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Forums › Erbium Lasers › General Erbium Discussion › Visibility of bone – Biology of crown lengthening

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  • June 15, 2004 at 12:58 pm #2970

    Dan Melker
    Spectator

    (Edited by Dan Melker at 7:46 pm on June 29, 2004)

    June 15, 2004 at 10:44 pm #7714

    kellyjblodgettdmd
    Spectator

    Dan – what wavelength of laser did you use for this?

    June 16, 2004 at 1:06 am #7718

    Dan Melker
    Spectator

    Kelly,
    I am still using a scalpel and bur. No doubt this case could be done with a laser. The key to the case is seeing the osseous. Ideal parabolic osseous contours can be created.
    Thanks,
    Danny

    June 16, 2004 at 2:19 am #7705

    Anonymous
    Guest

    Danny,
    Any radiographs of this case (especially post surgery to see root to crown ratio)?

    June 16, 2004 at 3:25 pm #7719

    Dan Melker
    Spectator

    Ron,
    The key to correcting Altered Active Eruption is removing EXCESSIVE bone to creat a BIOLOGIC WIDTH. When there is bone touching the cej. it must be removed to allow a space for the BW if not the case will absolutely relapse.
    Years ago I did try to beat the BW by not removing bone and only tissue and the procedure failed every time!
    Thanks,
    Danny
    This why GV’s usually do not work

    June 16, 2004 at 4:39 pm #7710

    Anonymous
    Guest

    Danny, I’m just trying to picture in my mind what the final restorative looked like. I can’t tell picture wise, did you just remove bone slightly past the CEJ or did you do some root shaping here also?
    Thanks,

    June 16, 2004 at 5:25 pm #7720

    Dan Melker
    Spectator

    Good question Ron.
    If you look closely on the final photo you can see the cej.’s. I did reshape this area to remove roughness of cej. I make enough space for the BW. from cej. to bone. I slightly lengthened #8 and #9 for cosmetics so they would be a tad longer based on #7 and #10.
    Thanks,
    Danny

    June 16, 2004 at 5:48 pm #7706

    Anonymous
    Guest

    Is the CEJ the green or blue line (approximately)?

    cej.jpg

    The green is about where I’d expect it (CEJ) to be. Was there lengthening of the laterals also?
    Is the blue line about where the restoration will end?

    Thanks for all the explanations, Danny.  Just trying to learn a bit here,  in my office neighborhood, major procedures for cosmetics just aren’t in demand because of lack of disposable income but I still find it interesting.

    June 16, 2004 at 8:30 pm #7721

    Dan Melker
    Spectator

    Ron,
    Any question you ask is a great question! If you look at the original photo all teeth were involved with osseous touching the cej. I would expect that actually the final margin would be just slightly apical to the green line. The patient is in India for several months and when she reutrns I will have photos to post. She is a Doctor and has a year in India. I did the work and Bill Strupp restored her and she left.
    I will photograph her when she returns.
    Thanks,
    Danny

    June 16, 2004 at 9:28 pm #7708

    Anonymous
    Guest

    Well Danny, I don’t know how great the next question will be but I got to get them in before I head to the Dominican Republic.

    BTW, David K is watching the board while I’m gone on my mission trip, so watch out! 😉

    If the finish line will be just apical to the green line, why won’t a psuedo pocket be created? It appears that the distance from green line to bone is more that I’d expect for a biological width in this area. Just glancing I’d expect the BW (sulcus area) to be about from the blue line to bone.
    Also, would you attribute the thickness in the bone to the bruxing?

    Can you teach me a little bit more?

    June 16, 2004 at 10:46 pm #7724

    Dan Melker
    Spectator

    Ron,
    When we think of the BW it is very misleading. Remember that is not including the sulcus. A very healthy  sulcus could easily be 1-2mm. So in reality we could be dealing with a space from bone to margin of restoration of 5mm.
    That is why I do my surgery wait 6wks. and do a touch up if necessary.
    There have been cases shown everywhere on DT and LF where the surgery and impressions are taken the same day. I have yet to see a case a year later that is representative of pink healthy tissue. Go back and see the cases, no one shows a follow up. Yes it can be done but not with health in mind. Sorry if I step on toes but we need to start respecting the BW more. I have great respect for the BW and still I constantly have to touch up surgeries.
    Thanks,
    Danny

    (Edited by Dan Melker at 8:36 pm on June 16, 2004)

    June 17, 2004 at 12:24 am #7711

    dkimmel
    Spectator

    Danny if you know what the BLW is at the time of sx, would not that same BLW be recreated after the sx. That is to say if the BWL was 5mm on the central after your osseous reduction would you not expect to get a 5mm BLW again?

    While we are at it what detemines BLW? Why is there such a range?

    DAvid

    June 17, 2004 at 12:41 am #7716

    Dan Melker
    Spectator

    Davey,
    As you know the BW ranges from 1-5mm. Surgically, the BW is altered by reshaping the bone, reshaping teeth creating negative contours, adding connective tissue.
    Thick tissue, thin tissue, thick bone, thin bone, position of the tooth in the bone, extruded tooth, intruded tooth, tooth in heavy occlusion-ALL have an affect on the BW.
    As I know you know, when I do surgery I let the individual patients biology determine the BW.
    Danny

    June 17, 2004 at 1:36 am #7715

    Benchwmer
    Spectator

    This is a laser forum.
    Why show Perio cases from 10-20 years ago? Explaining why this is the only way to retain proper BW.
    Danny, Why don’t you show examples of your cases , before and after, I haven’t seen any of your cases after one year? I want to see your preservation of papilla, no inflamtion, tissue responses over time, how these cases where you resect these large amounts look and react over time. Do you have cases where you have gone back in after a year or more and to see what kind of osseous contours exist?
    All these cases I’ve seen you post do not show follow ups. Why? You just like putting down everyone elses ideas and work.
    I’ve been performing Nd:YAG laser soft tissue surgeries and Laser Periodontal Surgeries for five years, this isn’t some new experimental gadget, that may make it. Lasers are a proven tools. My procedures stand the test of time. Why do you think laser cases fail?
    This is not DT Perio forum. Get yourself a laser.
    I think Ron has been too kind.
    Jeff

    June 17, 2004 at 2:05 am #7712

    dkimmel
    Spectator

    Jeff,
    I have just edited my first reponse to your post after reading Dannys response. I think he was too kind.
    I think your off base.
    Dan has not bashed lasers on this forum. He has only pointed out biological principals that should be followed no matter what tool we use. He has been trying to understand how lasers work. He has also shared his clinical experience with us.
    As far as post op cases. I have seen his case first hand. They have stood the test of time. There are post ops on DT and I am sure he will post some here if you wish.
    I can tell you that the only thing Danny is against is BAD DENTISTRY.

    Attacking each other is non productive. I have yet to see Danny attack anyone one this forum. He has been very careful about pointing out his concerns. As we all know critique someones posted case is always a touchy thing to do. I think he has done a great job at it.

    DAvid

    (Edited by dkimmel at 10:33 pm on June 16, 2004)

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