Crown Lengthening Case: How Do We Expose Sufficient Tooth Structure Without Compromising Implant Esthetics?

You could consider forced eruption prior to crown lengthening.

Endodontics and forced eruption, as mentioned earlier is your best alternative. If you cannot obtain a ferrule effect of at least one millimeter around the failed bridge abutments, the longevity and strength of a new fixed bridge will be reduced drastically. On the other hand, by removing bone with a crown lengthening osseous surgery you will be affecting the tissue levels around the adjacent implant and possibly the available bone for a future implant in those sites when the bridge fails. The concerns in this case is the temporization while doing the forced eruption. Depending on the cosmetics of the case, such as soft tissue biotype, gingival display, bone levels, etc... it might still be advisable to do the forced eruption even with implants planned. My first choice would be a three unit implant bridge if the ferrule is not there. Hope this helps.

1.these radiographs didn't be taken at the correct vertical angle so the distance between alveolar crest and remaining tooth structure is not clear. maybe in the appropriate radiography the sufficient ferrule effect can be achiveable without crown lengthening. 2.regards to the site of this problem the final esthetics of the bridge on these two teeth is more important than prosthesis on the implants and it's depends to the lip line of the patient when he or she talking or smiling. sometimes this factor can presents the ugly long teeth after crown lengthening and the result is unsatisfied patint, 3.the force eruption by the ancorage on what ?! the implants ?! in this case the force eruption isn't practical. 4. please take the radiograrhy with the paralell technique and analyse the lip line then plan the treatment. be luck.

Let your patient know your concerns related to esthetics and bone support. I would also be concerned about the prognosis of another bridge supported by the two compromised roots. I feel two new implants for #7 and 9 for an implant supported bridge would offer a far superior prognosis. The costs for root canal therapy, forced orthodontic eruption, crown lengthening, post and core build-up and a new bridge on two compromised roots seems like a poor investment.

There are only two methods of creating crown length: Move the bone and attachment apical or move the tooth away from the bone. The degree of crown length required is minimized by the utilization of high strength in dentin bonding (adhesive dentistry, but this is something that requires a very specific technique that is not being taught frequently. Modern bonding techniques are NOT sufficient. The best bond strengths were achieved in the middle '90s and have been decreasing ever since in the interest of clinical time, a poor reason to not provide the best for our patients, but this is another story). With proper dentin bonding, the 2mm ferrule is no longer necessary. See studies by Pascal Magne. In the interest of esthetics or adjacent concerns, resective crown lengthening is less than desirable, so the only other choice as mentioned by others is OFE (Ortho.forced.erup.) followed by tissue management to allow proper margin placement with sufficient biologic width for a healthy result. In this particular case, the concern is crown/root ratio with either method of treatment given that these appear to be bridge abutments. Therefore, choose to either save them or not, place implants in the sites of the teeth or between, depending on whether the choice is to save the teeth or the extract them. Many would choose to extract and place implants with a fixed bridge in place. I hope this gives you the philosophical biologic approach to choosing which to perform as this and other cases emerge. M,

Orthodontically there are 2 ways of force erruptions ; slow and rapid . rapid OFE is the choice here, w/c can compromise the adjacent implant in some cases and a lot of efforts and time , and the expences..., and poor prognosis. As some colleagues mentioned, the best is to place 2 implants w/ a 3 unit bridge. think wisely, and be lucky.

dr b, 1. do osseous surgery away from implant side i.e. mesial side & on the buccal & palatal side & gain the more tooth structure support for crown placement. 2. do the endo for teeth.

I really appreciate what you post. You have a new subscriber now. My site is about Good stocks to invest in