Search Results (25)

The management of deep subgingival carious lesions presents significant challenges for achieving durable adhesive restorations due to limited access, moisture control, and proximity to periodontal tissues. Two main approaches are currently adopted to manage these cases: Deep Margin Elevation (DME) and Surgical Crown Lengthening (SCL). This systematic review (PROSPERO registration CRD420250654262) aimed to compare the performance and survival of restorations placed following DME versus SCL in teeth with deep subgingival margins. A comprehensive literature search was conducted in PubMed, B-ON, and the Cochrane Library for studies published between 2014 and 2025. Following PRISMA guidelines, six studies were included. Methodological quality and risk of bias were assessed using ROBINS-I, RoB 2, and the CARE guidelines. The available evidence indicates that both DME and SCL provide satisfactory periodontal stability, high restoration survival rates, and a low incidence of recurrent caries. DME emerged as a minimally invasive strategy that facilitates adhesive procedures by relocating deep margins to more accessible positions, potentially improving marginal integrity while preserving tooth structure and gingival architecture, particularly in patients with a thick gingival biotype. The choice between DME and SCL should be individualized. Further long-term clinical studies are required to clarify their impact on adhesive interface durability in subgingival environments. Full article

Background: Language serves as a significant barrier to accessing dental services. Dental treatment options are often complex and involve terminology that is unfamiliar to most patients. In some cases, dental students may use technical terms that patients do not understand, leading to confusion and misunderstandings. Therefore, this study aimed to assess the language barriers faced by dental students and patients in Riyadh, Saudi Arabia. Methods: A mixed-methods research design was employed to evaluate language barriers between dental students and patients, as it provides an in-depth understanding and generates information beyond mere numerical data. The study was conducted from 1 September 2024, to 30 August 2025, in Riyadh, Saudi Arabia. Data collection primarily involved conducting interviews with focus group members using a comprehensive topic guide consisting of predetermined questions. Results: Forty dental students and forty patients agreed to participate in this study. The students encountered significant difficulty explaining terms such as crown lengthening (72.5%) and periodontitis (67.5%), while patients reported limited understanding of interim removable dental prosthesis (65%) and fixed dental prosthesis (60%). Comparative analysis indicated that sixth-year students reported significantly more difficulty explaining “crown lengthening” and “prefabricated post and core” compared to fifth-year students. It was also observed that patients’ educational level had a significant impact on their understanding of terms such as “interim dental prosthesis” and “removable dental prosthesis.” Qualitative analysis revealed patients’ partial understanding or misinterpretation of dental terminologies. Conclusions: Our findings indicate that language discordance, even among speakers of the same native language, can hinder effective communication, particularly when technical vocabulary is involved. Students may struggle to explain procedures in a manner that patients can easily understand. This can lead to incomplete patient comprehension and potential non-compliance with treatment recommendations. Hence, we recommend incorporating Arabic dental terminologies alongside English into the curriculum, developing bilingual glossaries, and using visual aids when communicating with patients. Full article

Background: Altered passive eruption (APE) is one of the etiological factors associated with excessive gingival display and is commonly treated with esthetic crown lengthening (ECL). However, existing classification systems provide limited guidance for selecting appropriate treatment approaches. Objectives: The aim of this study was to evaluate (1) the expected outcome of ECL in eliminating unattractive excessive gingival display (4 mm) based on digital smile assessment and (2) the distribution of teeth and patients according to the modified APE classification. Methods: Forty-two Thai patients with APE underwent clinical examination, digital smile assessment, intraoral scanning, and CBCT. Predicted gingival display (PGD) was calculated to assess the expected outcomes of ECL. The modified APE classification, incorporating CEJ–BC distance and buccal bone thickness, was analyzed at both the tooth and patient levels. Results: A total of 252 maxillary anterior teeth were assessed. Most patients (78.57%) presented with APE and hyperactive upper lip. The mean gingival display (GD) was 6.04 ± 1.76 mm, with GD ≥ 4 mm observed in 92.86% of patients. The mean PGD was 3.56 ± 1.71 mm, and ECL was predicted to reduce GD to < 4 mm in 66.67% of patients. Teeth were classified as Class I (28.97%), II (15.48%), III (41.27%), and IV (14.28%); only Types II (11.9%) and III (88.1%) occurred at the patient level. Conclusions: ECL performed at the CEJ level is predicted to eliminate excessive gingival display in approximately two-thirds of APE patients. The modified APE classification offers guidance for selecting surgical approaches, highlighting the necessity of open-flap procedures and the limited applicability of flapless approaches. Full article

