Fully Digital Guided Esthetic Crown Lengthening Surgery

NCT ID: NCT06801548

Last Updated: 2025-02-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

18 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-20

Study Completion Date

2025-05-20

Brief Summary

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The goal of this randomized controlled clinical study is to compare Fully digital to wax-up/mock-up guided esthetic crown lengthening procedure in management of excessive gingival display caused by altered passive eruption type 1B

The main question it aims to answer is:

Does the fully digital guided gingivectomy approach able to introduce a more precise, accuracy and reliability technique with more patient satisfaction compared to the mock-up guided method?

Detailed Description

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In today's world, the idea of smile and dental aesthetics extends beyond just the teeth. The fundamentals of a smile center on the interaction between the three key elements: the teeth, lips , and the gingiva.

Gummy smile (Excessive gingival display) is acknowledged by the American Academy of Periodontology (AAP) as a deformity and mucogingival problem that impacts the area surrounding the teeth

This condition may result from various etiological factors: short lip, hypermobile/hyperactive lip, short clinical crowns, dentoalveolar extrusion, altered passive eruption (APE), gingival hyperplasia, and vertical maxillary excess.

Altered passive eruption is described as "the gingival margin in adults is positioned incisal to the crown's cervical convexity and distanced from the tooth's cementoenamel junction."

Altered passive eruption defined as "the gingival margin in the adult is located incisal to the cervical convexity of the crown and removed from the cementoenamel junction of the tooth".

Altered passive eruption classified into two main classes according to the relationship of the gingiva to the anatomic crown and furthermore subdivided those classes according to the position of the osseous crest. The two types are subdivided into four categories: 1A, 1B and 2A, 2B.

The diagnosis of APE is made on a collective clinical and radiographic examination, it begins with analyzing the repose during a natural smile followed by analyzing the gingival display, the alveolar crest level, as well as the lip line of the patient.

Determination can be made whether a gingivectomy alone will suffice or a gingival flap will be needed with or without ostectomy will depend of the diagnosis of APE and classification of each case.

The selection of one technique over another depends on several patient related factors such as esthetics, clinical crown to root ratio, root proximity, root morphology, furcation location, individual tooth position, collective tooth position and ability to restore the teeth.

Esthetic crown lengthening (ECL) approach (both gingivectomy and bone removal) is used when less than 2 mm exists between the crest of the bone and the new gingival margin, and an adequate attached gingiva will remain after surgery (APE type IB).

Diagnostic mock-up fabricated using a temporary bis-acrylic resin with a putty guide directly from the wax-up can be used to provide the patient and clinician with an evaluation of the future outcome and can be used as a surgical guide for crown lengthening procedures.

The major limitations with wax-up/ mock-up guided esthetic crown lengthening procedure would be the time consumed during making and modifying conventional wax-ups as well as the unpredictable estimate of where the gingival margin should be.

Utilization of digital workflows allowed the enhancement of communication and might improve the predictability of contemporary ECL approach.

The introduction of computer-aided design and computer-aided manufacturing (CAD-CAM) techniques has helped surgeons perform more precise and predictable surgery and contributed to improved esthetics.

By combining the use of Digital Smile Design and CAD/CAM technology with (3D) printing, a surgical guide for ECL procedure could be produced.

The aim of the present study will be to evaluate accuracy and reliability of digital guided method of ECL procedure using CAD CAM technology versus conventional method using resin Mock-up as ECL surgical guide.

Conditions

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Gummy Smile

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Conventional arm

Esthetic crown lengthening surgery is done using mock-up based guide

Group Type ACTIVE_COMPARATOR

Esthetic crown lengthening surgery

Intervention Type PROCEDURE

Esthetic crown lengthening surgery using mock-up based guide

Digital arm

Esthetic crown lengthening surgery is done using digital guide

Group Type ACTIVE_COMPARATOR

Esthetic crown lengthening surgery using Digital guide

Intervention Type PROCEDURE

Esthetic crown lengthening surgery using digital guide based on DSD and CBCT

Interventions

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Esthetic crown lengthening surgery

Esthetic crown lengthening surgery using mock-up based guide

Intervention Type PROCEDURE

Esthetic crown lengthening surgery using Digital guide

Esthetic crown lengthening surgery using digital guide based on DSD and CBCT

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients who have Altered passive eruption (APE) type 1 B, according to classification of APE by Coslet et al.

