A. Traumatic injuries to the periodontal structures include.
1. Tooth fractures or deep decay.
2. Deep injuries to the teeth and or gums.
When a deep fracture occurs to a tooth, the tooth must be repaired with a cap or onlay to restore comfort or function. The obstacle that restorative dentists face is threefold:
1. Often the loss of tooth structure extends underneath the gumline. This prevents the dentist from obtaining an accurate impression of healthy tooth structure. Without an accurate impression, the laboratory technician will be unable to deliver a properly fitting tooth restoration.
2. A deep fracture also removes much of the mechanical retention a tooth requires to hold onto a cap for long periods of time.
3. If the fracture extends to the immediate area of the bone around the tooth, any restoration placed in this space will irritate the normal thickness of the gum tissue. This violation of natural tissue space will result in chronic inflammation. Redness, puffiness, and tenderness of the gums around the poorly positioned dental restoration most often accompany this in turn.
B. The recommended treatment for deep fractures is the Crown Lengthening Procedure.
Crown Lengthening procedures will provide the dentist a correction of any one or all three of the above concerns. This procedure exposes more tooth structure by positioning the gums beyond the fracture line. Then the dentist can register accurate impressions of the tooth. Also, the additional exposure of tooth structure provides more retention and avoid the need to bury crown margins too close to the bone.
The technique usually requires the following protocol:
1. Local anesthetic or novocaine injections.
2. Incisions that allow for the separation and reflection of gums away from the tooth.
3. Clean out of inflamed or irritated gum tissue.
4. Evaluation of how much tooth structure extends out of the bone socket. A minimum of 3mm of intact tooth structure must extend beyond the bone.
5. Possible removal of slight amounts of bone around the fractured tooth. Usually, only one millimeter or so may be removed to expose the necessary 3mm of tooth structure.
6) Sewing the gums to a position exposing the necessary tooth structure.
This procedure would also benefit teeth with deep or recurrent decay and people with overly gummy smiles.
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