Background/Objectives: The stability of the gingival margin after crown lengthening is a key determinant of esthetic success in anterior rehabilitation. Digital workflows have been proposed to improve surgical precision, but their long-term impact on marginal stability remains insufficiently substantiated. Methods: A total of 87 patients (622 maxillary anterior and premolar teeth) who underwent esthetic crown lengthening were retrospectively evaluated. Patients were allocated to either a digitally guided workflow (G1, n = 62) or a freehand approach (G2, n = 25). Gingival margin stability was assessed using standardized intraoral photography and calibrated digital measurements at baseline, 1–2 months, and 12 months. Recurrence, periodontal parameters, complications, and patient satisfaction (VAS) were recorded. Mixed-effects models accounted for the clustering of teeth within patients. Results: Both workflows achieved predictable crown lengthening outcomes. At 12 months, median gingival margin recurrence was significantly lower in the guided group (G1: 0.14 mm [IQR 0.10–0.19]) compared with the freehand group (G2: 0.27 mm [IQR 0.20–0.34]) (p < 0.001). Secondary surgical revision was required in 1.6% of G1 patients versus 16.0% of G2 patients (p < 0.001). Patient satisfaction was high overall but greater in G1 (mean VAS 9.65 ± 0.52) than in G2 (8.96 ± 0.73). No major biological complications occurred. Conclusions: Digitally guided crown lengthening resulted in improved gingival margin stability and reduced the need for secondary correction compared with the freehand approach. Precise control of the bone crest position relative to the planned gingival margin is critical for long-term esthetic success. Full article

Background. Orthodontic extrusion (OE), or forced eruption, is a conservative technique used to recover teeth affected by coronal fractures, traumatic intrusions, or severe caries. It involves applying light, continuous forces to induce vertical tooth movement, promoting tissue remodeling through periodontal ligament stimulation. Materials and Methods. This narrative review included studies investigating OE as a therapeutic approach for the management of deep or subgingival carious lesions, traumatic dental injuries (such as intrusion or fracture), or for alveolar ridge augmentation in implant site development. OE is typically performed using fixed appliances such as the straight-wire system or, in selected cases, clear aligners. Forces between 30 and 100 g per tooth are applied, depending on the clinical situation. In some protocols, OE is combined with fiberotomy to minimize gingival and bone migration. Results. Studies show that OE leads to significant vertical movement and increases in buccal bone height and interproximal septa. It enhances bone volume in targeted sites, making it valuable in implant site development. Compared to surgical crown lengthening, OE better preserves periodontal tissues and improves esthetics. Conclusions. In this narrative review is analized how OE is effective for managing traumatic intrusions and compromised periodontal sites, particularly when paired with early endodontic treatment. It reduces the risks of ankylosis and root resorption while avoiding invasive procedures like grafting. Although clear aligners may limit axial tooth movement, OE remains a minimally invasive, cost-effective alternative in both restorative and implant dentistry. Full article

The aim of this study was to evaluate the impact of autoclaving on the dimensional stability of surgical guides (SGs) for aesthetic crown lengthening (ACL) using different resins/printing methods. Fifty SGs for ACL were printed using five different resin/printer combinations (FL, SR, ND, KS and VC). All the SGs were scanned before (T0) and after (T1) sterilization. Autoclaving was conducted at 134 °C during 4 min. The STL files of each SG at T0 and T1 were compared with the original design (TR). Dimensional stability was measured using trueness and precision. Deviations from TR to T1 were calculated in the three space axes and by measuring the area between three reference landmarks. At T0, the FL group showed the best trueness and precision, while the SR group performed significantly worse than the other groups. At T1, all the groups except VC exhibited significant dimensional alterations compared with T0. Also, VC showed the best trueness and precision values. All the groups had a significant deviation in at least one space axis, while only the SR group exhibited significant variations from T1 to TR in the area between the reference landmarks. Most of the evaluated resin/3D printer combinations suffered significant dimensional alterations after autoclaving. Full article

