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Digital planning and guided dual technique in esthetic crown lengthening: a randomized controlled clinical trial

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Abstract

Objectives

The present study aimed to compare the guided dual technique with the conventional technique in esthetic crown lengthening (ECL).

Materials and methods

The trial registration number is NCT04922086. Twenty-four participants diagnosed with altered passive eruption (APE) type I subcategory B were selected and allocated into two groups. In the control group (n = 12), the ECL procedure was planned by clinical examination and transgingival probing; in the test group (n = 12), the ECL procedure was carried out using digital planning and a double guide. Clinical parameters were assessed at baseline, immediately after the intervention (IAI), and at 4, 8, and 12 months of follow-up.

Results

The clinical crown length (CCL) mean at baseline was 8.09 mm (± 0.77) and increased significantly to 9.92 mm (± 0.62) IAI, with minimal significant reduction after 12 months (9.47 mm [± 0.60]) in the control group. Similarly, in the test group, the mean CCL at baseline was 8.04 mm (± 0.69) and increased significantly to 9.94 mm (± 0.57) IAI, with minimal reduction after 12 months (9.35 mm [± 0.80]). No differences were found between the mean CCL determined in the digital planning and after 12 months. No correlation was found between gingival thickness and gingival margin stability. High esthetic satisfaction was demonstrated by participants/specialists without differences between groups.

Conclusions

In conclusion, the guided dual technique was as effective as the conventional technique for treatment of APE, with stable results after 12 months of follow-up.

Clinical relevance

The guided dual technique aims to transfer both the gingival and bone resection planned position to facilitate the ECL surgical procedure and increase treatment predictability.

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References

  1. Hempton TJ, Dominici JT (2010) Contemporary crown-lengthening therapy: a review. J Am Dent Assoc 141(6):647–655

    Article  PubMed  Google Scholar 

  2. Gargiulo AW, Wentz FM, Orban B (1961) Dimensions and relations of the dentogingival junction in humans. J Periodontol 32(3):261–267

    Article  Google Scholar 

  3. Arias DM, Trushkowsky RD, Brea LM, David SB (2015) Treatment of the patient with gummy smile in conjunction with digital smile approach. Dent Clin North Am 59(3):703–716

    Article  PubMed  Google Scholar 

  4. Garber DA, Salama MA (2000) The aesthetic smile: diagnosis and treatment. Periodontol 1996(11):18–28

    Google Scholar 

  5. Garcia PP, da Costa RG, Calgaro M, Ritter AV, Correr GM, da Cunha LF et al (2018) Digital smile design and mock-up technique for esthetic treatment planning with porcelain laminate veneers. J Conserv Dent 21(4):455–458

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liu X, Yu J, Zhou J, Tan J (2018) A digitally guided dual technique for both gingival and bone resection during crown lengthening surgery. J Prosthet Dent 119(3):345–349

    Article  PubMed  Google Scholar 

  7. Lack JD (2009) Aesthetic crown lengthening: a step by step surgical guide and biologic considerations. Alpha Omegan 102(4):133–141

    Article  PubMed  Google Scholar 

  8. Schulz KF, Altman DG, Moher D, Group C (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 340:c332

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sterrett JD, Oliver T, Robinson F, Fortson W, Knaak B, Russell CM (1999) Width/length ratios of normal clinical crowns of the maxillary anterior dentition in man. J Clin Periodontol 26(3):153–157

    Article  PubMed  Google Scholar 

  10. Januario AL, Barriviera M, Duarte WR (2008) Soft tissue cone-beam computed tomography: a novel method for the measurement of gingival tissue and the dimensions of the dentogingival unit. J Esthet Restor Dent 20(6):366–73 (discussion 74)

    Article  PubMed  Google Scholar 

  11. Batista EL Jr, Moreira CC, Batista FC, de Oliveira RR, Pereira KK (2012) Altered passive eruption diagnosis and treatment: a cone beam computed tomography-based reappraisal of the condition. J Clin Periodontol 39(11):1089–1096

    Article  PubMed  Google Scholar 

  12. Cairo F, Graziani F, Franchi L, Defraia E, Pini Prato GP (2012) Periodontal plastic surgery to improve aesthetics in patients with altered passive eruption/gummy smile: a case series study. Int J Dent 2012:837658

    Article  PubMed  PubMed Central  Google Scholar 

  13. Silva CO, Soumaille JM, Marson FC, Progiante PS, Tatakis DN (2015) Aesthetic crown lengthening: periodontal and patient-centred outcomes. J Clin Periodontol 42(12):1126–1134

    Article  PubMed  Google Scholar 

  14. Eren G, Atilla G (2014) Platelet-rich fibrin in the treatment of localized gingival recessions: a split-mouth randomized clinical trial. Clin Oral Investig 18(8):1941–1948

    Article  PubMed  Google Scholar 

  15. Mufti S, Dadawala SM, Patel P, Shah M, Dave DH (2017) Comparative evaluation of platelet-rich fibrin with connective tissue grafts in the treatment of miller’s class I gingival recessions. Contemp Clin Dent 8(4):531–537

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G (2018) Esthetic treatment of altered passive eruption. Periodontol 2000 77(1):65–83

    Article  PubMed  Google Scholar 

  17. Camargo PM, Melnick PR, Camargo LM (2007) Clinical crown lengthening in the esthetic zone. J Calif Dent Assoc 35(7):487–498

