Closed Piezoelectric vs. Open Flap for Esthetic Crown Lengthening

Overseen By Jaspreet Farmaha, PHD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Augusta University

Disqualifiers: Systemic conditions, Smoking, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 1 day

36 Participants Needed

Trial Summary

What is the purpose of this trial?

In this randomized clinical trial, the investigators are comparing two different approaches for Esthetic crown lengthening- a minimally invasive approach using piezoelectric (PZ) and a traditional open flap approach (OF).

Do I need to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Closed Piezoelectric vs. Open Flap for Esthetic Crown Lengthening is an effective treatment?

The available research does not provide specific data comparing Closed Piezoelectric and Open Flap techniques for Esthetic Crown Lengthening. However, it discusses various techniques and modifications in esthetic crown lengthening over the years. One study mentions a modified technique and assesses outcomes after 6 months, suggesting ongoing evaluation of effectiveness. Another study compares a guided dual technique with a conventional one, indicating that different methods are being explored for better results. While these studies highlight the evolution and exploration of techniques, they do not provide direct evidence of the effectiveness of Closed Piezoelectric versus Open Flap specifically. ^{1 2 3 4 5}

What safety data exists for esthetic crown lengthening treatments?

The available research provides insights into various techniques for esthetic crown lengthening, including piezosurgery and atraumatic surgical extrusion. Piezosurgery is highlighted for its precision and safety in cutting hard tissue, suggesting it is a safe option for crown lengthening. The atraumatic surgical extrusion technique is noted for not causing functional or esthetic deformities, especially in the anterior esthetic zone. However, specific safety data or adverse effects are not detailed in the provided abstracts. ^{1 2 3 4 6}

Is the treatment ECL-mPZ, ECL-OF a promising treatment for esthetic crown lengthening?

Yes, the treatment ECL-mPZ, ECL-OF is promising for esthetic crown lengthening. It offers a minimally invasive approach, which can lead to better cosmetic results and less discomfort for patients. This treatment is part of a well-established procedure that has been refined over many years, aiming to improve the appearance of teeth by adjusting the gum line. ^{1 2 3 4 5}

Research Team

Ahmed El-Awady, BDS, MS, PHD

Principal Investigator

Augusta University

Eligibility Criteria

This trial is for individuals with a gummy smile caused by excess gum tissue over their upper front teeth and normal muscle function of the upper lip. They should not have had previous gum surgery in that area, be non-smokers, free from systemic conditions preventing gum surgery, and not pregnant.

Inclusion Criteria

I have a gummy smile because of my upper front teeth's appearance.

My upper lip moves normally.

You do not have any issues with the alignment of your spine.

Exclusion Criteria

I have had gum surgery in the same area before.

People who smoke.

I have a health condition that prevents me from having gum surgery.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo esthetic crown lengthening using either a minimally invasive piezoelectric approach or a traditional open flap approach

1 day

1 visit (in-person)

Follow-up

Participants are monitored for changes in supracrestal width, probing depth, bleeding on probing, and clinical attachment level

12 months

3 visits (in-person) at 6 and 12 months

Treatment Details

Interventions

• ECL-mPZ
• ECL-OF

Trial Overview The study is comparing two techniques for improving the appearance of 'gummy smiles': a minimally invasive method using piezoelectric tools (ECL-mPZ) versus the traditional method where gums are pushed back through surgery (ECL-OF).

Participant Groups

Group I: Test group: Crown lengthening using a minimally invasive approach by piezoelectric (PZ). Experimental Treatment 1 Intervention

Esthetic Crown lengthening done using a minimally invasive approach using piezoelectric (PZ).

Group II: Control group: Crown lengthening using a traditional open-flap approach (OF). Active Control 1 Intervention

Esthetic Crown lengthening done using a traditional open-flap approach (OF).

