Dentaltown January 2023 - 61
* Why not do crown lengthening? I am totally
into minimally invasive approaches, and crown
lengthening is a bit invasive and may affect the
cosmetic view. Certainly, it is appropriate in the
posterior, and I have done it there for more ferrule
effect; however, in doing crown lengthening, one
must consider the bone anatomy of the adjacent
teeth. Also, critically, one cannot invade the biologic
width-noted to be, on average, 3 mm. I have
seen several incoming patients who had chronic
inflammation where the margin of the crown was
placed too close to the bone, invading the biologic
width. These are the cases that should have had
eruption as described in this article. (In fact, erupting
biologic width crown invasion can be corrected by
forced eruption.)
* Up to this point, I have not mentioned a removable
appliance technique. Yes, it is possible to erupt with
an Invisalign-type appliance or a retainer, but the
expense, time and predictability is, in my hands,
not worth the effort.
Summary
Restoring fractured or severely decayed anterior or bicuspid
teeth for a long-lasting predictable outcome can be
compromised by how much tooth structure is left beyond
the gingival margin to get a well-retained crown to stay in
place indefinitely.
Of the choices to retain the root, supereruption is the
least invasive technique to overcome the issue for sufficient
retention of a crown. The technique is straightforward and
accepted by most patients, and the outcomes are valued by
patients. n
Fig. 20
Fig. 17
Fig. 18
Fig. 19
When Not To Attempt Forced Eruption
* The root or leftover tooth is too damaged,
especially with decay up into the root area.
(Even this is a bit subjective.)
* The patient refuses to wear orthodontic
brackets.
* The patient has an implant, likes it and
wants another.
* The prognosis is too questionable for
any " sure " outcome.
* The patient can't afford procedures,
and wants no treatment or a temporary
partial.
* The patient wants an outcome ASAP-
so, an extraction with bridge prepped
the same day and temporized.
* The root is too short, or split.
* The root/crown break is above the
bone line.
I would always recommend an implant over a bridge where two virgin teeth would need to be
prepped. However, if the cosmetics could be vastly improved with a bridge, I do consider that.
dentaltown.com \\ JANUARY 2023 59
http://www.dentaltown.com
Dentaltown January 2023
Table of Contents for the Digital Edition of Dentaltown January 2023
Dentaltown January 2023 - Intro
Dentaltown January 2023 - Cover1
Dentaltown January 2023 - Cover2
Dentaltown January 2023 - 1
Dentaltown January 2023 - 2
Dentaltown January 2023 - 3
Dentaltown January 2023 - 4
Dentaltown January 2023 - 5
Dentaltown January 2023 - 6
Dentaltown January 2023 - 7
Dentaltown January 2023 - 8
Dentaltown January 2023 - 9
Dentaltown January 2023 - 10
Dentaltown January 2023 - 11
Dentaltown January 2023 - 12
Dentaltown January 2023 - 13
Dentaltown January 2023 - 14
Dentaltown January 2023 - 15
Dentaltown January 2023 - 16
Dentaltown January 2023 - 17
Dentaltown January 2023 - 18
Dentaltown January 2023 - 19
Dentaltown January 2023 - 20
Dentaltown January 2023 - 21
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Dentaltown January 2023 - 24
Dentaltown January 2023 - 25
Dentaltown January 2023 - 26
Dentaltown January 2023 - 27
Dentaltown January 2023 - 28
Dentaltown January 2023 - 29
Dentaltown January 2023 - 30
Dentaltown January 2023 - 31
Dentaltown January 2023 - 32
Dentaltown January 2023 - 33
Dentaltown January 2023 - 34
Dentaltown January 2023 - 35
Dentaltown January 2023 - 36
Dentaltown January 2023 - 37
Dentaltown January 2023 - 38
Dentaltown January 2023 - 39
Dentaltown January 2023 - 40
Dentaltown January 2023 - 41
Dentaltown January 2023 - 42
Dentaltown January 2023 - 43
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Dentaltown January 2023 - 47
Dentaltown January 2023 - 48
Dentaltown January 2023 - 49
Dentaltown January 2023 - 50
Dentaltown January 2023 - 51
Dentaltown January 2023 - 52
Dentaltown January 2023 - 53
Dentaltown January 2023 - 54
Dentaltown January 2023 - 55
Dentaltown January 2023 - 56
Dentaltown January 2023 - 57
Dentaltown January 2023 - 58
Dentaltown January 2023 - 59
Dentaltown January 2023 - 60
Dentaltown January 2023 - 61
Dentaltown January 2023 - 62
Dentaltown January 2023 - 63
Dentaltown January 2023 - 64
Dentaltown January 2023 - 65
Dentaltown January 2023 - 66
Dentaltown January 2023 - Cover3
Dentaltown January 2023 - Cover4
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