Perio-prosthetic management in restoring teeth with reduced clinical crown in children

The purpose of this article is to underline the importance and to discuss the indications and techniques of crown lengthening procedures prior to prosthetic treatment of mutilated or undererupted permanent teeth of children. The aim of surgical crown lengthening is the exposure of at least 3 to 4 mm of healthy tooth structure coronally to the alveolar crest, length that will allow the formation of the new epithelial attachment and the existence of 1 to 2mm of tooth structure for the construction of a biologically acceptable crown margin. If the margin of the defect is inadequate distance from the alveolar crest the surgical procedure involves reduction of the attachment complex and is limited to the soft tissues only (a gingivectomy, apically repositioned full thickness flap, distal wedge). When the margin of the defect is close to the alveolar crest, less than 3 mm, the surgery involves also modification of the hard tissues of the periodontium (apically repositioned full thickness flap with ostectomy-osteoplasty). Although cases of children generally call for a conservative approach, the necessity for harmony between restorative procedures and materials with the supporting structures make surgical intervention inevitable.