prepared pig cadaver models to teach crown lengthening surgical procedures to postgraduates.

Success rate of fractured teeth receiving modified crown lengthening surgery and restorations

BACKGROUND

Whether to preserve a structurally compromised tooth or remove it is a dilemma often encountered by clinicians. The aim of this study was to assess the long-term success rate of fractured teeth preserved by modified crown lengthening surgery and restorations.

METHODS

Thirty-nine patients with a total of 45 fractured teeth who had received modified crown lengthening surgery were recruited and examined. Numbers of teeth lost were recorded, and the criteria for successful teeth were defined. Kaplan-Meier estimator was used to determine the success rate. Possible risk factors were compared between successful and unsuccessful groups by a Cox regression analysis to explore the potential predictors of failure with a significant level at α = 0.05.

RESULTS

The mean ± SD of success time without considering variants was 6.2 ± 0.6 years (95% CI 5.1-7.7). The mean survival rates ± SD at 1.0-, 2.0-, 3.0-, 5.0-, 7.0-, and 9.0-year intervals was 97.8 ± 2.2%, 92.2 ± 4.4%, 72.8 ± 7.9%, 68.2 ± 8.6%, 60.7 ± 10.5%, and 40.4 ± 13.6%, respectively. Failure cases in teeth with poor plaque control and step-shaped fracture margin were significantly more than those with good plaque control and knife-shaped fracture margin (HR = 7.237, p = 0.011; HR = 15.399, p = 0.006; respectively).

CONCLUSIONS

Fractured teeth treated with modified crown lengthening surgery are anticipated to have a high clinical success rate for 6.2 ± 0.6 years. Plaque control and fracture morphology appeared to be significantly associated with the success of the multidisciplinary treatment approach.

Virtual Planning and Rapid 3D Prototyping Surgical Guide for Anterior Crown Lengthening Surgery: A Clinical Case Report

Progress with additive 3D printing is revolutionizing biomaterial manufacturing, including clinical dentistry and prosthodontics. Among the several 3D additive printing technologies, stereolithography is very popular as it utilizes light-activated resin for precise resolution. A simplified digital technique was used to fabricate two designs of a surgical guide for crown lengthening. Two cases are presented that utilized digital DICOM files obtained with computed tomography (CT) imaging and processed using four CAD software (Blue Sky Plan, Exocad, Meshmixer and 3D Slicer). The final models were converted to standard tesselation (STL) files and the guides were 3D printed with an additive sterelithography (SLA) printer. The first case was fabricated with a bone model from CBCT data, and the second case was generated with intraoral and wax-up scans alone. Both methods appear to be equally effective compared to using a conventional method of guide frabication. However, proximal bone reduction was a concern with both designs. Digitally fabricated 3D printed surgical guide for crown lengthening has merit and a practical design is needed for future clinical validation. This article is protected by copyright. All rights reserved.

Treatment Prognosis of Restored Teeth with Crown Lengthening vs. Deep Margin Elevation: A Systematic Review

Crown lengthening surgery and deep margin elevation are two distinct approaches used to manage decayed teeth. This systematic review examined the survival rate of badly decayed teeth when restored using the crown lengthening technique and compared it to the deep margin elevation technique. The search was conducted during July 2020 and then again updated at the end of July 2021, and no restriction concerning publication status and time was applied during the search. Cochrane Database, EBSCO, Scopus, and Medline databases were searched electronically for relevant literature. Google Scholar was used as a secondary source. Predefined inclusion and exclusion criteria were used to select the relevant articles. PRISMA guidelines were followed. The focused PICO question was: 'Does the crown lengthening technique (I) provide a better survival rate (O) than deep margin elevation technique (C) following the restoration of badly decayed teeth (P).' A total of six articles were included after performing screening based on the eligibility criteria. Four studies focused on crown lengthening while two focused on deep margin elevation technique. A majority of the studies showed a high risk of bias owing to methodological insufficiencies. Crown lengthening (CL) treated cases showed a change in the free gingival margin at six months post-surgery. A tissue rebound was seen that was correlated to the periodontal biotype. Teeth treated with the deep margin elevation (DME) technique showed high survivability. There is a lack of high-quality trials examining surgical comparisons between CL and DME with long-term follow-up. Patient- and dentist-reported outcomes have not been given adequate consideration in the literature. Based on the limited evidence, it can be concluded that for restorative purposes, crown lengthening surgery can be successful in long-term retention of restored teeth. However, the deep margin elevation technique has a better survival ratio. Future well-designed and executed research will have an effect on the evidence and level of certainty for the best approach to treating severely decayed teeth.

