ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Ostectomy with Apically Positioned Flap Most Effectively Maintains Post-Surgical Gingival Crest Positions Compared to Gingivectomy
Clinical Question In a periodontally healthy patient, undergoing crown lengthening procedures, would an ostectomy with gingival flap better preserve the post-surgical gingival crest level compared to gingivectomy?
Clinical Bottom Line In systemically and periodontally healthy patients, an ostectomy with gingival flap preserves the post-surgical positioning of the gingiva better than a gingivectomy procedure.
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) 22969804Ganji/2012Patient Group 30 systemically and periodontally healthy patients with short clinical crown length but adequate root length, 20-40 years of age.Randomized Controlled Trial
Key resultsBy the 12th week post surgery, the amount of tissue rebound in the gingivectomy procedure was greater than the ostectomy with gingival flap procedure. Gingivectomy showed no statistical changes in Tcal-value (1.1524) between the 1st and 12th post-op week, while the Ostectomy procedure showed significant difference in Tcal value (27.299) between the 1st and 12th post-op week.
#2) 15515347Deas/200425 periodontally healthy patients/43 teeth; 18 males and 7 females.Case Series
Key resultsThe post-surgical gingival margin was not stabilized by the 3 to 6 month period. The mean measurements were significantly different for each treatment group. On average, the restorative margin gained a height of 2.27 ± 1.1 mm at the time of surgery; 1.91 ±1.08 mm at 1 month; 1.69 ± 1.02 mm at 3 months; and 1.57 ± 1.01 mm at 6 months.
Evidence Search PubMed search for Ganji article: “crown lengthening and gingivectomy” PubMed search for Deas article: ("Alveoloplasty"[Mesh]) AND "Crown Lengthening/methods"[Mesh]
Comments on
The Evidence
The validity of the Ganji article appears credible because all the groups were treated equally and 100% of the patients carried out the surgery and follow up procedures to completion. There was an adequate length of follow up after the surgical procedures and much attention to detail was put into obtaining accurate and reproducible measurements. One area of improvement would be the patient sample size. Perhaps a larger patient pool than 30 would give a more reliable outcome. For many reasons the Deas article is reliable. For example, all groups were similar at the start of treatment, there was adequate follow up of the results, and the study has more than an 80% completion rate of the treatment. However, the groups were not all treated by the same oral surgeon and the study was not double blinded.
Applicability Overall, the findings of this search are applicable to periodontally stable and systemically healthy patients with adequate root length and short clinical crowns. The location of the restorative gingival crest is more predictable with an ostectomy with gingival flap compared to a gingivectomy. It must be kept in mind that the trade off for a more stable periodontal result is a more invasive ostectomy with gingival flap procedure. As of now there is a need for more literature and research regarding the stability of the restorative gingival margin after crown lengthening procedures.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Crown lengthening; Gingivectomy; Ostectomy
ID# 2433
Date of submission: 03/21/2013spacer
E-mail garzanm@livemail.uthscsa.edu
Author Natalie Garza
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author William Francis Rose, Jr., DDS
Faculty mentor/Co-author e-mail rosew@uthscsa.edu
Basic Science Rationale
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