Evaluation of Flapless Esthetic Crown Lengthening Using Piezoelectric Surgery Compared with the Conventional Method: A Randomized Controlled Clinical Trial

Abstract

Background and aim: Surgical crown lengthening is the most common treatment for gummy smile caused by altered passive eruption type 1B. The traditional techniques and tools for this surgery have many disadvantages, which requires more research about methods that may give more effective results. This study aimed to compare the clinical outcomes of the closed-flap method with piezoelectric surgery compared to open-flap and surgical rotary burs for up to six months after crown lengthening.

Materials and methods: The sample included 20 patients who needed a crown lengthening procedure. In the test group, 10 patients were treated with gingivectomy then osteotomy using piezoelectric surgery without raising a flap, while in the control group, 10 patients were treated with gingivectomy then osteotomy using traditional rotary surgical burs. The clinical crown length was evaluated in each patient before surgery, immediately after surgery, and after 6 months. Pain scores and satisfaction with the aesthetic appearance were also studied in each patient.

Results: The results showed an increase in clinical crown length by statistically significant values in both groups in all observation periods. The test group maintained a stable clinical crown length score after 6 months more than the control group, with a statistically significant difference. The significance level was less than 0.05 when comparing the two groups in all observation periods in the pain and satisfaction indicators in favor of the test group.

Conclusions: The Esthetic Crown Lengthening without raising a flap and performing osteotomy with piezoelectric surgery achieved a gain in the clinical length of the crown similar to the gain achieved by the traditional method. The amount of gain remained constant in the Test group after 6 months, which means a reduction in the amount of gingival rebound compared to the control group. It can also be said that using Piezoelectric osteotomy without raising a flap reduced pain and increased patient satisfaction with the aesthetic appearance compared to the traditional method.