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25.01.2023 | Research

Pre-restorative crown lengthening surgery: influence of restorative treatment timing on clinical outcomes—a pilot study

verfasst von: Georgia A. Malamoudi, Ioanna Tsachouridou, Georgios Menexes, Georgios Mikrogeorgis, Dimitrios Tortopidis, Lazaros Tsalikis

Erschienen in: Oral and Maxillofacial Surgery | Ausgabe 1/2024

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Abstract

Objectives

Aim of this study was to assess the influence of restorative treatment timing on the periodontal, patient and operator-reported outcomes following crown lengthening surgery (CLS).

Materials and methods

Eighteen study participants requiring CLS were divided into two groups based on prosthetic rehabilitation timing (6 or 14 weeks postoperatively). Clinical parameters were recorded around treated and neighboring teeth before and after surgery, 6 and 14 weeks postoperatively, at prosthesis delivery, and three and six months after. Soft tissue and radiographic bone changes were evaluated. Patients assessed their perception of the procedure by means of a questionnaire. The final treatment outcome was rated by both patients and prosthodontists.

Results

CLS resulted in statistically significant and stable apical displacement of the gingival margin, at both treated and adjacent sites. Plaque and bleeding scores remained low throughout. No statistically significant differences were observed between groups for any clinical or radiographic parameter examined. Healing was uneventful and treatment outcome was satisfying for both patients and prosthodontists, without statistically significant differences between groups.

Conclusions

The present study has been characterized as pilot, because it was not possible to reach the sample size indicated by the a priori power analysis. CLS is an effective pre-prosthetic procedure as long as it is performed under a certain surgical protocol which predicts for at least a 3 mm distance between bone crest and the flap margin at suturing. Within the limitations of this study, six weeks after surgery may be an adequate healing time for the onset of prosthetic restoration.

Clinical relevance

Crown lengthening surgery is commonly performed in daily clinical practice with the aim to restore teeth with short clinical crowns. Based on periodontal, patient and operator-reported criteria, 6 weeks after CLS may be adequate healing time before the onset of prosthetic restoration.

Trial registration

ClinicalTrials.gov Identifier: NCT03947658, 13/05/2019, retrospectively registered.

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Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Yamazaki K (2018) Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Clinical Periodontology 45(December 2017):S219–S229. https://doi.org/10.1111/jcpe.12951CrossRefPubMed

Bosshardt DD, Lang NP (2005) The junctional epithelium: from health to disease. J Dent Res 84(1):9–20. https://doi.org/10.1177/154405910508400102CrossRefPubMed

Ursell MJ (1989) Relationships between alveolar bone levels measured at surgery, estimated by transgingival probing and clinical attachment level measurements. J Clin Periodontol 16(2):81–86. https://doi.org/10.1111/j.1600-051X.1989.tb01618.xCrossRefPubMed

Lanning SK, Waldrop TC, Gunsolley JC, Maynard JG (2003) Surgical crown lengthening: evaluation of the biological width. J Periodontol 74(4):468–474. https://doi.org/10.1902/jop.2003.74.4.468CrossRefPubMed

Perez JR, Smukler H, Nunn ME (2007) Clinical evaluation of the supraosseous gingivae before and after crown lengthening. J Periodontol 78(6):1023–1030. https://doi.org/10.1902/jop.2007.060485CrossRefPubMed

Barboza EP, MonteAlto RF, Ferreira VF, Carvalho WR (2008) Supracrestal gingival tissue measurements in healthy human periodontium. Int J Periodontics Restorative Dent 28(1):55–61PubMed

Shobha KS, Mahantesha S, H., Mani, R., & Kranti, K. (2010) Clinical evaluation of the biological width following surgical crown-lengthening procedure: a prospective study. J Indian Soc Periodontol 14(3):160–167. https://doi.org/10.4103/0972-124X.75910CrossRefPubMedPubMedCentral

Ganji KK, Patil VA, John J (2012) A comparative evaluation for biologic width following surgical crown lengthening using gingivectomy and ostectomy procedure. Int J Dentistry 2012:479241. https://doi.org/10.1155/2012/479241CrossRef

Lang NP, Kiel RA, Anderhalden K (1983) Clinical and microbiological effects of subgingival restorations with overhanging or clinically perfect margins. J Clin Periodontol 10(6):563–578. https://doi.org/10.1111/j.1600-051x.1983.tb01295.xCrossRefPubMed

10.

Reitemeier B, Hänsel K, Walter MH, Kastner C, Toutenburg H (2002) Effect of posterior crown margin placement on gingival health. J Prosthet Dent 87(2):167–172. https://doi.org/10.1067/mpr.2002.121585CrossRefPubMed

11.

