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J Periodontol • July 2001

Surgical Crown Lengthening: A 12-Month

Clinical Wound Healing Study
Roberto Pontoriero* and Gianfranco Carnevale†

Background: Surgical crown lengthening has been proposed as a means of facilitating restorative proce-
dures and preventing periodontal injuries in teeth with structurally inadequate clinical crowns or exposing tooth
structure in the presence of deep, subgingival pathologies which may hamper the access for proper restora-
tive measures. The few clinical studies in the current literature on postsurgical soft tissue modifications after
crown lengthening procedures report conflicting results. The present study was designed to assess the alter-
ations of the marginal periodontal tissues as an immediate outcome of surgical crown lengthening and over
a 12-month healing period.
Methods: The patient sample included 30 patients (84 teeth) who presented with various conditions ham-
pering proper restorative measures in one or more teeth and, therefore, requiring surgical exposure of tooth
substance. After initial supportive therapy, the patients were recalled for a baseline examination, and the fol-
lowing parameters were evaluated at interproximal and buccal/lingual sites of each experimental tooth: plaque
index, gingival index, position of the gingival margin, probing depth, and attachment level. After baseline
examination, the patients underwent apically positioned flap surgery with osseous and connective tissue attach-
ment resection. During surgery, the amount of resection and the achieved lengthening of the clinical crown
were evaluated. The patients were enrolled in a maintenance program including professional tooth cleaning
every 2 to 4 weeks. The patients were reexamined 1, 3, 6, 9, and 12 months postoperatively.
Results: 1) Immediately after surgery, a significantly (P <0.001) increased clinical crown length of 3.7 ±
0.8 mm (mean) at interproximal and 4.1 ± 0.9 mm (mean) at buccal/lingual sites was achieved; 2) healing
resulted in a statistically significant coronal displacement of the gingival margin of 3.2 ± 0.8 mm at inter-
proximal (P <0.001) and 2.9 ± 0.6 mm at buccal/lingual (P <0.002) sites; and 3) as a consequence of this
postsurgical soft tissue regrowth, the amount of the available tooth structure immediately after surgery decreased
to 0.5 ± 0.6 mm at interproximal sites (P <0.0015) and to 1.2 ± 0.7 mm at buccal/lingual sites (P <0.001) at
the 12-month examination.
Conclusions: The results of the present clinical investigation demonstrated that during a 1-year period of
healing following surgical crown lengthening, the marginal periodontal tissue showed a tendency to grow in a
coronal direction from the level defined at surgery. This pattern of coronal displacement of the gingival mar-
gin was more pronounced (P <0.001) in patients with “thick” tissue biotype and also appeared to be influ-
enced by individual variations in the healing response (P <0.001) not related to age or gender. J Periodontol
2001;72:841-848.
KEY WORDS
Crowns; dental restorations, permanent; dental prosthesis design; gingiva/surgery.

* Private practice, Milan, Italy.

