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Esthetic Crown Lengthening with Flapless Osseous Reduction using Abrasive Bur: A New Innovative Approach

RM Norman Tri Kusumo Indro and Leonard C Nelwan

Introduction: A smile design were evaluation and analysis of both facial and dental composition. Facial driven principle like basic shape of face, incisal edge position, tooth components and gingival levels were key factor to achieving pleasing smile. In crown lengthening with open flap procedure, black triangle was the most common complication. But in some indications, it is possible to do osseous reduction in flapless approach.
Objectives: Facial driven measurement protocol and flapless osteotomy in crown lengthening will result more predictable and less risk of black triangle. This new approach provide more user friendly for clinician.
Case management: Patient come in a private practice clinic for smile esthetic complain. Face profile were long straight, insisal edge position on smiling showing more than 2.0 mm gingival expose, F and V test were added to determine labiolingual position. Teeth’s proportion and gingival level using Chu guiding system. Sulcus and bone sounding were measured. Gummy smile and osseous reduction crown lengthening was indicated. Flapless osteotomy procedure performs to prevent black triangle. This approach where gently elevate marginal gingival through alveolar crest with gingival retractor after gingivoplasty without interfere its papilla and then perform osteotomy using small round bur until reach ideal dento-gingival complex.
Conclusion: Among the benefits of this protocol were more accurate, low morbidity with no sutures, less bleeding and greater patient acceptance. The outcomes are fair result. Flapless osteotomy in Esthethic crown lengthening is one alternative minimally invasive approach which, when indicated, offers realistic clinical benefits to patients.