please help with crown lengthening

[hafnium45nm]

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Can someone outline the exact steps on how to do crown lengthening?

It'll be for a mandibular premolar. I intend to turn this into a crown prep but the tooth has some decay below the gingiva. I expect some osseous contouring on this one. The tooth has not yet been prepped but I'll eventually do a crown prep with shoulder and bevels.

I need the following info:
1) The exact steps on crown lengthening, including, but not limited to, armamentarium and flap design
2) And the amount of healing time before I start cutting the tooth away for a crown.

Thank you.

 

[aphistis]

Can someone outline the exact steps on how to do crown lengthening?

It'll be for a mandibular premolar. I intend to turn this into a crown prep but the tooth has some decay below the gingiva. I expect some osseous contouring on this one. The tooth has not yet been prepped but I'll eventually do a crown prep with shoulder and bevels.

I need the following info:
1) The exact steps on crown lengthening, including, but not limited to, armamentarium and flap design
2) And the amount of healing time before I start cutting the tooth away for a crown.

Thank you.

You should prep the tooth as completely as possible, especially the finish line in the area in question, before you do the crown lengthening. The whole reason you're doing the CL procedure is, presumably, to recover biologic width, so you need to figure out where the crown margin will be so you can remove an appropriate amount of bone.

The technique and armamentarium can be found in any number of perio texts, and I typically wait four weeks before restoring the tooth. It's important to have a good temporary during the healing period so the patient doesn't constantly impact food into the surgical site, which can further prolong healing.

 

[hafnium45nm]

You should prep the tooth as completely as possible, especially the finish line in the area in question, before you do the crown lengthening. The whole reason you're doing the CL procedure is, presumably, to recover biologic width, so you need to figure out where the crown margin will be so you can remove an appropriate amount of bone.

1) When making flaps, do you hold your scalpel firmly against the bone?

2) When making sulcular incisions, again, are you supposed to do it gently?

3) Is it acceptable to use a regular highspeed handpiece with round carbide burrs when cutting away the bone? My clinic doesn't offer surgical handpieces.

4) Is it easy to accidentally damage root structure while drilling away the surrounding bone?

5) Should you be able to reflect flaps without any resistance? Should I expect them to be taut when doing the reflection?

6) Do you cut away excess gingival tissue before or after osseous recontouring?

7) What do you use to smoothen the bone after cutting parts of it away?

8) The tooth in question is a #29. Making note of the mental foramen, what precautions would you take in the flap design and incisions?

 

[DrTacoElf]

1) When making flaps, do you hold your scalpel firmly against the bone?
Always in a single pass

2) When making sulcular incisions, again, are you supposed to do it gently?
Firm enough to cut just don't tear anything


3) Is it acceptable to use a regular highspeed handpiece with round carbide burrs when cutting away the bone? My clinic doesn't offer surgical handpieces.
combination of slow and high with irrigation. Surgical would be best due to risk of air emphysema with normal type

4) Is it easy to accidentally damage root structure while drilling away the surrounding bone?
you remove the part closest to the tooth with hand instruments
5) Should you be able to reflect flaps without any resistance? Should I expect them to be taut when doing the reflection?
they will always be somewhat taught, if you feel it is too much do a releasing incision

6) Do you cut away excess gingival tissue before or after osseous recontouring?
after or you have no idea about clousure

7) What do you use to smoothen the bone after cutting parts of it away?
bone files

8) The tooth in question is a #29. Making note of the mental foramen, what precautions would you take in the flap design and incisions? you should not be anywhere near this as far as the apical extent of your reflection. I would make a flap from about the distal of #30 to the mesial of #28 on the buccal and lingual. If you have to release on the buccal I would do it in the distal. And of course make sure you are subperiosteal before reflecting. As long as you are subperiosteal you will be able to identify and avoid vital structures.

See Above

 

[aphistis]

1) When making flaps, do you hold your scalpel firmly against the bone?

2) When making sulcular incisions, again, are you supposed to do it gently?

3) Is it acceptable to use a regular highspeed handpiece with round carbide burrs when cutting away the bone? My clinic doesn't offer surgical handpieces.

4) Is it easy to accidentally damage root structure while drilling away the surrounding bone?

5) Should you be able to reflect flaps without any resistance? Should I expect them to be taut when doing the reflection?

6) Do you cut away excess gingival tissue before or after osseous recontouring?