† Private practice, Rome, Italy

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S
uccessful restorative treatment of teeth usually The reason for these different results may be related
requires preparation of well-defined restoration to several factors, including surgical skill and healing
margins easily accessible for conservative mea- time. Moreover, other factors such as patient age and
sures and impression taking, correct fitting of pros- tissue biotype may influence the extent and duration
thetic crowns, and adequate plaque control. There are of periodontal tissue alterations during the wound heal-
clinical situations, however, when these requirements ing process.
cannot be fulfilled. The present clinical study was designed to assess
In fact, the presence of a carious lesion, endodontic alterations in the periodontal tissue levels as an imme-
perforation, crown-root fracture, or preexisting margins diate result of surgical crown lengthening and over a
of failing restorations in a deep subgingival location 1-year healing period.
may hamper access for proper restorative measures. In
addition, due to destructive caries, altered passive erup- MATERIALS AND METHODS
tion, or pathologic wear, the supragingival available The clinical study included 30 patients, 19 to 62 years
tooth structure may not be sufficient to permit adequate of age (mean age, 40.5), selected on the basis of var-
retention of the reconstruction. Furthermore, an increase ious conditions hampering proper restorative measures
in clinical crown length may be required to correct gin- on one or more teeth and requiring surgical exposure.
gival margin asymmetries for esthetic reasons. Indications for surgical crown lengthening included: 1)
In such instances when attempts are made to obtain gain of retention in teeth with insufficient amount of
access or retention by extending preparations too deep supragingival dental structure for prosthetic recon-
subgingivally, a periodontal lesion characterized by struction; 2) accessibility to deep, subgingivally located
gingival inflammation, loss of attachment, and alveo- lesions or preexisting faulty preparation margins for
lar bone resorption will result.1-3 restorative treatment; and 3) correction of gingival tis-
In order to facilitate restorative procedures and to sue asymmetries present in the anterior segments of
prevent periodontal injuries in teeth with structurally the dentition for esthetic reasons.
inadequate clinical crowns, the apically positioned flap The treatment plan called for the tooth and at least
technique with osseous resection has been recom- 2 adjacent teeth (if present) to undergo surgical length-
mended.4-6 ening; the study population provided 84 teeth.
Several authors have suggested surgically remov- After an initial examination and treatment planning
ing the periodontal support to an extent, leaving a dis- session, each patient received detailed instruction in
tance from the level of the planned reconstruction mar- proper self-performed plaque control measures9 and
gin to the level of the newly recontoured osseous crest underwent full-mouth scaling/root planing and
of 3 mm,4 2.5 to 3.5 mm,5 and 4 mm6 in the exposed removal of marginal irritants. After 1 to 2 months of
tooth. plaque control supervision, the patients were recalled
These amounts of dental structure exposure were for a baseline examination. At the baseline examina-
considered adequate to accommodate a new gingival tion, the following parameters were recorded for each
unit formed by the regrowth of the supracrestal soft tis- experimental tooth at 4 sites (center mesial, center
sues, which will proliferate coronally during healing distal, midbuccal, and midlingual): 1) plaque index
and yet leave sufficient supragingival tooth substance (PI);10 2) gingival index (GI);11 3) position of the gin-
to complete the restorative procedures. gival margin (GM), determined by assessing the dis-
In these reports, however, sufficient information was tance between a fixed reference point (cemento-
not provided regarding the dimension of the postsur- enamel junction, preparation line, occlusal surface)
gical soft tissue modifications or the amount of time and the gingival margin with a calibrated periodon-
necessary to achieve the complete healing of the peri- tal probe (diameter = 0.5 mm); 4) probing depth (PD),
odontal tissues and, therefore, the stability of the soft measured from the gingival margin using the peri-
tissue levels. odontal probe and recorded to the nearest 1 mm; and
The few clinical studies on periodontal tissue alter- 5) clinical attachment level (CAL), calculated as the
ations which occur during healing after surgical crown sum of the PD and the position of the gingival mar-
lengthening reported conflicting results.7,8 van der gin.
Velden observed, 3 years after surgery, a considerable In order to standardize the location of the probe dur-
amount of coronal regrowth of the interproximal gin- ing measurements, round notches or vertical grooves
gival tissue from the level where the osseous crest was were prepared in the tooth/root as reference points.
located after surgery.7 On the contrary, Bragger et al. The patient’s tissue biotype12 was assessed and
found, over a 6-month healing period after surgical recorded as normal, thin, or thick. Following the base-
crown lengthening, stable periodontal tissues, with min- line examination, patients underwent apically posi-
imal changes in the gingival margin levels from surgery tioned flap surgery with osseous resection and recon-
to the end of the study.8 touring.4,6

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J Periodontol • July 2001 Pontoriero, Carnevale

Surgical Procedure Table 1.

