Dentaltown January 2022 - 24

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davidpalmer
Member Since: 04/14/00
Post: 30 of 90
I can think of a few reasons.
1. It's quite painful to the patient. I had CL done one time for #15 and it hurt like hell. Much
more than I expected. If you haven't had it done on you, it's easy to think it's no big deal.
2. It adds a signifi cantly higher cost to the crown procedure, which can put a fi nancial barrier
on your patient as well.
3. We have great cements and adhesives now. Combine that with carefully prepped nearparallel
walls and CL becomes optional for almost every crown.
For what it's worth, I've only done a handful in 34 years now. Mainly in aesthetic areas
before veneers. I let the periodontist get me to the right starting place, especially on the highlip-line
(gummy smile) cases. ■
5/10/2021
eschoud2
Member Since: 07/25/03
Post: 31 of 90
I agree about the costs. As the years go by I am doing less and less crown lengthening.
Usually when the patient is faced with the cost of RCT/CCL/BU/CRN in relation to long-term
prognosis, the discussion turns toward ext/implant.
Early diagnosis is the key. With proper surgical/restorative techniques combined with adequate
home care, we can make the teeth last a very long time. (I jokingly tell the patient, " I just
need it to last one day longer than you. " ) The worst is when the RCT is already done, crown
has been delivered and the patient has been coming back with complaints of sore and bleeding
gums and you can clearly see that BWI occurred. Not fun to tell the patient that in order to get
the gums healthier, I will have to remove so much bone that the furcation will be exposed and/
or the tooth will now be mobile. ■
5/10/2021
dkdocterry
Member Since: 09/17/07
Post: 82 of 90
Late to this party, but years ago (35-plus) I placed many margins near the bone just to save
the patient's tooth because I could always extract it if there was a problem later. But like many
previous comments it really was not an issue. Patients with poor hygiene certainly had " puffy
gums " around these deep restorations, but with good hygiene it looks healthy. Bone remodels as
well as the gingiva, in my opinion, and that is what I have seen over the years.
Many of my patients had all they could do to afford the restorations so I did not want to add
extra charges for something I was not seeing they might need. They told us a lot of untruths in
dental school, probably because many were not wet-fi ngered dentists and still believed what they
were taught. Takes a few years to unlearn some of what we were taught! Just my two cents. ■
5/22/2021
DDS'06
Member Since: 02/07/14
Posts: 83 and 84 of 90
CL is absolutely needed in some cases. I write specifi c instructions to my periodontist. I do
my crown prep fi rst and put my crown margins where I need to and put a temporary crown on
tooth. So my periodontist knows where my margins are going to be. He then opens fl ap and
reduces bone 3-4 mm as needed so there is enough space for biological width and at least 1 mm
sulcus. Patient stays in temporary crown for healing period. We bring patient back in four to six
weeks, remove the temporary crown, refi ne the prep and take fi nal impression. That's CL for me.
Never heard of closed CL and that can't be done. If you are doing closed CL, that means you
are traumatizing the tissue and doing guesswork. Body will go through phases of infl ammation
and bone loss and infl ammation establish biological width eventually. Patient will suffer. Do it
in a more predictable way.
Also if you put a crown margin close to bone in a patient with gingival infl ammation everywhere,
that patient might not notice that because it's just another tooth for them. But if you
violate BW in a patient with absolutely healthy gingival everywhere else, those folks will come
back with issues. But again, those patients probably won't let things go that far. ■
5/22/2021
24 JANUARY 2022 // dentaltown.com

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Dentaltown January 2022

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