Surgical template for crown lengthening: A clinical report.

one of the most commonly used procedures in contemporary periodontics. Indications include: (1) lack of sufficient length of a clinical crown to ensure a tooth preparation for fixed prosthodontics with retentive and resistance form; (2) preexisting dental caries or restorations in the vicinity of the free gingival margins that prevent preparation of finish lines for restorative margins coronal to the biologic width; (3) the need to develop a ferrule for pulpless teeth restored with posts 1,2 ; and (4) unesthetic gingival architecture as a result of altered passive eruption. 3 The classic research by Gargiulo et al 4 in 1961 defined the " dento-gingival junction " as 3 distinct components: gingival sulcus, junctional epithelium, and connective tissue attachment. The dentogingival junction was later redescribed as the " biologic width " by Cohen as the sum of junctional epithelium and connective tissue attachment. 5 This biologic width averaged 2.04 mm, whereas the mean sulcular depth was 0.69 mm. Despite the inordinate standard deviation and the limited sample size in the study by Gargiulo et al, 4 these numbers have been used as guidelines for decades in clinical practice to determine the extent of bone resection necessary to establish a biologic width. The soft tissue coronal to the osseous crest includes the biologic width and free-gingival margin and has been described as the " dentogingival complex " by Kois 6 and the " supracrestal gingival tissue " by Smukler and Chaibi. 7 Recent reports have indicated that there is considerable intraindividual and interindividual variability to the supracrestal gingival tissue. 8 Therefore, the supracrestal gingival tissue must be estimated for each patient and at each surgical site when surgically recontouring the alveolar bone. Preoperative " sounding " of the alveolar crest at a surgical site should be accomplished to estimate the osseous contour and supracrestal dimension of the gingival tissue (Fig. 1). Nevertheless, it may be difficult to apply the information that was gathered preoperatively during the surgical intervention. Bragger et al 9 reported a gingi-val margin at the original preoperative level for 20% of the teeth in their study that had received surgical crown lengthening, and 2.5% were more coronal to the baseline. This finding was probably the result of inadequate bone recontouring and lent credence to the need for more definitive guides for the periodon-tist when performing crown-lengthening procedures. 10 The dentist will usually prepare the finish lines of the tooth …