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Evaluation of the Effect of Surgical Crown Lengthening on Periodontal Parameters

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Evaluation of the Effect of Surgical Crown Lengthening on Periodontal Parameters Original Research Evaluation of the Effect of Surgical Crown Lengthening on Periodontal Parameters Farzane Vaziri 1, Ahmad Haerian 2, Mohammad Hossein Lotfi Kamran 3, Maryam Abrishami 4 1 Assistant Professor, Periodontology Department, School of Dentistry, Shahid Sadoughi University, Yazd, Iran 2 Professor, Periodontology Department, School of Dentistry, Shahid Sadoughi University, Yazd, Iran 3 Assistant Professor, Prosthodontics Department, School of Dentistry, Shahid Sadoughi University, Yazd, Iran 4 Post-graduate student, Periodontology Department, School of Dentistry, Shahid Sadoughi University, Yazd, Iran Received 4 April 2015 and Accepted 20 June 2015 Abstract presence of good oral hygiene, except BW (biological Background: Surgical crown lengthening is needed width), other parameters including PD, BL, KG, and for teeth with subgingival caries, fractured teeth, TSP had significant changes after crown lengthening insufficient crown length, and deep subgingival margin surgery in the period of 1 month and 3 months (P<0.05). of failed restorations. Since there is no agreement on the effects of crown lengthening surgery on gingival Key words: Crown lengthening surgery, periodontal parameters, the purpose of this study was to evaluate treatment, healthy periodontium. periodontal parameters in patients who needed crown lengthening surgery. Methods: Twenty patients who --------------------------------------------------------------- had healthy periodontium and needed surgical crown Vaziri F, Haerian A, Lotfi Kamran MH, lengthening were included in this study. After Abrishami M. Evaluation of the Effect of Surgical professional dental cleaning, gingival parameters Crown Lengthening on Periodontal Parameters. J Dent including gingival index (GI), probing depth (PD), bone Mater Tech 2015; 4(3): 143-50. level (BL), and transsulcular probing (TSP) were recorded in interproximal and keratinized gingiva (KG) in mid buccal portion. The patients were evaluated one Introduction and three months after the surgery. Results: After one In order to have long-term success in restoration, and three months of the surgery, the amount of PD healthy periodontium is necessary; which must be in reduced from 2.32 mm to 1.25 mm and 1.17 mm, balance with restorative and esthetic demands. Very respectively (P=0.001). The mean of BL reduction was deep subgingival extending preparations are performed 0.88 mm after one month (P=0.001), but there was no in teeth with subgingival caries, fractured teeth, reduction between 1 month and 3 months. Amounts of insufficient crown length, and deep sub gingival margin KG at baseline andone month later were 4.2 mm and 2.9 of failed restoration (1,2) As a result, such deep mm, respectively (P=0.001), and remained at the same subgingival extending of preparation causes invasion to level up to three months. TSP significantly reduced biologic width resulting in inflamed gingiva, attachment (from 3.67 mm at baseline to 2.62 mm after 1 month, loss, and bone loss (3,4). Surgical crown lengthening and to 2.27 mm after 3 months) (P=0.001, P=0.005). with apically positioned flap and bone resective surgery Conclusion: The present study suggests that in the Vaziri, et al JDMT, Volume 4, Number 3, September 2015 143 are recommended to prevent periodontal breakdown and University, Yazd, Iran, from April 2014 to June 2014 to facilitate prosthetic treatment (5,6). for crown lengthening surgery. The study was approved Removal of soft tissue and sometimes even hard by the Ethics Committee of the Shahid Sadoughi tissues occurs in crown lengthening surgery. Soft tissue University (Protocol no 17/1/31915). Patients received removal is performed when there is more than 3mm of an explanation about the purpose of the study and soft tissue over the bone. In cases with less than 3mm of provided written informed consent before clinical soft tissue or inadequate attached gingiva, bone periodontal examination. recontouring and flap procedure are recommended. To Patients were screened for eligibility. Their teeth maintain healthy periodontium, there should be a 4-mm were approved according to the following criteria: distance from bone crest in fractured teeth and deep Need of surgical exposure for appropriate caries (7). prosthetic treatment Although Bragger et al. reported that the gingival Subgingival caries or fracture margin remained stable during the healing period and Insufficient crown length for proper retention that gingival enlargement was little (8), some Uneven gingival height evaluations showed significant reduction of SOG (supra Proper prognosis and crown root ratio osseous gingiva) after crown lengthening in the follow- Having a single root up study 2 and 6 months later (9,10). Moreover, in an The following criteria were approved for the animal study, different dimensions