ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Surgical Extrusion with Periotome More Effectively Preserves Gingival Tissue While Minimizing Possible Complications Compared to Apically Displaced Flaps
Clinical Question In patients requiring crown lengthening, will surgical extrusion with periotome be better at maintaining a more esthetic crown while also minimizing possible complications to the gingival tissues than an apically displaced flap?
Clinical Bottom Line For patients requiring crown lengthening, surgical extrusion with periotome is more effective in preserving gingival tissue and minimizing possible complications compared to apically displaced flaps. This is supported by a randomized clinical trial in which patients who underwent surgical extrusion demonstrated more gingival tissue preservation at 3 months postoperatively compared to patients that underwent apically displaced flap. If esthetics and tissue preservation are a concern, crown lengthening through surgical extrusion should be the technique of choice for patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23946567Nethravathy/201315 patients with short crowns Randomized Controlled Trial
Key resultsThe clinical crown length, width of attached gingiva, and mean interdental papilla height were measured preoperatively and 3 months postoperatively for all patients who underwent either surgical extrusion or apically displaced flap surgery. There was no change in the mean width of the attached gingival and only minimal change in the mean interdental papilla height for patients who underwent surgical extrusion with periotome. The patient group who underwent apically displaced flap experienced 50% decrease in the mean width of attached gingival and 33% decrease in mean interdental papilla height.
Evidence Search "crown lengthening"[MeSH Terms] OR "crown lengthening"[All Fields] OR ("crown lengthening "[All Fields] AND "surgical extrusion"[All Fields]) OR " crown lengthening "[All Fields]) AND ("apically displaced flap"[MeSH Terms] OR "displaced flap"[All Fields]
Comments on
The Evidence
Validity: In this randomized controlled trial, all patients were adults and 100% completed the trial. The study's authors noted its small sample size, and this was also mentioned in the conclusion. This study needs to be done on a larger sample size to further support its claims. Due the small number of subject in each group (five) it is not likely that the three groups were balanced according to age, sex or oral health status at the beginning of the study. The author also failed to mention the inclusion criteria required to participate in this study or the reason why patients desired crown lengthening. The pulpal status of the tooth prior to the crown lengthening was also not mentioned in the article. Perspective: The study was well-constructed. However, the preoperative condition of the patients’ gingival tissues was not stated. The preoperative health status of the gingival tissues could influence its healing abilities and preservation postoperatively. The sample size is too small to confidently draw conclusions from these results.
Applicability Patients who have short clinical crowns due to tooth fracture, iatrogenic factors, or dental caries should consider undergoing surgical extrusion with periotome for a more esthetically pleasing result. Within the limitations of this study, surgical extrusion with periotome is the preferred treatment for patients who can not afford further loss of gingival tissue, such as periodontally compromised patients or those suffering from gingival recession. General dentists are also able to perform this procedure in-office with minimal training.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Crown lengthening, surgical extrusion with periotome, apically displaced flap, short crown, gingival tissue preservation
ID# 3151
Date of submission: 03/28/2017spacer
E-mail lama3@livemail.uthscsa.edu
Author Amanda Lam
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author William F. Rose, Jr., DDS
Faculty mentor/Co-author e-mail ROSEW@uthscsa.edu
Basic Science Rationale
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