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Background Patient satisfaction is the primary focus of the healthcare system. Patient-reported outcome measures (PROMs) are standardized and valid measures obtained directly from the patients and are used to assess and compare the efficacy of healthcare services. This can help improve the service provided by the healthcare system. Therefore, this study aimed to assess PROMs during the first week post-surgery across different periodontal surgical procedures and explore their correlation with surgical duration. Furthermore, the study sought to evaluate the occurrence of postoperative complications. Methodology A total of 30 healthy patients with no systemic history, requiring periodontal surgical procedures such as crown lengthening (CLP), open flap debridement (OFD), and soft tissue grafting (STG) were included in the study. The Visual Analog Scale (VAS) was utilized for gathering PROMs concerning bleeding, swelling, bruising, and pain at intervals of days zero, three, five, and seven after the surgical procedure. Results On the surgical day and over seven days, VAS scores were the lowest for CLP and highest for STG procedures. This result is in accordance with the duration required for surgery. VAS scores for OFD were intermediate. Prevalence of 20% soft tissue graft dehiscence and 40% tenderness on palpation was observed. Swelling and bleeding were noticed in 10% and 20% of OFD cases. Conclusions One week post-surgically, the mean VAS scores were minimum for CLP, whereas maximum for STG procedures. As CLP and OFD require less duration compared to STG, duration plays a significant role in post-surgical outcomes. Prevalence of the post-surgical complications is also related to the duration of the surgery.

Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets\' depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science.

OBJECTIVE: To assess adherence to follow-up maintenance visits among patients who had previously undergone crown-lengthening surgery and investigate the different factors impacting their compliance.
METHODS: A total of 314 patients were identified for follow-up appointments. Based on their responses, participants were categorised into four groups: attendees, non-attendees, refusals, and unreachable. Furthermore, data on sociodemographic factors (age, sex, nationality, marital status, education, occupation, and residential area), medical history, dental history (including missing teeth, implants, or orthodontic treatment history), and past appointment attendance (average yearly appointments, missed appointment percentage, and last appointment date) were collected and analysed to understand their influence on patient compliance.
RESULTS: In a sample of 314 patients, 102 (32.5%) attended the appointments successfully. Improved attendance rates were significantly associated with being female, Saudi Arabian, married, and employed (p < 0.05). Moreover, patients with a high frequency of annual appointments and a recent history of appointments exhibited better compliance. None of the analysed dental factors affected the attendance rates.
CONCLUSIONS: About one-third of patients who had undergone crown lengthening surgery were compliant with the follow-up visits. Different factors influenced this compliance pattern to varying extents, with more efforts needed to enhance patients\' commitment to these visits.

Maintenance of biological width serves as a primary factor in periodontal-restorative relationships. Crown lengthening (CL) is a technique to prevent violation of biological width, with the laser method offering the advantage of surgical and patient-related outcomes. Laser CL with retraction helps with the excision of tissues, increasing the CL, maintaining the gingival contour with adequate exposure to the finish line to record the tooth preparation features. This helps to achieve the functional and esthetic outcomes essential for restorative dentistry. The marginal fit, contour, and adaptation of the crown can be further enhanced by computer-aided design and computer-aided manufacturing (CAD/CAM) technology improving patient and clinical outcomes. Hence, this case report aims to indulge the laser-assisted procedures and CAD/CAM technology to fabricate and deliver a zirconia crown maintaining the periodontal-restorative factors.

To compare the clinical periodontal parameters of teeth restored with a single ceramic crown, with and without crown lengthening procedure.
This prospective, longitudinal, controlled, and single-blinded clinical trial involved 22 patients with a total of forty-one teeth with ceramic crowns. The teeth were divided into two groups: test (n = 21), comprising teeth rehabilitated post crown-lengthening surgery, and control (n = 20), comprising teeth rehabilitated without crown-lengthening surgery. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL) were compared between groups (surgically treated and non-surgically treated) and within each group for each type of site (treated -tt; adjacent - ad; and nonadjacent - nad). Additionally, gingival phenotype (GP), gingival recession (GR), and keratinized tissue width (KTW) were also assessed post- restoration. Statistical analyses used a significance level set at 5 %.
PI, GI, and BoP were reduced, but no statistically significant differences were observed within each group or between groups for most follow-up periods. CAL of the TT sites was consistently higher in the test group, and PD was also higher in the test group (p < 0.05), except at T3. adPD, nadPD, adCAL, and nadCAL demonstrated no significant differences between groups and periods. A significant association was identified between GP and the occurrence of GR, with the thick-flat phenotype demonstrating less association with GR, regardless of whether crown lengthening was performed or not.
Crown-lengthening surgery in rehabilitated teeth does not significantly affect PI and GI after 12 months. Although crown-lengthening surgery affected PD and CAL in TT sites, it did not affect adjacent and non-adjacent sites.
These findings emphasize the importance of considering individual patient factors and the potential impact on periodontal tissues when planning crown-lengthening surgery. Clinicians must have a comprehensive understanding of the dynamics of the periodontal tissues involved in restorative treatments to optimize the procedure, increase success rates, and minimize potential complications.