Partial-thickness flaps were raised at the buccal and
lingual aspects of the alveolar process of the experi- Baseline Examination at Interproximal and
mental teeth. After secondary flap or supracrestal soft Buccal/Lingual Sites; Distances Between the
tissue removal, ostectomy and osteoplasty were per- Reference Point and Gingival Margin (GM),
formed by using hand chisels and rotating diamond Between the Reference Point and Alveolar
burs. Following osseous recontouring, in order to Crest Before (AC before) and After (AC after)
remove any possible remnant of connective tissue
Resection as Well as Between the Reference
attachment coronal to the alveolar crest, the exposed
root surfaces were carefully planed with sharp curets Point and Flap Margin (FM) After Suturing
or rotating flame-shaped finishing burs. The complete
removal of remaining root cementum with inserting Interproximal Buccal/Lingual
collagen fibers was performed to prevent reattachment GM 1.1 ± 1.6 1.6 ± 2.5
of the surgically separated fibers in an undesired coro-
nal position.2,8,13-16 AC before 3.9 ± 1.8 4.7 ± 2.3
(P <0.001) (P <0.001)
The buccal and lingual flaps were subsequently AC after 4.8 ± 1.7 5.7 ± 2.4
adjusted, attempts were made to position them at or
below the level of the alveolar crest, and they were FM 6.9 ± 1.0 5.8 ± 2.2
stabilized with periosteal anchored sutures, which Difference
resulted in a complete exposure of the interdental alve- AC after-GM 3.7 ± 0.8 (P <0.001) 4.1 ± 0.9 (P <0.001)
olar bone crest.
Mean values in mm ± standard deviation.
To evaluate the changes in the osseous and peri-
odontal tissue levels obtained at surgery, the following
linear measurements were recorded during the sur- statistically significant difference between the 2 indi-
gical procedure on each experimental tooth: 1) the vidual values. Repeated measurements ANOVA was
distance in an apico-coronal direction between the performed for probing depth and attachment level at
fixed reference point and the alveolar crest before baseline and at the end of the study, and the differences
ostectomy (AC before); 2) the distance in an apico- were analyzed for the effects of between-patient char-
coronal direction between the fixed reference point acteristics (age, gender, tissue biotype) by means of
and the alveolar crest after ostectomy (AC after); and a backward stepwise ANOVA scheme, using type III
3) the distance in an apico-coronal direction between sums of squares, separately for interproximal and buc-
the fixed reference point and the margin of the sutured cal/lingual measurements. The analyses for the dis-
flap. These parameters were recorded at the same 4 tance between the reference point and the gingival
sites used at the baseline examination. margin were similar but also included within-patient
Following the surgical procedure, a periodontal characteristics (amount of alveolar bone removed dur-
dressing‡ was applied. The periodontal dressing and ing surgery dichotomized as 0 to 0.5 and >0.5; and flap
sutures were removed 10 days after surgery and a margin position categorized as <0, 0, >0).
plaque control regimen was reinstituted. The least significant difference test was applied when
the appropriate F was significant to test for significant
Maintenance
differences between groups. For all analyses, the level
During the 12-month healing period, patients were
of significance was set at 0.05.
maintained on a plaque control program which
included professional tooth cleaning every second week RESULTS
for the initial 3 months and every fourth week for the At the baseline examination, the mean distance
remaining 9 months. between the reference point and the gingival margin
measured at interproximal sites was 1.1 ± 1.6 mm,
Reexamination
and the corresponding distance measured at buc-
Patients were reexamined at 30, 90, 180, 270, and
cal/lingual sites was 1.6 ± 2.5 mm (Table 1).
360 days after surgery. Periodontal tissue modifica-
tions were studied by assessing the same parameters Surgical Phase
recorded at the baseline examination. During surgery, after flap elevation and secondary flap
or supracrestal soft tissue removal, the mean distance
Statistical Analysis between the reference point and the level of the alve-
The data were analyzed by means of analysis of vari- olar crest was 3.9 ± 1.8 mm at interproximal and 4.7
ance (ANOVA), separately for interproximal and buc- ± 2.3 mm at buccal/lingual sites.
cal/lingual measurements. Buccal and lingual mea-
surements were combined in the absence of a ‡ Coe-Pak, GC America Inc., Alsip, IL.

