Crown Lengthening,

Gummy smile,
Gingivoplasty, gingivectomy

* Department of Periodontology
Introduction
The attachment apparatus of a human tooth is composed of
these elements:
1. An epithelial attachment that attachs the enamel surface
with hemidesmosome
2. A connective tissue attachment made of type 1 collagen
fibers and sharpey fibers inserting into the cementum at a 90
angle
3. Alveolar bone covered by bundle bone in its inner surface
and periosteum on it outer surface
4. A periodontal ligament with type 1 and 3 collagen fiber
bundles and Sharpey fibers inserted in alveolar bone and the
cementum
5. Cementum overlaying dentin on the root surface.
Crown lengthening is indicated in the following
situations:
1. Caries
2. Tooth fracture
3. Existing restoration impinging on the biologic width
4. Lack of available tooth stucture for prosthetic
retention or lack of ferrule effect
5. Improved aesthetic in the presence of short clinical
crown or excessive gingival display.
Crown lenghtening cosmetic goal

It is performed in the following situasians:

1. Short clinical crowns

2. Excessive gingival display in the aesthetic area gummy

smile
Crown lengthening can be performed in two different ways:

1. Surgical crown lengthening :

1. medical history
2. contra indication to surgery
3. clinical finding
4. radiographic
5. premedication

2. Orthodontic extrusion
Gingivectomy and Gingivoplasty

Gingivectomy is the excision of the soft tissue wall of a

pathologic periodontal pocket to eliminate the pocket and
restore a physiologic gingival contour

Gingivoplasty is reshaping of the gingiva to a so-called

physiologic form
Indication for gingivectomy/gingivoplasty :

1. To eliminate gingival pocket suprabony pocket

2. To reduce gingival enlargement resulting from
medications or genetic factors
3. To create clinical crown length for restorative or
endodontic purposes when ostectomy is not required
4. To eliminate soft tissue craters resulting from
disease or subsequent to oher surgical procedure
5. To create aesthetic gingival form in cases of delayed
passive eruption
Wound healing

Study of Englar et al (1966) epithelialization post

gingivectomy migrating epithelial cells cover the wound
12-24 hours after surgery. Complete healing sulcus 4-5
weeks, although the surface appears to be healed after two
weeks

Englar et al, Lisgarten, Stahl and Witkin wound healing in

humen after gingivectomy 3-5 weeks (physiologic gingival
crevice, normal epithelial attachment, connective tissue repair)