a systematic review Presented by Dr Syeda Mahvash Hussain Resident Operative Dentistry Aga Khan University Hospital Karachi Contributors Drs Maham Muneeb Lone Sana Ehsen ID: 547685
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Amount of tooth substance gained by crown lengthening:a systematic review
Presented by: Dr. Syeda Mahvash HussainResident Operative Dentistry Aga Khan University Hospital Karachi Contributors: Drs. Maham Muneeb Lone, Sana Ehsen Supervised by: Dr. Farhan Raza Khan & Dr. Munawar RahmanSlide2
Biologic Width
TOOTH GINGIVA
Takei
, HH;
Azzi
, RR; Han, TJ: Preparation of the
Periodontium
for Restorative Dentistry. In Newman, MG; Takei, HH; Carranza, FA; editors: Carranza’s Clinical Periodontology, 9th Edition. Philadelphia: W.B. Saunders Company, 2002. page 945.
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Chronic inflammation and bleeding
Loss of alveolar bone because of restoration overhang
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Crown Lengthening
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Indications
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Methods Gingivectomy/ gingivoplastySurgical blade
Electro cauteryLasers
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Apical repositioning of flapWith osseous reductionWithout osseous reductionOrthodontic extrusion Combination
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ReviewThe most common technique for crown-lengthening surgery
is APF with osseous surgery Padbury Jr A, Eber R, Wang H-L. Interactions between the gingiva and the margin of restorations. J Clin Periodontol 2003; 30: 379–385
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Review QuestionAmount of tooth substance gained by crown lengthening
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PICO
Patient /population
:
Human, mature permanent teeth
Intervention:
Different methods of crown lengthening
Comparison of the intervention
:
Comparing the different methods
Outcome(s)
:
Amount of tooth structure gained
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Registration of ReviewRegistration No: CRD42014013266
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Search StrategyGoogle scholarPubMed(NLM)
CINAHL Plus (Ebsco) “Gingivectomy” or “Gingival cautery” or “Gingivoplasty” or “Gum resection” AND“Tooth gain” or “Tooth exposure” or “Crown lengthening” or “ Ferrule”12 Literature search
key termsSlide13
Study Selection Inclusion
Criteria: Exclusion Criteria: 13Studies-Human permanent mature teeth where
CLS
was done
Outcome
-Amount of tooth gained
Primary teeth
Immature permanent teeth Animal basedIn vitro studiesLanguages other than EnglishSlide14
First Electronic Search 412
Selection of relevant titles 273After excluding
No
Abstract
available
83
Abstracts available
190Techniques
only different outcome 33
Case reports 92
RCT/Clinical trials n=8
(321 teeth)
Reviews/guidelines
42
Trials not relevant to objective
10
Finally selected for this review
14
Duplicates
Not relevant to topic
Not in English
Animal based studies
Commentary 1
C.S survey 1
In-vitro 1
Retrospective 2 Slide15
Registration No
: CRD4201401326615DATA EXTRACTIONSlide16
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DATA EXTRACTIONSlide17
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Contribution of Data By Weight
19N.AYUBIAN n=20HERRERO n= 21HAN n= 27DINIZ n= 30
DEAS n= 43
BRAGGER n= 43
ARORA n= 53
PONTERIERO n= 84Slide20
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Indication For Crown Lengthening
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Follow up of CLS
Number of teeth Minimum(mm) Maximum(mm) Mean (mm)Std. DeviationAmount of tooth structure gained Initially with APF and bone reduction
300
1.32
4.00
2.46
1.03
Amount of tooth structure gained in 3 months with APF and bone reduction
1461.601.871.75
0.13
Amount of tooth structure gained in 6 months with APF and bone reduction
1961.001.80
1.49
0.32
Tooth Structure Gained By Crown Lengthening
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DISCUSSION
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AUTHOR
TITLE SEARCH STRATEGYSUMMARY
Hempton
T.J et al
2010
Contemporary crown lengthening therapy
A REVIEW
Pub med Google scholar
Methods of CLS
Sharma A et al2012
Short clinical crowns (SCC) –
treatment considerations and techniques A REVIEW
Pub med
Methods for CLS
The role of restoration margin location
Effects of violation of the
supracrestal
gingivae
AKUH
2014
Amount
of tooth substance gained with crown lengthening –
A SYSTEMATIC REVIEW
Pub med
Google scholar
CINAHL
plus (
Ebsco
)
Identified the characteristics
of the relevant studies:
Most commonly used method for CLS
Type of study
Amount of tooth substance gained
Year of Publication
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conclusions
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The number of clinical trials on CLS were limited n = 8 ( 321 teeth)The quality of the studies which report data on CL was mostly inadequate
APF with bone reduction was the most commonly used technique (7/8 studies) for CLSThe mean amount of tooth structure gained initially was 2.46mm which decreased to 1.49mm after 6months29Slide30
Strengths
and Limitations30Slide31
STRENGTHS The first ever Systematic review on this topic
LIMITATIONS Only three search engines were usedStudies lacked homogeneity in reporting the outcomeOnly experimental studies were included31Slide32
Explore more data through other search engines to expand existing researchMore clinical trials are needed to answer the research question32
recommendationsSlide33
Thank you!
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