Errors and complications following surgical crown lengthening

Abstract

Introduction: It is a common sense to the dental practitioners that surgical crown lengthening is a procedure that should be delivered to more than 30% of patients. Especially in the cases where the root reminiscences are still present but no ferrule effect can be achieved, this surgical procedure is highly indicated. Methods: All of the patients that were treated by means of surgical crown lengthening with a total number of 45 - were analyzed thoroughly before the procedure, at the time of procedure, and retrospectively 1 week, 3 weeks, 6 weeks, 8 weeks and 6 months after the surgical crown lengthening. During this period of analysis patients were examined for the main periodontal indexes, the level of keratinized gingiva, the sound tooth structure furthermore used as a component of the abutment, all of the issues presented by the patient after the procedure, as long as other parameters. Results: All of the patients presented minor to medium intensity of pain, only 2 patients presented violent ones. Pain was easily medicated by the use of antialgics and lasted no more than 3 days. 13 patients presented minor edema and one patient presented a hematoma. An error considered by us was the failure to leave the periostium intact to the surface of the bone, so that no apical displacement of the flap was achievable - this situation was present in 5 cases, all of them with highly scalloped and thin periodontium. One case presented the failure to achieve the presence of sound tooth structure so that the tooth could be restorable. No proper displacement of the flap was present in 2 cases, by that we mean the impossibility to cover the hole periostium so some of the tissues were left for healing as a secondary intention. At a period of time after the surgical crown lengthening the only major complication is the loss of keratinized attached gingiva. Conclusions: The major complication of the surgical crown lengthening is the loss of attached keratinized gingiva, a factor which may further be advocated as an extraction of the lengthened tooth. Another problem is the failure to leave the periostium intact, so no apical displacement is possible. We think that these issues are conditioned by the presence of the thin and scalloped gingiva. A more meticulous case selection is advocated for the dental practitioner.