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Caution is critical in picking patients for crown lengthening

The first step in deciding whether to proceed with a crown-lengthening procedure is to see if you can talk yourself out of it, Dr. Jon Suzuki told a full house attending his live patient demonstration yesterday at the Hawaii Convention Center.

"Try to rule out why periodontal surgery should not be performed," he advised. "Why shouldn't we do this procedure?"

It was his way of stressing that patient selection is vital to achieving success in crown lengthening for restorative dentistry. Dr. Suzuki is associate dean for Graduate Studies and director of the Graduate Periodontology Specialty Program at Temple University School on Dentistry. His presentation was part of the Education in the Round program.

Early in his talk and before beginning the hands-on treatment, Dr. Suzuki explored a wide range of factors to be taken into account as part of case selection, starting with a thorough and current medical history. That history, he said, should include such factors as blood pressure; liver, heart and lung health; diabetes mellitus; connective tissue diseases; and arthritis (rheumatoid and osteo).

The dentist should know what medications the patient is taking and the patient's personal habits. The patient who smokes a pack a day or abuses drugs or alcohol is not a viable candidate, he said. And the dentist should never "charge ahead" without appropriate radiographs.

Other factors to consider in deciding on a crown-lengthening procedure (not a comprehensive list):

  • apical extent of fracture or caries;
  • crestal bone level;
  • root length and root form;
  • root proximity;
  • gingival health;
  • probing depth;
  • keratinized gingival width;
  • mobility of teeth;
  • pulpal involvement.

"Listen to patients," Dr. Suzuki advised. "Listen to what patients tell you in terms of pain here and pain there to rule out pulpal involvement."

He also advised always having a backup sterilized surgical kit to ensure peace of mind in case you drop something. And if you do, he said, "Don't say 'Oops.'!' Patients don't like to hear 'Oops.'"

With that, Dr. Suzuki donned personal protective equipment and proceeded with the hands-on portion of the program.