Quintessence of Dental Technology (QDT) 2021

The success of any anterior implant surgery comes partly from the surgical procedure and partly from the prosthetic design to support the tissue. This lesson learned from implant dentistry can be important in terms of rethinking how we manage natural teeth scenarios. Unlike implants, in which the provisional or final restorations are used to guide the soft tissue during healing, dental restorations are placed in fully healed periodontal tissues. This means that once a crown-lengthening surgery is performed, it seldom has the final prosthetic restorative support—and no restorative guidance or limited provisional guidance. The final restoration is then fabricated after the periodontal healing phase. This reactive approach to tissue healing often leads to modifications in the restoration design to accommodate the changes that occurred during the healing process. Due to advancements in digital dentistry, specifically in the speed of manufacturing and library-based design, which allow a more consistent and predictable fabrication of well-designed restorations, a new narrative is emerging: the use of digital design based on natural teeth morphology, similar to the way it currently is used for implantsupported restorations. Library-based design can be used to support and act as a scaffold of healing for both crown lengthening and grafting procedures. It allows less invasive crown-lengthening techniques. The following case describes and illustrates an innovative crown-lengthening approach guided by the final restorative design for optimal healing of the periodontal tissues.