BACKGROUND: One of the important things to preserve during crown lengthening is the biologic width (BW), recently called supracrestal tissue attachment. A healthy periodontium with adequate BW is very essential for the success of restored teeth. There are various techniques to perform crown lengthening procedures. Most of the studies have focused on assessing the changes in the position of the marginal gingiva and bone as outcome parameters rather than BW. Also, most of the research was done on animal models.
OBJECTIVE: The purpose of this study was to assess the periodontal tissue changes at three months and six months following two different surgical crown lengthening procedures.
METHODS: Sixty mandibular first molars among 60 patients that required surgical crown lengthening were enrolled in the study and subjected to two different procedures, gingivectomy (Group I; n=30) and apically positioned flap with ostectomy (Group II; n=30). The following parameters were recorded at baseline, three months, and six months, position of free gingival margin (FGM), probing depth (PD), relative attachment level (RAL), bone level (BL), and BW. These measurements were made at three sites in every patient: treated tooth sites (TT), adjacent tooth\'s adjacent sites (AD), and adjacent tooth\'s non-adjacent sites (NAD). The data was then subjected to statistical analysis using SPSS software (Version 20.0). Statistical significance was set to p<0.05.
RESULTS: When groups I and II were compared at three and six months, there was no statistical difference in terms of position of FGM, PD, and RAL (p>0.05). When BW was compared between the two groups at three and six months, group II showed better reestablishment of BW at any given time period and was statistically significant (p<0.05).
CONCLUSIONS:  Following surgical crown lengthening, the bone level was shifted apically and allowed for the reestablishment of BW. At six months of follow-up, the apically positioned flap with ostectomy was superior in restoring the BW compared to gingivectomy.

OBJECTIVE: Esthetic crown lengthening (ECL) is commonly advocated to treat patients with altered passive eruption (APE). Since the introduction of the minimally invasive surgical concept, a limited number of studies have investigated this technique in a standardized manner, with further studies required to verify the validity and predictability of the minimally invasive FL-technique. The current randomized trial compares a minimally invasive (ECL), using piezosurgery with flapless-approach (FL), versus an open-flap (OF) approach in the management of patients with APE Type 1B.
METHODS: Twenty-four patients diagnosed with APE Type 1B were randomly assigned into test (FL) with tunneling approach or control (OF) group with minimally invasive flap reflection (n = 12/group). Postoperative pain was assessed during the first 48 h. Gingival margin (GM) level relative to a custom-made stent (rGM) and patient satisfaction were assessed preoperative, immediately after surgery, at 3 and 6 months postsurgically. Postoperative swelling was reported for the first week postsurgically. Plaque index (PI), bleeding on probing (BoP), clinical attachment level (CAL), pocket depth (PD) and pink esthetic score (PES), were evaluated at baseline and 6 months. Linear regression analysis was conducted for pain.
RESULTS: OF-group reported significantly higher pain and swelling scores than FL-group during the first 48 h (p < 0.05). FL-group showed no significant differences regarding rGM between 3 and 6 months, in contrast to OF-group, where a significant decrease in rGM was notable (p < 0.05). No significant differences in PI, BoP, CAL, PD, PES, and patient satisfaction scores were evident between groups (p > 0.05). Regression analysis demonstrated that treatment and gender were significant predictors for pain (p < 0.05).
CONCLUSIONS: Within the current study\'s limitations, piezo-surgical ECL with FL-approach presented significantly lower postoperative pain, swelling, and early GM stability compared to OF-approach.
CONCLUSIONS: Piezosurgical ECL with a FL-approach can be considered a predictable technique with advantages over the OF-approach in the management of patients with APE Type1B.

Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web.
Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening.
This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information.
The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources.
DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to.
With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.

BACKGROUND: A minimally invasive aesthetic suturing technique was employed in aesthetic crown lengthening surgery (ACLS). The objective of this report was to evaluate the clinical and patient- reported outcomes of this technique for ACLS.
METHODS: Fifteen patients who underwent ACLS were treated utilizing the described suturing technique. Clinical parameters, including plaque index (PI), gingival index (GI), bleeding index (BI), papilla index score (PIS), early wound healing index (EHI), visual analogue scale (VAS), pink esthetic score and white esthetic score (PES/WES), were recorded at baseline, immediately post-surgery and during follow-up visits spanning 5 days to 24 months. The two-sample t-test was performed to evaluate statistical significance (α = 0.05).
RESULTS: 100% of the patients reported a high level of satisfaction, with a stable high postoperative VAS scores. From baseline to 5-day postoperation, there was no statistically significant increase in PI, although there was a slight deterioration observed in GI (0.13Å}0.23, P＜0.05) and BI (0.49Å}0.55, P＜ 0.05). Early wound healing (EHI 1) was achieved by all patients at 5 days post-surgery. Additionally, 3 patients exhibited changes in PIS within the initial 3 months following surgery, after which, all patients attained an optimal degree of papilla filling (degree III).
CONCLUSIONS: The application of the minimally invasive aesthetic suturing technique in ACLS demonstrates favorable outcomes in terms of patient satisfaction and long-term stability. However, the assertion of its superiority over conventional suturing methods for ACLS necessitates substantiation through rigorous investigation via well-designed randomized controlled clinical trials.