Template for Surgical Crown Lengthening:

Fabrication Technique
Mu y Walker, MS, ODs, and Paul Humen, ODs2
Thi s article describes a technique for t he easy fabrication of a t empl at e t o faci l i tate surgical
l engtheni ng of t he clinical crown t o enhance esthetics andl or increase retenti on of a fi xed
prosthesis. The use of thi s surgical guide should resul t i n more predi ctabl e clinical results.
J Prosthod 1998;7:265-267. Copyright o 1998 by The American College of Prosthodontists.
INDEX WORDS: surgical guide, surgical l engtheni ng
URGICAL CROWN LENGTHEMIYG, an api-
S cally positioned flap with ostectomy/osteoplasty,
is often a component of the restorative treatment
plan. The crown-lengthening proccdure may become
necessary as a result oi tooth iracture, margin loca-
tion of prcviously placed restorations, or correction of
short clinical crowns to enhance retention ofrcstora-
tions and/or esthetics.
To attain a biological width of 2 mm,1,2 at least 3
nim of supracrestal tooth structure should be ex-
posed apical to the proposed restoration rna~-g-in.~-~
However, Herrero et a1noted that the desired vcrsus
the actual amount of crown lengthening is noi
routinely achieved during the surgical procedure.
Wlvle surgical guidcs havc been used for more
predictable results in other oral surgical proccdures,
such as maxillary tuberosity reduction and dental
implant placement,8-13 such guides are seldom used
for crown-lengthening procedures.
The esthctic goals of anterior, surgical crown
lengthening are to provide incrcased tooth length
from cervical exposure arid a more synmctrical,
esthetically pleasing gingival matrix.-16 Ideally, the
length of central incisors is 10 to 11 mm, canines are
11 to 12 mm long, and lateral incisors are approxi-
mately 1 to 1.5 mm shortcr than central incisors. To
cstablish a more esthetic gingival pattern, the ccntral
incisor gingival margins should be at approximately
the same level as the gingival margins of the canines
and at the same level to 1 mm apical to the lateral
incisor gingival margins.
The increased use of surgical crown-lengthcning
procedures to improve esthetics demands an accu-
rate and predictable perioprosthetic surgical result.
In this regard, the present article describes the
fabrication of a simplc templatc for use as a guide
during surgical lengthening of short clinical crowns.
Procedure
1. Draw the desired crown length on the diagnostic
cast (Fig 1).
2. Place separating medium (tin-foil substitutc) on
the cast.
3. A template is formed of a veneer of light-
polymerized composite resin placed on the cast
over the facial surfaces of the teeth to be surgically
lengthened. Extend the resin from the proposed
gingival margins lo just over the incisal cdgcs,
providing a definite seat for proper template
positioning and stability (Figs 2 and 3) .
4. After light polymerization, carefully remove the
surgical tcmplatc from the cast.
5. The template is used during the crowm-lengthen-
ing procedure (Fig 4). The goal is to obtain 3 mm
of tooth exposure between thc proposed restora-
tion margin (template margin) and the alveolar
crest. This can be verified with a periodontal
probe.
From the tinzLersz& qf iWzssouri-Kamas Cib, School of Dml Ui y,
Resident. Graduale Prusthodontics Proyam.
%irertor, Graduate Prosfhodontics Progrum.
ArLeped J i m 19, i998.
Cormflonriencc lu: Dr. Mug1 Wulker. 9300 Lee Court, hawood, K.S
Coppnght Q 1998 by The American College ofrosthododsls
I u~~- . ~4l xl 98/ ~704- 0u07~~. 00/ 0
Kantar Cig, ,240.
66206.
Figure 1. Desircd crown length dram on a diagnostic
cast.
Jouinol of Imthodontzcs, VOLT 1% 4 (Dfcernber). 1998:pfi 265-267
265
Figure 6. Approximately 4 months' postoperatively, with
provisional restorations in place. Figure 2. Composite-resin surgical template fabricated
on a cast.
Figure 3. liicisal vicwroftcmplate on a cast.
6'. Figure 5 shows results irnmcdiately after surgery.
Teeth nos. 6 and 11 were not includcd in thc
crown-lcngthening procedure, because their gingi-
val margins are esthetically appropriate in rela-
tion to the surgically rcpositioned gingival mar-
gins of the central and lateral incisors. (Tooth 8
was extracted because of a vertical root fracture.)
7. Figurc 6 is approximately 4- months' postopera-
tively, with provisional restorations (teeth 6-1 1) in
place.
Summary
Thc proposed surgical template has obvious use for
surgical lengthening of short clinical crowns for
improved esthetics and/or increased rcstoration reten-
tion, especially when multiplc teeth are involved.
Generally, only a facial template will be rcquircd
when correction of clinical crown length involving
antcrior sextants is necessary for esthetic enhance-
ment. Allen noted that esthetic-lengthening proce-
dures rarely require a palatal flap.'j HOMWCF, if the
exposed lingual tooth struclure is insufficient for
crown retention, an additional template could be
made for palatal alveolar reduction. Although this
t)-pe of Pi de bvi l l bc used most often bjpith anterior,
esthetic-lengthening procedures, buccal and lingual
templates could also be helpful for lengthening
posterior teeth that rcquire increased crown reten-
tion.
The usc of this surgical template enables the
surgeon to visualize more accuratcly the dcsircd
clinical position of the crown gingival margin and
more closely approximate the desired 3 mm of tooth
exposurc. If 3 mni of cxposure is not attainable, the
surgeon can report how much tooth exposure was
Figure 4. Use of surgical guideduring crown-lengthening
pmc:din'e.
Figure 5. Result immcdiatel!; following surgeiy.
achieved apical to the templatc margin. Thc restor-
ative dentist can then discuss the esthetic/prosthetic
compromise with the patient and decide whether the
outcome will bc esthetically acceptable or whether
other treatnierit options should be considered before
tooth preparation.
Acknowledgment
The authors thank Dr. Charles Cobb, Professor of Pcriodon-
tics, UhlKC-School of Dentistry, for editorial assistance.
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