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Surgical Crown Lengthening Volume 72 • Number 7

After osseous resection, the alveolar crest level was ments remained substantially stable throughout the
located at a distance from the reference point of 4.8 study.
± 1.7 mm at interproximal and 5.7 ± 2.4 mm at buc- Probing depth. The mean PD values recorded at the
cal/lingual sites. baseline examination varied between 2.7 ± 0.9 mm at
The mean reduction of the crestal alveolar bone was interproximal and 1.4 ± 0.3 mm at buccal/lingual sites.
0.9 mm at interproximal sites and 1.0 mm at buc- At the 12-month final examination, the mean PD was
cal/lingual sites. At 43 interproximal (52%) and 43 2.8 ± 0.7 mm at interproximal and 1.3 ± 0.4 mm at
buccal/lingual sites (52%), the amount of crestal bone buccal/lingual sites. There was no statistically signifi-
removal varied between 1 to 1.5 mm; at 31 inter- cant difference between the PD values obtained at
proximal (36%) and 27 buccal/lingual sites (32%), it
amounted to 0.5 mm; and at 7 buccal/lingual sites
Table 2.
(8%), it ranged between 2 to 2.5 mm. At 10 inter-
proximal (12%) and 7 buccal/lingual sites (8%), no Number of Sites and Changes in Osseous
changes in the osseous crest level were observed Crest Level
(Table 2). The positions of the flap margin after sutur-
ing are reported in Table 1. The mean distances Interproximal Buccal/Lingual
between the reference point and the flap margin mea-
sured at buccal/lingual sites (5.8 mm) were similar to Change (mm) N (84) % N (84) %
the distance between the reference point and the alve- 0 10 12% 7 8%
olar crest obtained after resection at corresponding
sites, demonstrating that the position of the flap mar- –0.5 31 36% 27 32%
gin was in coincidence with the osseous crest. –1 33 40% 26 31%
At interproximal sites, the distance measured
between the reference point and the flap margin (6.9 –1.5 10 12% 17 21%
mm) was greater than the distance between the ref- –2 0 0% 5 6%
erence point and the interproximal alveolar crest after
resection (4.8 mm), reflecting a complete interdental –2.5 0 0% 2 2%
osseous denudation.
At the completion of the surgical proce-
dure, the mean distance between the refer-
ence point and the osseous crest/flap mar-
gin changed from the baseline values
(reference point, gingival margin) of 1.1 ±
1.6 mm to 4.8 ± 1.7 mm at interproximal
sites and from 1.6 ± 2.5 mm to 5.7 ± 2.4
mm at buccal/lingual sites. These changes
were statistically significant (P <0.001). Thus,
the surgical procedure resulted in an apical Figure 1.
displacement of the marginal tissues and in Interproximal osseous reduction and crown lengthening during the surgical phase
a significant (P <0.001) increased mean clin- (mean values in mm) ( : reference point).
ical crown length of 3.7 ± 0.8 mm at inter-
proximal and 4.1 ± 0.9 mm at buccal/lin-
gual sites (Figs. 1 and 2).

Healing Phase
Plaque and gingival indices. The mean PI
and GI scores calculated from measurements
made at baseline, and at the 1-, 3-, 6-, 9-
and 12-month examinations as well as a sta-
tistical analysis of the values are presented
in Tables 3 and 4, respectively. At baseline,
the mean PI values were 0.4 at interproximal
and 0.3 at buccal/lingual sites; at the 12-
month observation period, no statistically Figure 2.
Buccal/lingual osseous reduction and crown lengthening during the surgical phase
significant differences were present at any (mean values in mm) ( : reference point).
examination interval. Similarly, GI measure-

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J Periodontol • July 2001 Pontoriero, Carnevale

Table 3. Table 5.
Plaque Index Scores at Baseline and at 1-, Probing Depth Scores at Baseline and at 1-,
3-, 6-, 9-, and 12-Month Examination 3-, 6-, 9-, and 12-Month Examination
(mean values  SD) (mean values in mm  SD)

Examination Interproximal Buccal/Lingual Examination Interproximal Buccal/Lingual

