Clinical Evaluation of Conventional Versus Microsurgical Techniques of Esthetic Crown Lengthening

Study Overview
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Brief Summary
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the study compare gingival margin stability following conventional approach versus microsurgical approach of esthetic crown lengthening in management of patients with short clinical crowns in the upper anterior region.In management of patients with short clinical crowns in the upper anterior region, there is no difference in gingival margin stability between conventional and microsurgical approaches of esthetic crown lengthening.

Official Title
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Clinical Evaluation of Gingival Margin Stability Following Conventional Versus Microsurgical Techniques of Esthetic Crown Lengthening

Conditions
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Gummy Smile

Intervention / Treatment
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* Procedure: Test group
* Procedure: Control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with healthy systemic condition. Adult patients ˃ 18 years old. The presence of the six upper anterior teeth. Absence of sites with attachment loss and probing depth (PD) >3 mm Keratinized gingiva of at least 2mm width. Compliance with good oral hygiene. Patients accepts 6-months follow-up period (cooperative patients). Patients provides an informed consent Exclusion Criteria: Gummy smile with normal tooth proportions Presence of prosthetic crowns Extensive restorations Extensive incisal edge attrition. Misalignment on maxillary anterior teeth. Smokers ˃ 10 cigarettes / day.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Test group<br>esthetic crown lengthening with microsurgical approach | Procedure: Test group<br>* The surgery will be done with the use of 4x magnification loop, the knives are micro blades and micro-sutures 7//0 used with the microsurgical instruments kit<br>|
| Active Comparator: Control group<br>esthetic crown lengthening with conventional approach. | Procedure: Control group<br>* esthetic crown lengthening with conventional approach with an internal bevel incision, following CEJ anatomy, this will be followed by an intra-sulcular incision, removal of the strip of outlined marginal gingiva and elevation of a mucoperiosteal ﬂap to the level of the alveolar bone crest.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mid-buccal gingival margin level | periodontal probe with William's graduation will be used to measure the distance from the CEJ to the gingival margin at the mid-buccal surface | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pink Esthetic Score (PES) | The PES is based on seven variables: mesial papilla, distal papilla, soft-tissue level, soft tissue contour, alveolar process deficiency, soft-tissue color and texture. Each variable shall be assessed with a 2-1-0 score, with 2 being the best and 0 being the poorest score. The mesial and distal papilla will be evaluated for completeness, incompleteness or absence | 6 months | 
| Post-Surgical swelling | will be evaluated post-surgically with Verbal Rating Scale with words ranging from (absent-slight-moderate-intense) Absent (no swelling), Slight (intraoral swelling at the operated area), Moderate (moderate intraoral swelling at the operated area) and Intense (intensive extra oral swelling extending beyond the operated area). | 7days | 
| Post-Surgical Patient Satisfaction: 3-item questionnaire | A 3-item questionnaire is asked and the patients shall use a 7-point answer scale | 6 months |