Here’s a question that I was asked recently.
Is there a guide to know what is the most gum tissue we can remove without affecting the biological width?
If you can’t contour a lot of gum tissue away, BUT you can build a more symmetrical gingival architecture, this will be helpful for your cosmetic cases.
Pocket Depth/ Gingival Sulcus/ Periodontal Pocket
The average periodontal pocket/ probe depth is 0-3mm. This depth varies from tooth to tooth and surfaces.
When planning for laser gum contouring, the first thing to do is to get a periodontal probing of the patient as well as X-rays of the teeth.
Guidelines
The margin of the final restoration should be at least 2.5mm away from the crest of bone.
If the patient is anesthetized, you could sound or probe to bone to measure the gingival margin to the bone level to help assess how much gum tissue can be removed.
The margin or finish line of the final restoration should be 0.5mm below the gingival margin.
This makes me think:
- If the pocket measures 3mm you can take 1.5mm of gum tissue away.
- If the pocket measures 2.5mm you can take 1.0mm of gum tissue away.
- If the pocket measures 2.0mm you can take 0.5mm of gum tissue away.
- If the pocket measures 1.0mm, you can probably make only very slight alterations.
If you just don’t have enough room to take away gum tissue and will be impacting the biological width, consider the following:
- refer to a periodontist for an evaluation.
- there are many intrasulcular instruments or burs that can be used for a closed flap crown lengthening in a specific spot.
- take a course to learn crown lengthening.
- talk to your lab about the contours of porcelain and how they can add extra porcelain to “push” on the zenith of the gum tissue.
Again these are just guidelines. Do what’s best for your patient and do what you’re comfortable with.