Deep margin elevation (DME) is a widely adopted technique for managing subgingival cervical proximal margins by repositioning them to a supragingival location. This approach enhances access, visibility, and control in these anatomically challenging areas. This narrative review aimed to evaluate current evidence on the indications, materials, clinical protocols, and outcomes of DME. A structured search was conducted in PubMed, the Cochrane Library and Scopus up to February 2025, using keywords such as “deep margin elevation”, “proximal box elevation” and “subgingival margin.” Clinical studies, in vitro investigations, relevant reviews and reports in English were included. A total of 59 articles were selected based on eligibility criteria. The hypothesis was that DME can serve as a reliable alternative to surgical crown lengthening in appropriate cases. A variety of materials have been investigated for use as the intermediate layer, with composite resins of varying viscosities and filler compositions being preferred due to their favorable long-term mechanical properties. DME may reduce the need for surgical intervention while maintaining periodontal health; however further randomized clinical trials are needed to clarify the material selection, establish long-term outcomes, and standardize clinical protocols. Understanding the indications, limitations, and protocol of DME is critical for achieving biologically sound and predictably functional restorations. Full article

Introduction: In recent years, erbium-doped yttrium aluminum garnet (Er:YAG) and erbium, chromium/yttrium–scandium–gallium–garnet (Er,Cr:YSGG) lasers have been introduced as another possibility to perform less-invasive flapless (FL) crown-lengthening (CL) procedures. Objectives: The aim of this review is to describe the outcomes and complications of this approach. Materials and methods: A literature review was conducted to retrieve clinical studies and case reports that analyze different variables related to laser-assisted flapless crown lengthening and report their outcomes in terms of gingival margin level stability (GMLS), and postoperative complications. Results: A total of five studies were included in the final qualitative analysis; two of them were randomized controlled trials (RCTs) and the rest were case reports. The common variable measured in all studies was the GMLS, finding good stability in the FL groups at 3 months follow-up, but more tissue rebound was observed in patients with the thick biotype. Other variables were reported in different articles as the plaque index (PI), gingival index (GI), bone margin level, biotype, bleeding on probing (BP), probing depth (PD), and postoperative pain by the numeric rating scale (NRS). Discussion: There are a wide range of heterogenous clinical variables used to evaluate outcomes, as well as variations in the type of laser used and its parameters in terms of the applied technique. However, most analyzed studies showed better GMLS for the flapless technique, as well as less postoperative inflammation. Conclusions: The included studies showed promising clinical outcomes in the FL laser-assisted CL groups concerning GMLS at the 3-month postoperative period. However, more RCTs are needed with respect to fixed laser parameters and patient biotype selection to reach a definitive clinical protocol. Full article

Background: Crown lengthening (CL) in esthetic areas has become a versatile procedure with applications in many clinical situations. Knowledge concerning different periodontal phenotypes, and the supracrestal tissue attachment (STA)—former biological width—has allowed for a better understanding of surgical management, allowing for the individualization of surgical therapy. This review presented an individualized surgical approach to CL in esthetic areas based on evaluating the phenotype and current considerations about the STA, correlating them to suggestive surgical techniques. Methods: For an individualized surgical approach, it is primarily necessary to understand STA, including the relationship and distance between the cementoenamel junction (CEJ) and the bone crest (BC) and the position of the free gingival margin (FGM); secondarily, it is necessary to verify the periodontal phenotype to prepare surgical planning (gingivectomy or osseous resection/contouring). Three periodontal phenotypes are recognized, presenting different biological behaviors due to specific characteristics implicitly correlated to soft tissue management. Results: Then, after assessing the distance from the CEJ to the BC, the position of the FGM, and the periodontal phenotype, it is possible to individualize the treatment according to the phenotype. In cases of a thin and scalloped periodontium with delicate gingiva, there might be the presence of bone dehiscence, fenestration, and instability in the healing of the gingival margin, bringing extra attention to tissue manipulation and suggesting a minimally invasive technique (no flap). A partial-thickness flap is recommended for a thick and scalloped periodontium, keeping the periosteum adhered to the bone. For periodontium B (fibrous and dense gingiva and tissue resistant to injuries), the surgical approach recommended is an open full-thickness flap with osteotomy for horizontal and vertical bone volume removal. Then, observing first the specific parameters, such as the STA, CEJ, BC, FGM, and KTW, and then the characteristics of periodontal phenotypes, it is possible to determine the individualized surgical strategy and a reasonable surgical approach to tissue manipulation in clinical CL surgeries. Conclusions: The surgical approach must be defined according to individualized planning since several variables can influence the dynamics of the periodontal tissues. Full article

Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets’ depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science. Full article