Effect of photobiomodulation on pain control after clinical crown lengthening surgery

Background

Photobiomodulation is a novel technique to reduce pain following different surgeries and treatments. This study aimed to investigate the effect of photobiomodulation on pain control after clinical crown lengthening procedures.

Methods

Twenty patients were included and randomly assigned to two groups in this single-blind randomized clinical trial. The patients had been referred to the Periodontics Department, Tabriz Faculty of Dentistry, for crown lengthening surgery. In the laser group, diode laser therapy with a wavelength of 860 nm and a power of 100 mW was applied immediately after the surgery on the surgery day and three and seven days after the surgery. In the control group, the laser was turned off, and passive radiation was applied to the area as the test group for 30 seconds per session in non-contact mode. The pain was assessed by a visual analog scale (VAS) questionnaire on the study timelines. Data were analyzed with SPSS 20 using ANOVA and post hoc Tukey tests.

Results

Twenty patients were included in each study group, where the pain was relieved significantly over time. On the first (5.50±1.18) and seventh (1.8±0.42) days, the pain intensity was similar in the test and control groups. However, on the third day, the laser group (2.90±0.74) experienced a significantly lower pain intensity than the control group (4.0±0.67).

Conclusion

Photobiomodulation relieved pain after clinical crown lengthening surgeries.

Surgical guides for esthetic crown lengthening procedures: Periodontal and prosthetic aspects

BACKGROUND

In patients with gingival exposure on smiling due to altered passive eruption, esthetic crown lengthening is often indicated. Meticulous planning and surgical precision are key for successful outcomes. Surgical guides are helpful tools that are seldomly reported on in the literature related to esthetic crown lengthening procedures.

TYPES OF STUDIES REVIEWED

The authors searched the literature for articles that described the planning, tools, and execution related to esthetic crown lengthening procedures.

RESULTS

Several techniques have been reported to guide the esthetic crown lengthening procedure, ranging from direct bone level measurement to 3-dimensional printed surgical guides.

PRACTICAL IMPLICATIONS

This review serves the clinician as an aid in the decision-making process for esthetic crown lengthening procedures and available surgical guide options, including computer-based guides.

Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report

CLINICAL RELEVANCE

Combined techniques to expose circumferential tooth structure associated with subsequent restoration may represent a valid option in many situations. This case provides an example of the successful management of the anterior tooth rehabilitation combining root displacement and crown lengthening.

SUMMARY

Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.

Conservative management of extensively damaged endodontically treated tooth using computer-aided design and computer-aided manufacturing-based hybrid-ceramic endocrown: A clinical report

Restoring extensively damaged endodontically treated posterior teeth is always a challenge in dentistry. The use of endocrowns has gained popularity in restoring severely damaged endodontically treated teeth (ETT) in recent years. In this clinical report, a structurally compromised mandibular second molar with symptomatic irreversible pulpitis and normal apical tissue was endodontically treated. Surgical crown lengthening was attempted thereafter to increase the crown height. However, marginal periodontal tissue re-growth occurred after surgical crown lengthening. The tooth was subsequently restored with endocrown which was fabricated using computer-aided design and computer-aided manufacturing-based hybrid-ceramic. In conclusion, endocrown can be a viable restorative modality for ETT with compromised clinical crown height.

Periodontal plastic surgery for esthetic crown lengthening by using data merging and a CAD-CAM surgical guide

This article introduced a digital workflow by using data merging and a computer-aided design and computer-aided manufacturing (CAD-CAM) milled surgical guide for an esthetic crown lengthening procedure. The superimposition of intraoral scanning, digital photographs, cone beam computed tomography, and a CAD-CAM surgical guide should increase the predictability of esthetic crown lengthening surgery.

