Esthetic management of a flat periodontium through orthodontic extrusion

Patients who are prone to generalized interproximal anterior bone loss are an esthetic dilemma that plagues many restorative dentists. Treatment of these patients often results in extremely rectangular looking teeth since the periodontium is most likely flat. The patient in the picture above is an example of a very flat periodontium and the teeth have been restored to close the open gingival embrasures that existed. Luckily, she stated from the beginning of treatment that she was willing to do anything that would produce the most ideal results possible. The goals for her treatment are to end up with normal length contacts across the anterior teeth. For the centrals this means the tip of the papilla should be 5-6 mm from the incisal edge; currently hers are 7.5 mm. In addition, the papilla height between the centrals should be 4.5-5 mm, measured from the gingival margin to tip of papilla; hers is currently 2.5 mm. And finally the overall length of the centrals should end up 10.5-11 mm; currently hers are 10 mm. Using orthodontic extrusion followed by facial crown lengthening is really the only way to achieve the most esthetic result in these types of patients. Here is the treatment plan from start to finish.Reprinted with permission from Spear Education.