Maynard JG Jr, Wilson RDK (1979) Physiologic dimensions of the periodontium significant to the restorative dentist. J Periodontol 50:170–174. https://doi.org/10.1902/jop.1979.50.4.170CrossRefPubMed

12.

Pilalas I, Tsalikis L, Tatakis DN (2016) Pre-restorative crown lengthening surgery outcomes: a systematic review. J Clin Periodontol 43(12):1094–1108. https://doi.org/10.1111/jcpe.12617CrossRefPubMed

13.

Abou-Arraj RV, Majzoub Z, Holmes CM, Geisinger ML, Geurs NC (2015) Healing time for final restorative therapy after surgical crown lengthening procedures: a review of related evidence. Clinical advances in periodontics 5(2):131–139. https://doi.org/10.1902/cap.2014.140014CrossRefPubMed

14.

Häkkinen L, Uitto VJ, Larjava H (2000) Cell biology of gingival wound healing. Periodontol 2000(24):127–152CrossRef

15.

Brägger U, Lauchenauer D, Lang NP (1992) Surgical lengthening of the clinical crown. J Clin Periodontol 19(1):58–63. https://doi.org/10.1111/j.1600-051x.1992.tb01150.xCrossRefPubMed

16.

Wyatt G, Grey N, Deery C (2004) A cross-sectional survey of clinicians performing periodontal surgical crown lengthening. Eur J Prosthodont Restor Dent 12(3):109–114PubMed

17.

O’Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43(1):38. https://doi.org/10.1902/jop.1972.43.1.38CrossRefPubMed

18.

Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25(4):229–235PubMed

19.

Wachtel H, Schenk G, Böhm S, Weng D, Zuhr O, Hürzeler MB (2003) Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol 30(6):496–504. https://doi.org/10.1034/j.1600-051x.2003.00013.xCrossRefPubMed

20.

Reddy MS, Jeffcoat MK (1993) Digital subtraction radiography. Dent Clin North Am 37(4):553–565CrossRefPubMed

21.

Mikrogeorgis G, Lyroudia K, Molyvdas I, Nikolaidis N, Pitas I (2004) Digital radiograph registration and subtraction: a useful toolfor the evaluation of the progress of chronic apical periodontitis. J Endod 30(7):513–517. https://doi.org/10.1097/00004770-200407000-00013CrossRefPubMed

22.

West BT, Welch KB, Gatecki AT (2014) Linear mixed models: a practical guide using statistical software, second edition (2nd ed.). Chapman and Hall/CRC. https://doi.org/10.1201/b17198

23.

Toothaker, Larry E. (1993) Multiple comparison procedures. SAGE Publications, Inc., Thousand Oaks. https://doi.org/10.4135/9781412985178

24.

Nobre CM, de Barros Pascoal AL, Albuquerque Souza E, Machion Shaddox L, Dos Santos Calderon P, de Aquino Martins AR, de Vasconcelos Gurgel BC (2017) A systematic review and meta-analysis on the effects of crown lengthening on adjacent and non-adjacent sites. Clin Oral Invest 21(1):7–16. https://doi.org/10.1007/s00784-016-1921-1CrossRef

25.

Pontoriero R, Carnevale G (2001) Surgical crown lengthening: a 12-month clinical wound healing study. J Periodontol 72(7):841–848. https://doi.org/10.1902/jop.2001.72.7.841CrossRefPubMed

26.

Planciunas L, Puriene A, Mackeviciene G (2006) Surgical lengthening of the clinical tooth crown. Stomatologija 8(3):88–95PubMed

27.

Hamasni FM, Majzoub Z (2019) Effect of patient- and surgery-related factors on supracrestal tissue reestablishment after crown lengthening procedure. Quintessence international (Berlin, Germany: 1985) 50(10):792–801. https://doi.org/10.3290/j.qi.a43152CrossRefPubMed

28.

Arora R, Narula SC, Sharma RK, Tewari S (2013) Evaluation of supracrestal gingival tissue after surgical crown lengthening: a 6-month clinical study. J Periodontol 84(7):934–940. https://doi.org/10.1902/jop.2012.120162CrossRefPubMed

29.

Deas DE, Mackey SA, Sagun RS Jr, Hancock RH, Gruwell SF, Campbell CM (2014) Crown lengthening in the maxillary anterior region: a 6-month prospective clinical study. Int J Periodontics Restorative Dentistry 34(3):365–373. https://doi.org/10.11607/prd.1926CrossRef

30.