    Article  PubMed  Google Scholar 

  18. Dolt AH 3rd, Robbins JW (1997) Altered passive eruption: an etiology of short clinical crowns. Quintessence Int 28(6):363–372

    PubMed  Google Scholar 

  19. Claman L, Alfaro MA, Mercado A (2003) An interdisciplinary approach for improved esthetic results in the anterior maxilla. J Prosthet Dent 89(1):1–5

    Article  PubMed  Google Scholar 

  20. Levine RA, McGuire M (1997) The diagnosis and treatment of the gummy smile. Compend Contin Educ Dent 18(8):757–762 (64; quiz 66)

    PubMed  Google Scholar 

  21. Arora R, Narula SC, Sharma RK, Tewari S (2013) Evaluation of supracrestal gingival tissue after surgical crown lengthening: a 6-month clinical study. J Periodontol 84(7):934–940

    Article  PubMed  Google Scholar 

  22. Pontoriero R, Carnevale G (2001) Surgical crown lengthening: a 12-month clinical wound healing study. J Periodontol 72(7):841–848

    Article  PubMed  Google Scholar 

  23. Ribeiro FV, Hirata DY, Reis AF, Santos VR, Miranda TS, Faveri M et al (2014) Open-flap versus flapless esthetic crown lengthening: 12-month clinical outcomes of a randomized controlled clinical trial. J Periodontol 85(4):536–544

    Article  PubMed  Google Scholar 

  24. De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J (2009) The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 36(5):428–433

    Article  PubMed  Google Scholar 

  25. Greenberg J, Laster L, Listgarten MA (1976) Transgingival probing as a potential estimator of alveolar bone level. J Periodontol 47(9):514–517

    Article  PubMed  Google Scholar 

  26. Perez JR, Smukler H, Nunn ME (2007) Clinical evaluation of the supraosseous gingivae before and after crown lengthening. J Periodontol 78(6):1023–1030

    Article  PubMed  Google Scholar 

  27. Sun Z, Smith T, Kortam S, Kim DG, Tee BC, Fields H (2011) Effect of bone thickness on alveolar bone-height measurements from cone-beam computed tomography images. Am J Orthod Dentofacial Orthop 139(2):e117–e127

    Article  PubMed  Google Scholar 

  28. Sherrard JF, Rossouw PE, Benson BW, Carrillo R, Buschang PH (2010) Accuracy and reliability of tooth and root lengths measured on cone-beam computed tomographs. Am J Orthod Dentofacial Orthop 137(4 Suppl):S100–S108

    Article  PubMed  Google Scholar 

  29. Ballrick JW, Palomo JM, Ruch E, Amberman BD, Hans MG (2008) Image distortion and spatial resolution of a commercially available cone-beam computed tomography machine. Am J Orthod Dentofacial Orthop 134(4):573–582

    Article  PubMed  Google Scholar 

  30. Molen AD (2010) Considerations in the use of cone-beam computed tomography for buccal bone measurements. Am J Orthod Dentofacial Orthop 137(4 Suppl):S130–S135

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the “CEDRO 3D Alfenas” for performing the cone-beam computed tomography and the “DVI Radiologia Odontológica” for the design and printing of the double guide.

Funding

The study was funded by the CAPES (Process number: 88882.429928/2019–01).

Author information

Authors and Affiliations

  1. School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil

    Thaisa Macedo Iunes Carrera, Alice Engel Naves Freire, Sabrina dos Reis Nicolau, Noé Vital Ribeiro Junior & Suzane Cristina Pigossi

  2. Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil

    Guilherme José Pimentel Lopes de Oliveira & Suzane Cristina Pigossi

  3. Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP- São Paulo State University, Araraquara, SP, Brazil

    Elton Carlos Pichotano

  4. Centro Universitário Central Paulista – UNICEP, School of Dentistry, São Carlos, São Paulo, Brazil

    Luana Carla Pires

Authors
  1. Thaisa Macedo Iunes Carrera
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  2. Alice Engel Naves Freire
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  3. Guilherme José Pimentel Lopes de Oliveira
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  6. Noé Vital Ribeiro Junior
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  7. Luana Carla Pires
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  8. Suzane Cristina Pigossi
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Contributions

TMIC: participated in the study design, selected and examined the patients and wrote the main manuscript text; AENF: selected and examined the patients and helped in the surgical procedure; GJPLO: made the statistical analysis and wrote the main manuscript text; SRN: made the preparation phase and helped in the surgical procedure; ECP: made the ST-CBTC analysis; NVRJ: made the preparation phase and prepared figures; LCP: participated in the study design, made the DSD analysis and wrote the main manuscript text; SCP: participated in the study design, made the surgical procedure and wrote the main manuscript text; all authors reviewed the manuscript.

Corresponding author

Correspondence to Suzane Cristina Pigossi.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Carrera, T.M.I., Freire, A.E.N., de Oliveira, G.J.P.L. et al. Digital planning and guided dual technique in esthetic crown lengthening: a randomized controlled clinical trial. Clin Oral Invest 27, 1589–1603 (2023). https://doi.org/10.1007/s00784-022-04780-8

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  • DOI: https://doi.org/10.1007/s00784-022-04780-8

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