Baseline 0.4 ± 0.3 0.3 ± 0.2 Baseline 2.7 ± 0.9 1.4 ± 0.3

1 month 0.2 ± 0.3 0.3 ± 0.4 1 month 1.6 ± 0.6 0.9 ± 0.4

3 months 0.3 ± 0.5 0.2 ± 0.4 3 months 2.1 ± 0.7 1.1 ± 0.3

6 months 0.5 ± 0.4 0.3 ± 0.2 6 months 2.4 ± 1.0 1.2 ± 0.5

9 months 0.4 ± 0.3 0.2 ± 0.1 9 months 2.6 ± 0.9 1.2 ± 0.8

12 months 0.5 ± 0.2 0.3 ± 0.1 12 months 2.8 ± 0.7 1.3 ± 0.4

Table 4. Table 6.
Gingival Index Scores at Baseline and at 1-, Clinical Attachment Level Scores at
3-, 6-, 9-, and 12-Month Examination Baseline, After Surgery, and at 1-, 3-, 6-,
(mean values  SD) 9-, and 12-Month Examination (mean
values in mm  SD)
Examination Interproximal Buccal/Lingual

Baseline 0.8 ± 0.4 0.5 ± 0.4 Examination Interproximal Buccal/Lingual

1 month 0.7 ± 0.6 0.5 ± 0.4 Baseline 3.8 ± 1.6 3.0 ± 2.6

3 months 0.8 ± 0.7 0.4 ± 0.2 After surgery 4.8 ± 1.7 5.7 ± 2.4

6 months 0.6 ± 0.4 0.3 ± 0.3 1 month 4.3 ± 1.0 5.0 ± 2.1

9 months 0.8 ± 0.6 0.4 ± 0.2 3 months 4.6 ± 1.5 4.7 ± 2.0

12 months 0.7 ± 0.3 0.4 ± 0.4 6 months 4.3 ± 1.4 4.4 ± 2.5

9 months 4.4 ± 1.6 4.2 ± 2.3

baseline and those recorded at the final examination
(Table 5). 12 months 4.4 ± 1.5 4.1 ± 2.6
Clinical attachment level (CAL). CAL measurements Difference –0.6 ± 0.7 –1.1 ± 0.9
recorded at baseline and at the final examination are (baseline- (P <0.0015) (P <0.001)
presented in Table 6. Resective treatment resulted in 12 months)
a reduction at interproximal as well as buccal/lingual
sites. At the interproximal sites, the mean CAL reduc-
tion amounted to 0.6 ± 0.7 mm, while at the buc- month final examination, the gingival margin was
cal/lingual sites, the CAL shifted on average 1.1 ± 0.9 located a distance of 1.6 mm at interproximal and 2.8
mm in the apical direction. This difference was statis- mm at buccal/lingual sites from the reference point.
tically significant at both interproximal (P <0.0015) Therefore, the mean crown length difference
and buccal/lingual sites (P <0.001). between baseline and final examination was 0.5 mm
Position of the gingival margin. During the 12- at interproximal (P <0.0015) and 1.2 mm at buccal/lin-
month observation period, the location of the gingival gual (P <0.001) sites. This reduction from postsurgery
margin underwent significant alterations from the imme- to the final examination indicates that during healing,
diate postsurgical level (Table 7). In fact, the mean a displacement of the newly formed soft tissue mar-
distance between the reference point and the gingival gin in a coronal direction from the postsurgical level
margin which, at baseline, was 1.1 mm at interproxi- had occurred (Figs. 3 and 4).
mal sites and 1.6 mm at buccal/lingual sites and after In fact, the values calculated from measurements
surgery changed to (reference point/osseous crest) obtained after 12 months of healing showed that the
4.8 mm and 5.7 mm, respectively, remarkably position of the gingival margin was 3.2 ± 0.8 mm at
decreased during the course of healing. At the 12- interproximal and 2.9 ± 0.6 mm at buccal/lingual sites

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Surgical Crown Lengthening Volume 72 • Number 7

Table 7.
Mean Distance Between the Reference Point
and Gingival Margin at Baseline, After
Surgery, and at 1-, 3-, 6-, 9-, and 12-Month
Examination (mean values in mm  SD)

Examination Interproximal Buccal/Lingual

Baseline 1.1 ± 1.6 1.6 ± 2.5

After surgery 4.8 ± 1.7 5.7 ± 2.4

1 month 2.7 ± 1.5 4.1 ± 2.3

3 months 2.3 ± 1.6 3.6 ± 2.5

Figure 4.
6 months 1.9 ± 1.6 3.2 ± 2.5 Buccal/lingual soft tissue regrowth from bone level during the 12-month
observation period (mean values).
9 months 1.8 ± 1.5 3.0 ± 2.4

12 months 1.6 ± 1.4 2.8 ± 2.6 Table 8.