7) What do you use to smoothen the bone after cutting parts of it away?

8) The tooth in question is a #29. Making note of the mental foramen, what precautions would you take in the flap design and incisions?

With all due respect, with these questions I don't believe you should be attempting to perform this procedure. Refer your patient to a periodontist and ask to observe the procedure, and take some pertinent continuing education courses.

 

[tinker bell]

Seriously, don't try to cut flap if you don't know how to angle your scapel. Suture is a whole new other issue. I think even if it's free treatment, any human being deserves better. Try to shadow someone at least or get a CE course before cutting your patient up. Internet forum like this can't be a place to learn a surgical procedure.

 

[FutureDMD1234]

I don't know the answer obviously but it is common sense to not to attempt any procedures that you don't know about. I guess you should ask your professor or take CE courses.

 

[Dukie]

With all due respect, with these questions I don't believe you should be attempting to perform this procedure. Refer your patient to a periodontist and ask to observe the procedure, and take some pertinent continuing education courses.

Yes, that was precisely my point in the invisalign thread as well. I don't mean to sound condescending at all, but if you have to ask people on an internet forum how to do a procedure, you should not be doing it! It is not fair to the patient. Refer him or her to the appropriate specialist and there will be no problem. Crown lengthening, for example, is still a SURGERY and there is plenty of room for complications to arise.

 

[aphistis]

Yes, that was precisely my point in the invisalign thread as well. I don't mean to sound condescending at all, but if you have to ask people on an internet forum how to do a procedure, you should not be doing it! It is not fair to the patient. Refer him or her to the appropriate specialist and there will be no problem. Crown lengthening, for example, is still a SURGERY and there is plenty of room for complications to arise.

👍

 

[hafnium45nm]

Yes, that was precisely my point in the invisalign thread as well. I don't mean to sound condescending at all, but if you have to ask people on an internet forum how to do a procedure, you should not be doing it! It is not fair to the patient. Refer him or her to the appropriate specialist and there will be no problem. Crown lengthening, for example, is still a SURGERY and there is plenty of room for complications to arise.

But what if your employer isn't happy with your production values and the amount of cases being referred out?

I moved several hundred miles for this job. What should I do?

 

[hafnium45nm]

Seriously, don't try to cut flap if you don't know how to angle your scapel. Suture is a whole new other issue. .

What's different about flaps for crown lengthening ?

I do flaps for certain types of surgical exos ( although not many; I did my first couple by imitating some videos and textbook illustrations. Not sure if I did them right but the patients healed fine and there were no complaints ) and aren't flaps and suturing for crown lengthening pretty much the same?

 

[tinker bell]

But what if your employer isn't happy with your production values and the amount of cases being referred out?

I moved several hundred miles for this job. What should I do?

Your boss won't be with you at the court. Remember, the judge will not like it if he hears how you learned your surgical procedure: on an internet forum by a bunch of amateur newly grad more or less just like you. You are not only treating your patient unfairly, you are taking a lot of risk to make your boss rich. Ask yourself if it's worth it or not. If they cry about production, let them do. Who will cry when you lose your license over something silly like crown lengthening?

 

[tinman831]

But what if your employer isn't happy with your production values and the amount of cases being referred out?

I moved several hundred miles for this job. What should I do?

When you perform a procedure, you are ethically and legally bound to uphold a standard level of care with all your patients. If you can't, then you are doing your patients a disservice. If you cannot perform a procedure to a level of competency that your average practitioner is supposed to be able to do, due to lack of knowledge or experience, then you need to refer your case out to another dentist or specialist who can.

It doesn't matter if its a surgical implant placement, or a simple class 2 filling. Admit when you can't do something and save yourself the trouble of having to deal with the consequences. Your dentist must have known about your level of experience before hiring you and he needs to live with it. Don't let him push you, because like tinker bell said, he won't be there to hold your hand when you're standing in front of the judge for a lawsuit or in front of your state board who will decide the fate of your license.

 

[aphistis]

But what if your employer isn't happy with your production values and the amount of cases being referred out?

I moved several hundred miles for this job. What should I do?

What you should do: learn to do the procedure, or consider finding a new employer where you won't be under so much pressure to risk your patients' well-being in the name of in-house production.

What you should NOT do: Jeopardize your license and reputation by diving blindly into a periodontal surgery you currently know very little about. Good luck to you.