Background and Objectives: This review focuses on reviewing studies from the literature regarding the effects of deep margin elevation on the surrounding periodontium. Materials and Methods: A review of the literature was carried out using the following online databases: Embase, The Cochrane Library, MEDLINE-PubMed and Google Scholar. Our search was limited to articles from 2010 to 2023. The search terms consisted of keywords and MeSH terms, which were ‘deep margin elevation’, ‘coronal margin relocation’, ‘periodontium’ and ‘periodontal tissues’. The literature was searched thoroughly by two reviewers. Initially, the titles of the articles were extracted. After removing irrelevant and duplicate articles, abstracts were assessed for relevant articles. Finally, the reviewers analyzed full-text articles. Results: A total of twelve articles, including one randomized clinical trial, three systematic reviews, two prospective cohort, three case series, one a clinical study, one pilot study and one a retrospective study, were selected and analyzed. Conclusions: The review suggests potential benefits of Deep Margin Elevation (DME) over surgical crown lengthening due to reduced invasiveness, yet conclusive effects on periodontal tissue remain unclear, warranting further studies on clinical parameters and inflammatory biomarkers. Full article

The current pilot study investigates the effects following removal of excessive gingival tissue, which is often necessary in fixed prosthodontic cases. The aim of the study is to assess gingival healing after diode laser gingivectomy prior to prosthetic procedures. Materials and methods: The healing process of the gingiva after the diode laser gingivectomy of 41 teeth was assessed. The following parameters were examined: recovery time of the gingiva, possibility to take the impression at the same visit, duration of the manipulation, bleeding during the procedure, tissue adherence to the instrument, postoperative hemorrhage on probing, postoperative pain, and wound healing in regard to tissue color, tissue contour, and appearance of the wound. Results: At the 24th hour, all gingival wounds were covered with fibrinous plaque and an erythematous halo. At the 72nd hour, in two cases (4.9%), this wound’s characteristic had already passed through to the next healing stage—granulated surface and normal pale pink color. A granulated surface in the 1st week was reported in 10 (24.4%) cases, and in all of the other 31 (75.6%) cases, complete healing was reported. In the second week, all wound surfaces had a normal pale pink color. Bleeding was self-limiting in most of the cases and negligible from a clinical point of view. The postoperative pain levels were low or nonexistent. There was lack of postoperative hemorrhage on probing after the first week in all examined cases. Tissue recovery in terms of tissue contour, color, and appearance of the wound was asymptomatic. Conclusion: within the limitations of this pilot study, the outcomes of the wound healing after laser gingivectomy aided the clinicians to perform the prosthetic procedures in the same visit. Full article

This report describes a technique integrating facial and dental scanners for treatment planning and execution of a tooth-borne full-mouth reconstruction (FMR) with zirconia fixed prostheses. A partially edentulous female adult presented generalized worn dentition in the incisal and occlusal surfaces. The patient accepted the option for treatment with a fixed FMR solution using a fully digital workflow. An intraoral scan (IoS) for both arches and facial scans collected the initial clinical situation. A digital diagnostic wax-up was generated as part of the treatment plan, and the models were printed. The intervention included crown lengthening of the maxillary teeth aided by a printed guide, installing milled provisional restorations, and delivering permanent milled zirconia partial restorations, single crowns (SCs), and fixed dental prostheses (FDPs). The functional extraoral scanner permitted designing an FMR that created a harmonious dental, gingival, and facial relationship with the patient’s esthetic consent approval. IoS captured the initial clinical situation to design (CAD) and fabricate (CAM) the PMMA provisional and zirconia final partial restorations, SCs, and FDPs. Facial and intraoral scanners are technologies that can synergistically assist oral health providers in the diagnosis, planning, and execution of fixed FMR using an entirely digital workflow. Full article

The impairment of aesthetic function leads to a decreased quality of life. An unaesthetic smile due to excessive gingival exposure demands, most of the time, a complex treatment in which the objective is the vertical reduction of the amount of exposed fixed gingiva by obtaining a complete exposure of the anatomical crown of the teeth and restoring the ideal dimensions of the biological width. This paper presents a case of a 48-year-old female patient who was unsatisfied with her aesthetics and had disturbed masticatory function due to the absence of some posterior teeth. The cone beam computed tomography was performed to evaluate the facial and dental morphology. The treatment plan included diode laser and piezo-surgery utilization for the frontal area of the upper arch and implants to restore the distal area of the lower and upper arch. Zirconia ceramic was used for the final restorations. This complex and multidisciplinary full-mouth rehabilitation lasted for two years, and the patient was pleased with the result. This case showed that a well-established treatment plan is necessary to obtain long-lasting results. The use of adequate procedures and equipment ensures a predictable result. Full article

Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed. Full article