The perio-esthetic-restorative approach for anterior rehabilitation
A 28-year-old female patient who was referred from Department of Conservative Dentistry and Endodontics to Department of Periodontics, Subharti Dental College, Meerut to increase the length of the clinical crown in relation to maxillary right central incisor, maxillary right lateral incisor, maxillary left central incisor, maxillary left lateral incisor and maxillary left canine for placement of fixed prosthesis. A detailed medical and dental history was obtained from the patient. A thorough clinical examination was performed. It revealed severe loss of the tooth structure due to caries []. The teeth were endodontically restored. Radiographic examination showed Gutta Percha point in the apical one-third for the placement of post and core []. On probing, a generalized depth of 2 mm was observed [] with 3-4 mm of attached gingiva. The teeth were not mobile. Maxillary and mandibular impressions were taken and diagnostic casts were obtained along with pre-operative intraoral photographs.\nAn average of 2 mm of the clinical crown and 2 mm of biologic width was required to place the subgingival margins of the crown for which surgical crown lengthening was planned. According to classification by Lee[] the present case falls under Type III category. A signed consent form was obtained from the patient.\nBefore planning for the surgery, complete plaque and calculus removal was done. After giving anesthesia, bone sounding was carried out to determine the amount of osseous reduction to be done. Undisplaced flap surgery with osseous recontouring was performed to increase the clinical crown length and to maintain the biologic width [].\nMaximum preservation of keratinized gingiva was performed. Ostectomy followed by osteoplasty was performed to obtain at least 4 mm of healthy tooth structure above the alveolar crest. The scalloping of the flap was performed anticipating the final underlying osseous contour. Flaps were sutured back. Routine post-operative instructions were given. The medications prescribed were, amoxicillin 500 mg tid for 5 days and paracetamol tid for 3 days.\nPatient was recalled after 1 week for suture removal and after 1 month for re-evaluation []. 3 months post-surgery, the patient was referred to the Department of Conservative Dentistry and Endodontics for the fabrication of the crowns [].