Both genders aged from 20-50 years. Patients have thick gingival phenotype (thickness of gingiva is ≥ 1 mm) Patients should be systematically free from any disease.

Exclusion Criteria

* Pregnant and lactating females.
* Heavy smoker ≥ 10 cigarettes/day.
* Poor oral hygiene.
* Patients with occlusal or malalignment problems.
Minimum Eligible Age

20 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ain Shams University

OTHER

Sponsor Role lead

Responsible Party

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Abdallah Abdelnabi

Resident of Oral Medicine and Periodontology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ahmed E Amr, Ass.Prof

Role: STUDY_DIRECTOR

Faculty of Dentistry - Ain Shams University

Locations

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Faculty of Dentistry - Ain Shams University

Cairo, , Egypt

Site Status

Countries

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Egypt

Central Contacts

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Abdallah A. Aref, Master student

Role: CONTACT

00201111711467

Doaa A Khattab, Ass.Prof

Role: CONTACT

00201006814258

References

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Vercruyssen M, Cox C, Coucke W, Naert I, Jacobs R, Quirynen M. A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template. J Clin Periodontol. 2014 Jul;41(7):717-23. doi: 10.1111/jcpe.12231. Epub 2014 Apr 10.

Reference Type BACKGROUND
PMID: 24460748 (View on PubMed)

Lee EA. Aesthetic crown lengthening: classification, biologic rationale, and treatment planning considerations. Pract Proced Aesthet Dent. 2004 Nov-Dec;16(10):769-78; quiz 780.

Reference Type BACKGROUND
PMID: 15739921 (View on PubMed)

Ganji KK, Patil VA, John J. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure. Int J Dent. 2012;2012:479241. doi: 10.1155/2012/479241. Epub 2012 Aug 26.

Reference Type BACKGROUND
PMID: 22969804 (View on PubMed)

Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S237-S248. doi: 10.1002/JPER.17-0733.

Reference Type BACKGROUND
PMID: 29926943 (View on PubMed)

Shobha KS, Mahantesha, Seshan H, Mani R, Kranti K. Clinical evaluation of the biological width following surgical crown-lengthening procedure: A prospective study. J Indian Soc Periodontol. 2010 Jul;14(3):160-7. doi: 10.4103/0972-124X.75910.

Reference Type BACKGROUND
PMID: 21760669 (View on PubMed)

Nugala B, Kumar BS, Sahitya S, Krishna PM. Biologic width and its importance in periodontal and restorative dentistry. J Conserv Dent. 2012 Jan;15(1):12-7. doi: 10.4103/0972-0707.92599.

Reference Type BACKGROUND
PMID: 22368328 (View on PubMed)

Liu X, Yu J, Zhou J, Tan J. A digitally guided dual technique for both gingival and bone resection during crown lengthening surgery. J Prosthet Dent. 2018 Mar;119(3):345-349. doi: 10.1016/j.prosdent.2017.04.018. Epub 2017 Jul 8.

Reference Type BACKGROUND
PMID: 28689907 (View on PubMed)

Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000. 1996 Jun;11:18-28. doi: 10.1111/j.1600-0757.1996.tb00179.x. No abstract available.

Reference Type BACKGROUND
PMID: 9567953 (View on PubMed)

Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan. 1977 Dec;70(3):24-8. No abstract available.

Reference Type BACKGROUND
PMID: 276255 (View on PubMed)

Bhola M, Fairbairn PJ, Kolhatkar S, Chu SJ, Morris T, de Campos M. LipStaT: The Lip Stabilization Technique- Indications and Guidelines for Case Selection and Classification of Excessive Gingival Display. Int J Periodontics Restorative Dent. 2015 Jul-Aug;35(4):549-59. doi: 10.11607/prd.2059.

Reference Type BACKGROUND
PMID: 26133145 (View on PubMed)

Other Identifiers

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FDASU-ReclM122210

Identifier Type: -

Identifier Source: org_study_id

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