Altered Passive Eruption of Teeth Clinical Trial
Official title:
The Effect of Using Two Different Suturing Techniques on Free Gingival Marginal Stability After Esthetic Crown Lengthening for Treatment of Gummy Smile (Randomized Clinical Trial)
Gummy smile is one of the major esthetic problems nowadays; it is due to several causes that
either dental or skeletal. Etiology of the gummy smile is altered passive eruption, vertical
maxillary excess, different gingival enlargement conditions, deficient maxillary lip length
and excessive maxillary lip mobility, dento alveolar extrusion, combination of all these
factors.
Altered passive eruption is considered to be one of the most major causes, it is classified
into two types according to the location of the mucogingival junction with respect to the
bone crest and each type has two subtypes . Esthetic crown lengthening is the treatment of
choice for subtype B in both types as bone removal is mandatory to create a space for the
biological width.
Most of the studies stated that there is some degree of relapse of the gingival tissues after
the procedures in the follow ups, that relapse was related to the biotype of the gingival
tissues, the flap placement close or far from the bone can be correlated to the suturing
technique used for closure of the tissues.
In the investigator's study comparing of two different suturing technique was done to
evaluated their effect on gingival tissue relapse, 30 patients (26 females and 4 males) were
divided between 2 groups each group consisted of 15 patients. In the first group periosteal
suturing technique was done in the second figure of eight (modified interrupted) suturing
technique was.
Evaluation of the tissue relapse was done through the assessment of the amount of the
attached gingival tissues level of gingival margin and marginal tissue contour before and
after the surgery.
The results of the study showed that tissue relapse was more in the periosteal suturing
technique group that was related to the pressure on the tissues due to the fixation of the
suture at the periostium, the papillary tissue also showed more inflammation in the follow up
period prior to suture removal. The figure of eight group showed less relapse and tissue
inflammation as it prevents flap edge overlap and is tension free therefore better blood
supply to the tissue.
Patients were generally satisfied post-surgical with their smile, gingival tissue visibility
and teeth dimensions inspite of the relapse but it was better than prior to surgery. Also
they would recommend it to other patients complaining from the same problem.
Thirty patients (26 females, 4 males), who were candidates for esthetic crown lengthening,
participated in this prospective clinical trial.
Group 1 (15 patients) (Periosteal suture) :
Esthetic crown lengthening procedure: internal bevel, sulcular and interdental incisions,
flap elevation, bone removal then External vertical mattress suture was done (periosteal
suture).
Group 2 (15 patients) (Figure of eight suture) :
Esthetic crown lengthening procedure: internal bevel, sulcular and interdental incisions,
flap elevation, bone removal then modified interrupted suture was done (Figure of eight
suture).
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