ECL-mPZ is already approved in European Union, United States for the following indications:

Approved in European Union as Esthetic Crown Lengthening for:

• Restorative needs
• Esthetic concerns

Approved in United States as Esthetic Crown Lengthening for:

• Restorative needs
• Esthetic concerns

Who Is Running the Clinical Trial?

Augusta University

Lead Sponsor

Trials

219

Recruited

85,900+

Findings from Research

The article reviews the evolution of esthetic crown lengthening (ECL) surgery techniques over 30 years, focusing on improvements in incision methods, bone removal (ostectomy), and tissue placement.

It also addresses the issue of tissue rebound, which can affect the outcomes of ECL surgery, highlighting the importance of technique modifications for better results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Esthetic Crown Lengthening Surgery - A 30-Year Retrospective and Lessons Learned. Robbins, JW.[2022]

Atraumatic surgical extrusion using a periotome was successfully performed on four isolated teeth in the esthetic zone, providing an alternative to traditional crown lengthening techniques.

This method avoids functional or esthetic deformities, making it particularly suitable for restorative and non-restorative cases in the anterior esthetic zone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atraumatic surgical extrusion using periotome in esthetic zone: A case series. Mohan, KP., Ravindra, RN., Roopa, D., et al.[2021]

The modified esthetic crown lengthening surgery (ECLS) technique significantly improved periodontal esthetic parameters, as shown by the increase in the mean crown lengthening esthetic score (CLES) from 15.23 to 20.30 after 6 months in a study of 15 patients.

The study introduced a new method for categorizing esthetic outcomes, which may help in evaluating the effectiveness of ECLS, particularly in terms of gingival zenith and papillae, while noting that gingival recession did not change significantly.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modified technique for esthetic crown lengthening in the natural dentition: case series. Lobo, M., Monteiro, MF., Rodrigues, RQF., et al.[2022]

The guided dual technique for esthetic crown lengthening (ECL) was found to be as effective as the conventional technique, with both methods resulting in significant increases in clinical crown length immediately after the procedure and stable results after 12 months, based on a study of 24 participants.

Participants reported high esthetic satisfaction with both techniques, indicating that the guided dual technique does not compromise aesthetic outcomes while potentially enhancing surgical predictability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital planning and guided dual technique in esthetic crown lengthening: a randomized controlled clinical trial. Carrera, TMI., Freire, AEN., de Oliveira, GJPL., et al.[2023]

Crown lengthening is a common periodontal surgery aimed at correcting issues like subgingival caries and short clinical abutments, but its use for esthetic purposes in the anterior areas lacks a standardized evidence-based approach.

This paper outlines critical aspects of the esthetic crown-lengthening procedure, including ideal flap design, bone removal guidelines, flap margin positioning, and healing phase management, which are essential for achieving optimal outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Crown lengthening and restorative procedures in the esthetic zone. Marzadori, M., Stefanini, M., Sangiorgi, M., et al.[2019]

Crown lengthening is essential for maintaining healthy gums and achieving good aesthetics during restorative dental procedures, as it helps preserve the biological width of the periodontium.

Piezosurgery, which uses ultrasonic technology for precise cutting, is an effective and safe method for performing crown lengthening, making it suitable for complex dental cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Present Day Approach to Crown Lengthening - Piezosurgery. Lavu, V., Arumugam, C., Venkatesan, N., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Esthetic Crown Lengthening Surgery - A 30-Year Retrospective and Lessons Learned. [2022]

2. India pubmed.ncbi.nlm.nih.gov

Atraumatic surgical extrusion using periotome in esthetic zone: A case series. [2021]

3. Germany pubmed.ncbi.nlm.nih.gov

Modified technique for esthetic crown lengthening in the natural dentition: case series. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

Digital planning and guided dual technique in esthetic crown lengthening: a randomized controlled clinical trial. [2023]

5. Denmark pubmed.ncbi.nlm.nih.gov

Crown lengthening and restorative procedures in the esthetic zone. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

A Present Day Approach to Crown Lengthening - Piezosurgery. [2023]