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Dental Health Library Article

Crown Lengthening

Post Perio Pocket Surgery Gum Recession

The patient pictured here had crown lengthening performed by a periodontist to expose additional tooth structure needed for crown replacements across the entire upper jaw and also to recreate a natural appearing gum line on the upper arch. Treatment of perio pockets on several tooth structures caused varying amounts of soft tissue loss from tooth to tooth.

Post Perio Pocket Treatment Gum Recession
Residuals of Gum Recession after Perio Pocket Treatment
Fortunately no significant bone or tooth loss occurred although the newly defined gingival arches are a bit higher than before.

The darker colored areas above the current restorations represent the increases in tooth structure length that would be restored with new porcelain crowns.

Crowns and Bridge Removal

All of the patient's upper teeth, consisting of crowns and an anterior bridge, required replacement. The individual crowns were removed one by one, by carefully using a powered burr to split the crowns into sections for easy removal.

One by one remove crowns
Crowns Sectioned for Easy Removal
The motorized burr is manipulated carefully to assure the underlying tooth structure is not compromised. The crown material may also be sectioned off on the lingual side of the tooth.

A gentle prying of each sectioned crown is usually all that is needed to make the crown material "pop" off.

In the third picture of the treatment series it can be seen that the many of the previously prepped teeth have a thicker, collar-like area close to the gumline. This thicker area represents where the crown lengthening took place.

Crowns and Bridge Removed
Porcelain Crowns and Bridge Removed
The next step is to re-prepare each of the tooth structures, by trimming down each tooth with special instruments.

One tooth structure requires a post and build up, eliminating the need to extract the remaining tooth structure.

The last adjacent photo shows successful completion of reprepping the entire upper arch. The crown post and build up material can be seen here already shaped into a diameter and length appropriate for the size and type of crown (an integral part of a cemented fixed bridge) that will eventually be placed there.

Tooth Prep Completed
Prep Work Completed
Ready for Impressions and Temporaries
The remaining restorative steps include taking impressions and designing the fixed bridge prosthesis. To assure precision cosmetics and normalized function (occlusal bite), temporaries will be used to assure the Rule of Golden Proportions is adhered to.

During this diagnostic modeling and waxup phase, bite relationships are monitored to assure biting forces are normalized throughout all dentition and no undue lateral forces operate on the bridge or other critical tooth structures (anterior guidance).

A Nazarian, DDS

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