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Preoperativeview(PicCourtesy–Dr.SanaFarista)
CrownLengtheningProcedureusingDentalDiodeLaser
Introduction- Crown lengthening is a surgical procedure designed to increase the extent ofsupra- gingival tooth structure for esthetic and restorative purposes. Based on the clinical scenario, crown lengthening procedure is categorized as either esthetic or functional. Esthetic crown lengthening is usually done in the anterior esthetic zone of oral cavity, where the major concern is to reduce excessive gingivaldisplayandincreasetheclinicalcrownheight. While functionalcrownlengthening is done to expose the crown structure so that a functional prosthesis can be placed over the exposed crown. Preservation ofbiologic width is the therapeutic endpoint ofboth these procedures. Crown lengtheningcanbelimitedtosofttissueonly, orbothsoftandhardtissuecanbecontoured.
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Indications- There are several indications including: restorative needs, to increase clinical crown height lostdue to caries, fracture orwear, to access sub-gingival caries, to access aperforationinthe coronal third ofthe root, to relocate margins ofrestorations that are impinging on biological width, esthetics,shortteeth, unevengingivalcontourandgummysmile.
Treatment Modality- Crown lengthening procedure can accomplished either by the use of a periodontal knife/scalpel, rotary coarse diamond bur, electrosurgery etc. These techniques have certain disadvantages like surgical trauma, postoperative pain and swelling, bleeding during surgery, poor patient acceptance and also coronal migration ofthe soft tissue margins is seen during healing whichmakesitdifficultforrecordingthefinishlinesafterthetoothpreparation.
With recent advancements, conventional techniques are replaced by LASERS which offers a relativelybloodless surgicalprocedure, sterilizationofthe woundsite, minimal swelling, reductionof surgical time, high patient acceptance, reduced postoperative pain and much lesser need of post- operativemedications.
PIOON Laser offers different wavelengths like 450nm/810nm or 980nm. Out ofwhich 450nm can usedinnon-contactorcontactmode whereas 810nmand980nmare usedincontactmode inorderto performacrownlengtheningprocedure. The mostdesirable among themis 450nmwavelengthdueto fastercuttingandlesserthermaldamageduetonon-contactmodeofoperation.
In the present case, clinical and radiographic evaluation revealed adequate keratinized gingiva, presence ofsub-gingival caries and inadequate tooth structure on the lingual side oflower left first molar. Firstly assessment ofbiologic width was done by probing to the bone level (referred to as "bone sounding") andsubtracting the sulcus depthfrom the resulting measurement. Ifthis distance is <2 mm a diagnosis ofbiologic width violation can be confirmed. In this case, as there was sufficient sulcus depthof4mm, alasergingivectomy (crownlengthening procedure) was performed inorderto lengthen the toothwithout encroaching the biologic width using 450nm wavelength with 400 micron tipinnon-contactmodetakingallthesafetyprecautions.
AroraS etalin2016 used980nmwavelengthforcrownlengtheningandsuggestedthatdiode laseris very safe and useful for esthetic periodontal soft-tissue management because it precisely ablates soft tissues using various tips, andthe woundhealing is more favourable, whichleads to minimal thermal alteration ofthe treated surface. Lagdive S et al in 2010 used semiconductor diode laser for surgical
crownlengthening andsuggestedthatthe diode lasertechnique is easier, is wellacceptedbypatients, andprovidespredictablepostoperativeresults.
Conclusion- Taking into considerationthe excellentclinical outcome, the dental diode lasers canbe consideredasabetterandacceptablealternativeforconventionalcrownlengthening.
References- Arora S et al. Clinical Crown Lengthening Using Soft Tissue Diode Laser: A Case Series. Int. Journal of Oral Health and Medical Research 2016;81-3 and Lagdive S et al. Surgical Lengthening of the Clinical Tooth Crown by Using Semiconductor Diode Laser: A Case Series. The Journal of Oral Laser Applications 2010;53-7.