A Digital Esthetic Rehabilitation of a Patient with Dentinogenesis Imperfecta Type II: A Clinical Report

A 19‐year‐old female affected by dentinogenesis imperfecta type II (DI‐II), a genetic disease that affects the structural integrity of the dentin, presented with a chief complaint of discolored teeth. For this patient, digital techniques, including digital smile design (DSD), the ARCUSdigma axiograph and computer‐aided design/computer‐aided manufacturing (CAD/CAM), were extensively used in all phases of the rehabilitation process. Compared to traditional analog methods, these digital techniques could reduce the constant confirmation of occlusion, promote communication between clinicians and dental technicians, achieve accurate occlusion with relatively high efficiency, and improve the efficacy of esthetic rehabilitation in the treatment of this patient with DI‐II.

Effects of orthodontic tooth extrusion produced by different techniques, on the periodontal tissues: a histological study in dogs

OBJECTIVE

The aim of this study was to compare the periodontal tissue changes resulting from different methods of orthodontic tooth extrusion in dogs.

MATERIALS AND METHODS

Notches were surgically prepared in the root surface at the bone crest level of the first premolars of mongrel dogs. After 37 days, extrusion of the first lower and upper premolars was randomly performed by 3 different methods: conventional orthodontic extrusion (OE); open flap debridement performed immediately before orthodontic extrusion (OF); and orthodontic extrusion associated with weekly fiberotomy and scaling (FS). For all groups, extrusion was performed for 21 days followed by one-month retention and sacrifice. Periodontal parameters, descriptive histology, and histomorphometric analyses were performed at the end of the experimental period.

RESULTS

The median extrusion was 2.25 in the fiberotomy group, 2.0 mm in the open flap group and 1.0 mm in the orthodontic extrusion group with no significant differences between groups. The highest distance between reference notch and bone crest was observed in the fiberotomy group (p < 0.05). Histologically, radicular resorption repaired with cellular cementum was detected in all groups.

CONCLUSIONS

Tooth extrusion was successfully achieved with all of the different methods of orthodontic tooth extrusion with no statistical significance between techniques. The fiberotomy approach was effective in avoiding coronal displacement of periodontal tissues. Fiberotomy associated with scaling should be indicated if the objective of the treatment is extrusion without periodontal tissue displacement.

Managing Excessive Gingival Display Using a Digital Workflow

This technique article describes an approach to managing excessive gingival display by lengthening of the clinical crowns using a digital workflow. An intraoral scanner was used to obtain a template to be used for the crown lengthening surgical procedure considering the patient-desired diagnostic setups while fully seating the template on the patient's teeth during surgery. Using a digital approach for lengthening the clinical crowns decreased the likelihood of the need for postsurgical modifications, thus shortening the treatment duration. After the crown lengthening healed for 12 weeks, full-mouth reconstruction proceeded. Maxillary and mandibular preparation reduction guides were digitally designed and printed to facilitate conservative crown preparations. An intraoral scanner was used to make full-arch scans and interocclusal records for the fabrication of provisional and final crowns. Fully guided implant planning and placement were also executed.

Surgical extrusion: A dental technique

This article describes a technique for surgically extruding severely compromised roots needing prosthetic rehabilitation. Unlike previously described approaches, the technique does not require advanced clinical skills or equipment, may reduce the risk of tooth or bone fracture during the luxation maneuvers, and does not seem to interfere with the alveolar socket healing process.

[Clinical application of laser in crown lengthening]

Crown lengthening is one of the most common surgeries in clinical practice. Under the premise of ensuring the biologic width, the adequate crown is exposed by resecting the periodontal soft tissue and (or) hard tissue to meet the prosthodontic and (or) aesthetic requirements. Considering the various advantages of oral laser, such as safe, precise, minimally invasive and comfort, laser has become a promising technology which can be used to improve the traditional crown lengthening. In this review, the principles and characteristics of laser application in crown lengthening, especially in the minimally invasive or flapless crown lengthening will be reviewed. Its pros and cons will also be discussed.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.