of SOG were shown patients: in mandibular and maxillary teeth after surgery (11). No systemic disease contraindicated with Curnevale and Pontorieo reported coronal growth of gingival surgery gingival margin in a year after crown lengthening No drug use, no history of periodontal disease, surgery, which was noticed more in thick gingiva. non-smoker. The study was sampled from 20 Although it was affected by individual variations, it was patients (16 females and 4 males; aged 23 to 54 neither in relationship with age nor with sex (12). In a years; mean age 34.1 years) with 20 teeth which study by Deas et al, tissue rebound was significant after needed surgical exposure for proper restorative crown lengthening during a 6- month follow up; which treatment. was in relationship with the flap position toward the Clinical Measurements alveolar crest at suturing time (10). Perez-Smukler Two weeks before the surgery, all patients received (2008) stated that there was clinical variation in SOG oral hygiene instructions and also professional dental dimensions among patients with similar and different cleaning if needed. tooth types, arches, and surfaces (13). For each patient an acrylic stent was fabricated and Some studies reported stable results after the surgery vertical grooves were made at the interproximal and (8,9,14,15,18) , while other studies reported significant mid-buccal aspects of the teeth for standardization of tissue rebound after the surgery (10,12,16,19 ) the location of the probe during measurements. Since the effects of crown lengthening surgery on After local anesthesia (lidocaine/epinephrine gingival parameters were not the same in different 1:80.000, Daroopakhsh Co., Iran), clinical parameter studies, we aimed to evaluate periodontal parameters in including GI (gingival plaque index based on Loe and patients who needed crown lengthening surgery. Silness, 1967; table 1), PD, BL, and TSP in the vertical grooving of the interproximal area and KG in the Methods and Materials vertical grooving at the mid buccal portion were This study was an interventional case series with the measured by Williams probe. BW (biologic width) was observation periods of one and three months. calculated by subtracting the measurement of TSP from Individuals were referred to the Periodontology PD (9). Department, School of Dentistry, Shahid Sadoughi GI Score Description 0 No plaque 1 A film of plaque adherence to the free gingival margin and adjacent area of the tooth. The plaque may be seen in situ only after application of disclosing solution or by using the probe on the tooth surface. 2 Moderate accumulation of soft deposits within the gingival pocket, or the tooth and gingival margin which can be seen with the naked eye. 144 JDMT, Volume 4, Number 3, September 2015 Effect of Surgical Crown Lengthening 3 Abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin. Figure 1. Mean GI at baseline GI 1; GI2 1 month after surgery; GI 3 3months after surgery Surgical Procedure An internal bevel incision and full thickness flap The mean PD at baseline was 2.32 mm and within 1 procedures were performed at least one tooth mesially month and 3 months after surgery were respectively and distally. Bone surgery was carried out by hand and 1.52 mm and 1.17 mm. The mean PD change before the rotary instruments under saline irrigation for developing surgery and 1 month later was 0.8 mm (P=0.001), and positive bone architecture. Connective tissue and the change in the period between 1month and 3 months periodontal ligament were removed with finishing bur. after surgery was 0.35 mm, which was marginally Bone tissue was removed to add biologic width (9), for significant (P=0.05) (fig. 2). proper placement of restorative margins. The flaps were positioned over the alveolar bone crest at buccal and 1.4 lingual surfaces and continuous sling sutures were used for stabilizing. The surgical areas were covered with 1.2 periodontal dressing (Co-Pack, GC America Inc., Alsip, 1 IL, USA). 0.8 Antibiotics (500-mg amoxicillin capsules for 7 days) 0.6 and analgesics (400-mg ibuprofen tablets) were prescribed for each patient, also 0.2% chlorhexidine 0.4 gluconate mouth rinse twice a day was recommended 0.2 for 7 days. The sutures were removed one week later 0 and oral hygiene was then reinstructed. After one and PD1-2 PD1-3 PD2-3 three months later clinical parameter again was measured. Figure 2. Mean PD changes at baseline and 1 month Statistical analysis: after surgery PD1_2; at baseline and 3 months after Findings at baseline, one month and three months surgery PD1-3; 1 and 3 months after surgery PD2-3 after surgery were analyzed using SPSS 18. Data were analyzed by paired sample t-test and Wilcoxon singed The mean bone level had significant reduction one ranks test. P-value<0.05 was considered as significant month later (from 9.09 mm to 9.97 mm) (P=0.001), but level. Means were calculated for all the parameters at it was the same (9.97mm) between the first month and baseline and one month and three months after surgery.
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