This randomized controlled clinical trial aims to evaluate the clinical performance and patient-centered outcomes of dual digitally guided crown lengthening compared to the conventional surgical technique in the management of gummy smile caused by altered passive eruption (Type B1). A total of 18 patients will be randomly allocated into two groups: the control group will undergo conventional crown lengthening based on clinical measurements, while the intervention group will receive crown lengthening using a dual digitally fabricated surgical guide. The primary outcome is the gain in clinical crown length at 3 months. Secondary outcomes include operating time, pain perception, patient satisfaction, gingival margin stability, and periodontal clinical parameters. This study aims to determine whether digital guidance improves surgical accuracy, efficiency, and patient satisfaction compared to traditional techniques
Esthetic crown lengthening is a commonly performed periodontal surgical procedure indicated for the correction of excessive gingival display, particularly in cases of altered passive eruption. Achieving optimal esthetic outcomes requires precise determination of gingival and osseous resection levels, which can be challenging using conventional clinical methods. With the advancement of digital dentistry, computer-aided design and manufacturing (CAD/CAM) technologies have enabled the development of digitally guided surgical approaches. The dual digitally guided technique integrates two levels of guidance to control both soft tissue and bone resection, potentially enhancing surgical precision and predictability. This randomized controlled clinical trial is designed to compare the effectiveness of dual digitally guided crown lengthening with the conventional technique in patients presenting with gummy smile due to altered passive eruption (Type B1). Eighteen systemically healthy patients aged 18-40 years will be recruited and randomly assigned into two equal groups. The control group will undergo conventional crown lengthening using clinical measurements and manual surgical techniques. The intervention group will be treated using a dual digitally fabricated surgical guide based on digital smile design, CBCT analysis, and intraoral scanning. Clinical and patient-reported outcomes will be assessed at baseline and during follow-up periods. The primary outcome is the gain in clinical crown length measured at 3 months postoperatively. Secondary outcomes include operating time, pain (VAS), patient satisfaction (VAS), gingival margin level, probing depth, gingival index, plaque index, bleeding on probing, keratinized gingival height, and gingival thickness. The results of this study are expected to provide evidence regarding the benefits of digital guidance in periodontal esthetic surgery and its potential to improve clinical outcomes and patient experience.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
24
Conventional surgical crown lengthening performed based on clinical examination and manual measurements. The procedure includes gingival recontouring and osseous resection carried out according to standard periodontal surgical protocols without the use of digital guidance.
Crown lengthening performed using a dual digitally fabricated surgical guide. The procedure is planned using digital smile design, intraoral scanning, and CBCT imaging to guide both soft tissue and bone resection, enhancing surgical accuracy and predictability.
School of Dental Medicine
Damascus, Syria
Gain in Clinical Crown Length
Change in clinical crown length (mm), measured from the incisal edge to the gingival margin using a periodontal probe, to assess the effectiveness of crown lengthening procedures.
Time frame: Baseline and 3 months postoperatively
Surgical Operating Time
Total duration of the surgical procedure measured in minutes from the first incision to completion of osteotomy.
Time frame: During surgery (intraoperative)
Postoperative Pain (VAS)
Patient-reported pain assessed using a Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (worst pain imaginable).
Time frame: 24 hours, 7 days, and 14 days postoperatively
Patient Satisfaction (VAS)
Patient satisfaction with the esthetic and functional outcome measured using a Visual Analogue Scale (VAS).
Time frame: 7 days and 3 months postoperatively
Relative Gingival Margin Level
Measurement of gingival margin position (mm) relative to a fixed reference point to evaluate soft tissue stability.
Time frame: Baseline, 1 week, and 3 months postoperatively
Probing Depth
Periodontal probing depth (mm) measured at standardized sites using a periodontal probe.
Time frame: Baseline and 3 months postoperatively
Gingival Index (GI)
Assessment of gingival inflammation using the Gingival Index scoring system.
Time frame: Baseline and 3 months postoperatively
Plaque Index (PI)
Assessment of oral hygiene status using the Plaque Index scoring system.
Time frame: Baseline and 3 months postoperatively
Bleeding on Probing (BOP)
Presence or absence of bleeding upon gentle probing, expressed as a percentage of bleeding sites.
Time frame: Baseline and 3 months postoperatively
Keratinized Gingival Height
Width of keratinized gingiva (mm) measured from the gingival margin to the mucogingival junction.
Time frame: Baseline, 1 week, and 3 months postoperatively
Gingival Thickness
Thickness of gingival tissue (mm) measured using transgingival probing or ultrasound methods.
Time frame: Baseline and 3 months postoperatively
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