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Template for Surgical Crown Lengthening:Fabrication Techniqueuy WalkerMS,ODs nd Paul Humen ODs2

This ar t ic le descr ibes a technique for t he easy fabr icat ion of a template t o fac i l i ta te surg icallengthenin g of the c l in ica l crow n to enhance esthet ics and lor increase retent ion of a f ixedprosthes is . The use of th is surg ica l gu ide should resu l t in m ore pred ic tab le c l in ica l resu l ts .J Prosthod 1998;7:265 267.Copyright 1998by The American Collegeo Prosthodontists.IN EXWORDS: surg ica l gu ide surg ica l lengthenin g

URGICAL CROWN LENGTHEMIYG, an api-S ally positioned flap with ostectomy/osteoplasty,is often a component of the restorative treatmentplan. The crown-lengthening proccdure may becomenecessary as a result oi tooth iracture, margin loca-tion of prcviously placed restorations, or correction ofshort clinical crowns to enhance retention ofrcstora-tions and/or esthetics.

To attain a biological width of 2 mm,1,2 t least 3nim of supracrestal tooth structure should be ex-posed apical to the proposed restoration rna~-g-in.~-~However, Herrero et a1 noted that the desired vcrsusthe actual amount of crown lengthening is noiroutinely achieved during the surgical procedure.Wlvle surgical guidcs havc been used for morepredictable results in other oral surgical proccdures,such as maxillary tuberosity reduction and dentalimplant placement,8-13 uch guides are seldom usedfor crown-lengthening procedures.

The esthctic goals of anterior, surgical crownlengthening are to provide incrcased tooth lengthfrom cervical exposure arid a more synmctrical,esthetically pleasing gingival matrix.-16 deally, thelength of central incisors is 10 to 11 mm, canines are11 to 12 mm long, and lateral incisors are approxi-mately 1 to 1.5 mm shortcr than central incisors.Tocstablish a more esthetic gingival pattern, the ccntralincisor gingival margins should be at approximatelythe same level as the gingival margins of the caninesand at the same level to 1 mm apical to the lateralincisor gingival margins.

The increased use of surgical crown-lengthcningprocedures to improve esthetics demands an accu-rate and predictable perioprosthetic surgical result.In this regard, the present article describes thefabrication of a simplc templatc for use as a guideduring surgical lengthening of short clinical crowns.

Procedure1. Draw the desired crown length on the diagnostic

cast Fig 1).2. Place separating medium (tin-foil substitutc) onthe cast.

3. A template is formed of a veneer of light-polymerized composite resin placed on the castover the facial surfaces of the teeth to be surgicallylengthened. Extend the resin from the proposedgingival margins lo just over the incisal cdgcs,providing a definite seat for proper templatepositioning and stability (Figs 2 and 3 ) .

4. After light polymerization, carefully remove thesurgical tcmplatc from the cast.5. The template is used during the crowm-lengthen-ing procedure (Fig4 . The goal is to obtain 3 mmof tooth exposure between thc proposed restora-tion margin (template margin) and the alveolarcrest. This can be verified with a periodontalprobe.

From the tinzLersz& q iWzssouri-Kamas Cib, School o f Dml Ui y ,Resident. Graduale Prusthodontics Pro yam .

irertor, Gradua te Prosfhodontics Progrum.ArLepedJ i m 19 i998.Cormflonriencc lu Dr. Mug1 Wulker. 9300 Lee Court, hawood, K.SCoppnght 1998 y TheAmerican College ofrosthododslsI u ~ ~ - . ~ 4 l x l 9 8 / ~ 7 0 4 - 0 u 0 7 ~ ~ . 0 0 / 0

Kantar Cig,240.

66206. igure 1 Desircd crown length d ra m on a diagnosticcast.

Jouinol o Imthodontzcs, VOLT 4 Dfcernber).1998:pfi265 267 65

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igure6. Approximately months' postoperatively, withprovisional restorations in place.igure 2. Composite-resin surgical template fabricatedon a cast.

Figure 3. liicisal vicwroftcmplate on a cast.

6'. Figure 5 shows results irnmcdiately after surgery.Teeth nos. 6 and 11 were not includcd in thccrown-lcngthening procedure, because the ir gingi-val margins are esthetically appropriate in rela-tion to the surgically rcpositioned gingival mar-gins of the central and lateral incisors. (Tooth 8was extracted because of a vertical root fracture.)7. Figurc 6 is approximately 4 months' postopera-tively, with provisional restorations (teeth6-1 1) inplace.

SummaryThc proposed surgical template has obvious use forsurgical lengthening of short clinical crowns forimproved esthetics and/or increased rcstoration reten-tion, especially when multiplc teeth a re involved.Generally, only a facial template will be rcquircdwhen correction of clinical crown length involvingantcrior sextants is necessary for esthetic enhance-ment. Allen noted that esthetic-lengthening proce-dures rarely require a palatal flap.'j HOMWCF,f theexposed lingual tooth struclure is insufficient forcrown retention, an additional template could bemade for palatal alveolar reduction. Although thist)-pe of P i d e v i l l bc used most often bjpith anterior,esthetic-lengthening procedures, buccal and lingualtemplates could also be helpful for lengtheningposterior teeth that rcquire increased crown reten-tion.

The usc of this surgical template enables thesurgeon to visualize more accuratcly the dcsircdclinical position of the crown gingival margin andmore closely approximate the desired 3 mm of toothexposurc. If 3 mni of cxposure is not attainable, thesurgeon can report how much tooth exposure was

Figure 4 Use of surgical guide during crown-lengtheningpmc:din'e.

Figure 5. Result immcdiatel ; following surgeiy.

achieved apical to the templatc margin. Thc restor-ative dentist can then discuss the esthetic/prostheticcompromise with the patient and decide whether theoutcome will bc esthetically acceptable or whether

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