ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Flap-Less Microsurgery May Be a Suitable Alternative to Open-Flap Esthetic Crown Lengthening Surgery
Clinical Question For a periodontally healthy young adult receiving esthetic crown lengthening, will a minimally invasive flap-less microsurgery procedure have a better esthetic result compared to a traditional open-flap crown lengthening procedure?
Clinical Bottom Line The minimally invasive flap-less microsurgery technique for esthetic crown lengthening provides similar results as the traditional open-flap procedure in healthy young adults.
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) 23826645Ribeiro/201328 systemically-healthy patients with altered passive eruption in at least three anterior maxillary teeth per half quadrant (21-40 years old).Randomized Split-Mouth
Key resultsThere was no difference in satisfaction with esthetic appearance between the groups (p>0.05). Open-flap (OF) versus flap-less (FL) surgery showed no differences for plaque accumulation, marginal bleeding and bleeding on probing at any of the follow-up visits (p>0.05). When compared to baseline for FL and OF treatments, probing depths and keratinized gingiva height means were reduced significantly at all time-points (p<0.05), without differences between the groups (p>0.05). The OF group had a higher mean relative gingival margin when compared to FL group at 3 months (p<0.05). Both groups had mean probing depth decrease, while the relative gingival margin means increased significantly at all time points at the interproximal-buccal sites (p<0.05) when compared to baseline. The OF group mean percentage of bleeding on probing increased at 3 months and was higher than in the FL group at 3 months (p<0.05). The only variable that significantly influenced the nonappearance of creeping attachment of the gingival margin in a coronal position at 12 months, with respect to immediately after surgery was gingival thickness plus bone thickness.
Evidence Search PubMed search for “esthetic crown lengthening”
Comments on
The Evidence
Validity: Ribeiro and colleagues performed a split-mouth RCT on a similar group. They had about an eighty percent completion rate, and the individuals were all treated the same. They had adequate patient follow-up, but the study was not double-blind. Compliance was adequate and a recall bias was unlikely. The trial had no competing interests. Perspective: For periodontally healthy patients who wish to improve their gummy smile, minimally invasive flap-less microsurgery is as esthetically pleasing as the traditional open-flap esthetic crown lengthening surgery and is a great time saving alternative. This type of study has never been done before and could benefit from more trials.
Applicability Overall, the findings of this study are applicable to the thin periodontal biotype and systemically healthy patient that has an adequate zone of keratinized gingiva. Patients will experience some morbidity from both procedures, but the flap-less procedure showed faster healing, less scarring and lower tissue inflammation as well as shorter surgical time.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Crown lengthening, gingivoplasty, minimally-invasive surgical procedures, gingivectomy, plastic surgery
ID# 2650
Date of submission: 02/28/2014spacer
E-mail galvandd@livemail.uthscsa.edu
Author Daylon Galvan
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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