Difference 0.5 ± 0.6 1.2 ± 0.7 Postsurgical Gingival Margin Regrowth at
(12 months- (P <0.0015) (P <0.001) 1-, 3-, 6-, 9-, and 12-Month Examination
baseline) (mean values in mm  SD)

Examination Interproximal Buccal/Lingual

1 month 2.1 ± 0.8 1.6 ± 0.6

3 months 2.5 ± 0.7 2.1 ± 0.5

6 months 2.9 ± 0.6 (P <0.001) 2.5 ± 0.4 (P <0.002)

9 months 3.0 ± 0.5 2.7 ± 0.6

12 months 3.2 ± 0.8 2.9 ± 0.6

not related to age or gender and by the different tissue

biotype. In fact, the coronal regrowth of the soft tissue
margin at interproximal and buccal/lingual sites was
significantly more pronounced (P <0.001) in patients
with thick tissue biotype as compared to that recorded
Figure 3.
Interproximal soft tissue regrowth from bone level during the 12-month in patients with thin tissue biotype (Table 9).
observation period (mean values). DISCUSSION
The results of the present clinical investigation demon-
coronal to the level where the osseous crest and the strated that, during a 1-year healing period following
flap margin, respectively, were located immediately apically positioned flap surgery and osseous resec-
after surgery (Table 8). This postsurgical coronal dis- tion, the marginal periodontal tissue showed a distinct
placement of the soft tissue margin was statistically tendency to grow in a coronal direction from the level
significant at both interproximal (P <0.001) and buc- defined at surgery. At the end of the study, the gingi-
cal/lingual sites (P <0.002). val margin was 3.2 mm (interproximal) and 2.9 mm
A closer analysis of the data revealed that the pat- (buccal/lingual) coronally from where the osseous crest
tern of tissue regrowth which occurred during healing was located immediately following surgery. In other
appeared to be affected, within patients, by the differ- words, the amount of the available crown length
ent amounts of crestal bone reduction performed dur- increased from the presurgical level of 0.5 mm at inter-
ing surgery (P <0.04). proximal and 1.2 mm at buccal/lingual sites. The post-
On the other hand, between patients, this coronal surgical soft tissue remodeling occurred in conjunc-
displacement of the gingival margin seemed to be influ- tion with positive clinical measurements, as shown by
enced by variations in the healing response (P <0.001) the low plaque and gingival index scores throughout

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J Periodontol • July 2001 Pontoriero, Carnevale

Table 9.
Gingival Margin Regrowth by Tissue Biotypes at the 1-, 3-, 6-, 9-, and 12-
Month Examination (mean values in mm  SD)

Interproximal Buccal/Lingual

Examination Normal (N = 41) Thick (N = 20) Thin (N = 23) Normal (N = 41) Thick (N = 20) Thin (N = 23)