Pennel BM, King KO, Wilderman MN, Barron JM (1967) Repair of the alveolar process following osseous surgery. J Periodontol 38(5):426–431. https://doi.org/10.1902/jop.1967.38.5.426CrossRefPubMed

31.

Wilderman MN, Pennel BM, King K, Barron JM (1970) Histogenesis of repair following osseous surgery. J Periodontol 41(10):551–565. https://doi.org/10.1902/jop.1970.41.10.551CrossRefPubMed

32.

Donnenfeld OW, Hoag PM, Weissman DP (1970) A clinical study on the effects of osteoplasty. J Periodontol 41(3):131–141. https://doi.org/10.1902/jop.1970.41.3.131CrossRefPubMed

33.

Herrero F, Scott JB, Maropis PS, Yukna RA (1995) Clinical comparison of desired versus actual amount of surgical crown lengthening. J Periodontol 66(7):568–571. https://doi.org/10.1902/jop.1995.66.7.568CrossRefPubMed

34.

Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M, Duarte PM (2014) Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol 85(4):536–544. https://doi.org/10.1902/jop.2013.130145CrossRefPubMed

35.

Diniz DE, Okuda KM, Fonseca CR, Gonzalez MK, Greghi SL, do Valle AL, Lauris JR (2007) Surgical crown lengthening: a 12-month study - radiographic results. Journal of Applied Oral Science : Revista FOB 15(4):280–284. https://doi.org/10.1590/s1678-77572007000400008CrossRefPubMedPubMedCentral

36.

Dibart S, Capri D, Kachouh I, Van Dyke T, Nunn ME (2003) Crown lengthening in mandibular molars: a 5-year retrospective radiographic analysis. J Pers 74(6):815–821. https://doi.org/10.1902/jop.2003.74.6.815CrossRef

37.

Fardal O, Johannessen AC, Linden GJ (2002) Patient perceptions of periodontal therapy completed in a periodontal practice. J Perinatol 73(9):1060–1066. https://doi.org/10.1902/jop.2002.73.9.1060CrossRef

38.

Fardal Ø, McCulloch CA (2012) Impact of anxiety on pain perception associated with periodontal and implant surgery in a private practice. J Perinatol 83(9):1079–1085. https://doi.org/10.1902/jop.2011.110562CrossRef

39.

Tan WC, Krishnaswamy G, Ong MM, Lang NP (2014) Patient-reported outcome measures after routine periodontal and implant surgical procedures. J Clin Periodontol 41(6):618–624. https://doi.org/10.1111/jcpe.12248CrossRefPubMed

40.

Antoniazzi RP, Vieira AR, Da Rosa JL, Ferrazo KL, Zanatta FB, Feldens CA (2014) Periodontal dressing after surgical crown lengthening: a randomized clinical trial. Acta Odontol Scand 72(8):1025–1031. https://doi.org/10.3109/00016357.2014.942878CrossRefPubMed

41.

Silva CO, Soumaille JM, Marson FC, Progiante PS, Tatakis DN (2015) Aesthetic crown lengthening: periodontal and patient-centred outcomes. J Clin Periodontol 42(12):1126–1134. https://doi.org/10.1111/jcpe.12482CrossRefPubMed

42.

Kofina V, Lindholm D, Harunani A, Dentino AR, Singh M, Tatakis DN (2022) Post-surgical emergency afterhours calls: Prevalence, concerns, and management. J Dent Educ 86(7):814–822. https://doi.org/10.1002/jdd.12888CrossRefPubMed

43.

Cairo F, Graziani F, Franchi L, Defraia E, Pini Prato GP (2012) Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. International Journal of Dentistry 2012:837658. https://doi.org/10.1155/2012/837658

44.

Al-Sowygh ZH (2019) Does surgical crown lengthening procedure produce stable clinical outcomes for restorative treatment? a meta-analysis. Journal of prosthodontics: Official Journal of the American College of Prosthodontists 28(1):e103–e109. https://doi.org/10.1111/jopr.12909CrossRefPubMed

Titel: Pre-restorative crown lengthening surgery: influence of restorative treatment timing on clinical outcomes—a pilot study
verfasst von: Georgia A. Malamoudi
Ioanna Tsachouridou
Georgios Menexes
Georgios Mikrogeorgis
Dimitrios Tortopidis
Lazaros Tsalikis
Publikationsdatum: 25.01.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Oral and Maxillofacial Surgery / Ausgabe 1/2024
Print ISSN: 1865-1550
Elektronische ISSN: 1865-1569
DOI: https://doi.org/10.1007/s10006-023-01138-6

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Pre-restorative crown lengthening surgery: influence of restorative treatment timing on clinical outcomes—a pilot study