1 month 2.1 ± 0.8 2.2 ± 0.6 2.0 ± 0.5 1.6 ± 0.5 1.7 ± 0.6 1.6 ± 0.3

3 months 2.6 ± 0.9 2.8 ± 0.5 2.2 ± 0.5 2.2 ± 0.5 2.3 ± 0.3 2.1 ± 0.5

6 months 2.9 ± 0.7 3.0 ± 0.5 2.6 ± 0.6 2.4 ± 0.4 2.7 ± 0.4 2.4 ± 0.6

9 months 3.0 ± 0.8 3.3 ± 0.4 2.7 ± 0.6 2.6 ± 0.5 2.9 ± 0.4 2.6 ± 0.6

12 months 3.1 ± 0.7 3.6 ± 0.5 2.8 ± 0.7 2.9 ± 0.8 3.1 ± 0.8 2.6 ± 0.4

P <0.001 P <0.001

the study. It was also observed that the PD values ent study where 1 year after treatment, the mean coro-
tended to return to the presurgical values, with no dif- nal displacement of the interproximal gingival margin
ference between the baseline (interproximal: 2.7 mm, was 3.2 mm, the mean interproximal PD was 2.8 mm,
buccal/lingual: 1.4 mm) and the final examination and the mean PI for the interproximal surfaces was
(interproximal: 2.8 mm, buccal/lingual: 1.3 mm). How- 0.5.
ever, a difference was found between the CAL mea- The results of the present study differ, however, con-
surements obtained at the completion of the study and siderably from those obtained by Bragger et al.8 where,
those recorded presurgically, revealing an expected during 6 months of healing after surgical crown length-
loss of clinical attachment (interproximal: 0.6 mm, ening, the mean changes in the periodontal tissue lev-
buccal/lingual: 1.1 mm). els from those defined after surgery were reported to
These findings may suggest a tendency of the peri- be minimal. In this study, the authors showed that, in
odontium to reform a new “physiological” supracrestal 43 teeth in 25 patients who underwent clinical crown
gingival unit. The regrowth of the soft tissue from the lengthening, the mean apical displacement of the gin-
level where the osseous crest was defined at surgery gival margin was 1.3 mm following surgery; that dur-
had already begun 1 month after surgery, when the ing healing, this value remained stable; and at the 6-
gingival margin reached about 60% of its final coronal month final examination, the soft tissue margin was
position at interproximal sites and about 40% at buc- almost identical (1.4 mm) to that recorded immediately
cal/lingual sites. after surgery.
The factors influencing the amount of coronal dis- Furthermore, the mean probing depth values in the
placement of the marginal periodontal tissue seemed Bragger et al. report were somewhat deeper 6 months
to be related to the different tissue biotypes, since after surgery (2.2 mm) as compared with those
patients with thick tissue biotype demonstrated sig- recorded before surgery (1.9 mm).
nificantly more coronal soft tissue regrowth than The reason for these opposite patterns of marginal
patients with thin tissue biotype and to the natural bio- periodontal tissue alteration after surgical crown length-
logical differences in interindividual patterns of heal- ening may be due to differences in the interpretation
ing response. and/or execution of the surgical technique, which is
Few studies on surgical crown lengthening in the assumed to be an apically positioned flap with osseous
current literature report results on the location of the resection. In fact, this unusual soft tissue healing after
gingival margin after treatment in relation to the level surgical resective therapy might be related to the posi-
of the alveolar osseous crest defined during surgery.7,8 tion of the flap margin after suturing in relation to the
van der Velden7 investigated in 7 patients the posi- location of the alveolar crest. Bragger et al. reported
tion of the interproximal gingival margin 3 years fol- that, “the alveolar crest was reduced, thereby creating
lowing surgical denudation of the interdental alveolar a distance of 3 mm to the future reconstruction mar-
bone. The results showed that the location of the gin- gin.”8 This may imply, since the flap margin was at a
gival margin was found at a mean distance of 4.3 mm mean distance from the reference point of 1.3 mm,
coronally from where the bone level was defined at that the bone level after surgery was apically located
surgery; the mean PD was 2.2 mm; and the mean PI with respect to where the flap margin was sutured. As
was 0.8. These findings concur with those in the pres- a consequence, despite the apparent stability of the tis-

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Surgical Crown Lengthening Volume 72 • Number 7

sue margins following surgery as expressed by the Omegan 1977;10:62-65.

mean values, 30% of the sites showed an increase in 5. Palomo F, Kopczyk RA. Rationale and methods for crown
lengthening. J Am Dent Assoc 1978;96:257-260.
the amount of gingival recession during the healing
6. Rosenberg ES, Garber DA, Evian CI. Tooth lengthening
period and 33% demonstrated a coronal regrowth of procedures. Compendium Continuing Educ Dent 1980;
the gingival margin. Alterations of the periodontal tis- 1:161-172.
sues similar to those found in the present report and 7. van der Velden U. Regeneration of the interdental soft tis-
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