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The 3 procedures every dentist needs to know

Webinar by Dr. Ziv Simon

Dear enthusiastic doctor,

The following are the exact treatment protocols that I use in my practice to perform
the 3 procedures discussed in the webinar. I added some slides for clarification but in
reality this is not enough. You deserve to benefit from comprehensive education and
proper training to achieve surgical success.
The key to everything is understanding the etiology of a problem and the proper
planning (to avoid poor performance). Your patients deserve it.
Once you know more, you will become more competent and more confident.
Incorporating surgery in your practice is going to change your life. You will experience
more fun and practice growth. What else can one wish for?
Im here to help you along the way. Always feel free to engage with me and let me
know about your challenges and frustrations when it comes to surgery.
Together we will find a solution and get you to a very high performance level.

To your surgical success!

Ziv Simon, DMD, MSc
Creator of SurgicalMaster, The Surgical Training for Dentists
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Below are my treatment protocols for the following procedures:

1. Esthetic crown lengthening
2. Functional crown lengthening
3. Coronally reposition

Esthetic crown lengthening

1. Local anesthesia: Buccal infiltration PSA MSA ASA, greater palatine and
nasopalatine
2. Soft tissue incision (gingivectomy) per your surgical guide, wax-up, mock-up
and Chus proportions gauge. Using #15 blade and incision on the buccal only
and between the line angles.
3. Secondary intrasulcular incision and split thickness in the papilla area
(leaving the majority intact)
4. Full thickness buccal flap beyond the mucogingival junction.
5. Assess bone level and thickness in relation to the current CEJ and the desired
gingival level (surgical guide is helpful)
6. Vertical bone reduction on the buccal aspect of the teeth (where indicated).
Count apical 3 mm from the planned gingival margin (1mm for sulcus and 2
mm for the biologic width). Bone reduction with end cutting crown
lengthening bur or with thinning our with rounds diamond bur and hand
instruments.
7. Horizontal bone reduction with large round diamond bur. Create festooning
with a concave area between the roots and convex around the roots. Bone
edge ends at a knife-edge to the tooth. This phase is osteoplasty
8. Final ostectomy and osteoplasty with hand instruments and polishing burs.
9. Saline irrigation under the flap
10. Suturing in the papilla area with gut 5/0 (simple interrupted).
11. Hemostasis with gauze pressure
12. Post operative instructions
13. 1 week follow-up

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Functional crown lengthening

1. Local anesthesia: depending on the tooth treated.

2. The gingivectomy depends on the available attached and keratinized gingiva.
If minimal attached and keratinized gingiva choose and intrasulcular incision
and reflect at least one tooth distal and one tooth mesial (general guidelines).
3. If adequate tissue quality, use an internal bevel incision and a ~2mm discard
of tissue. Extend the incision from the mesial line angle of the distal tooth to
the distal line angle of the mesial tooth. It will depend how many teeth you
are treating The tooth requiring crown lengthening: extend from the mesial
line angle and gradually connect to the gingival line of the mesial tooth. Also
extend from the distal line angle and gradually connect to the gingival
margin of the distal tooth. Study the photo below.

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4. Remove provisional crown and clean according to your protocol
5. If multiple teeth need crown lengthening, the above describe incision will
overlap creating a flap with a scalloped pattern. The tip of each scallop is
called a surgical papilla (SP).
6. Repeat the incision with an Orban knife.
7. Remove the excess tissue with the Orban or a curette.
8. Create a secondary intrasulcular incision with the Orban
9. Reflect a full thickness flap beyond the mucogingival junction
10. Assess the intended finish line and where crown lengthening is needed
11. Use the end cutting crown lengthening bur (interproximal use a small size).
This but will create a step in bone
12. Use a diamond round bur to eliminate the step and blend bone levels to the
adjacent teeth
13. Osteoplasty with the same round bur (concave between the roots and
convex around the roots).
14. Use the Sugarman file in the interproximal area. Create a mild peak of bone
(minor)
15. Use the Ochenbein and straight chisel for final ostectomy and osteoplasty
16. Saline irrigation under the flap
17. Suturing the interproximal area (simple interrupted or figure 8 with gut
5/0). You will occasionally need vertical mattress sutures in the posterior
mandible,
18. Cement temporary crown temporarily
19. Post operative instructions
20. 1 week follow up

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Coronally repositioned flap

1. Local anesthesia: depending on the tooth/area to be treated

2. Scaling and root planing. Remove existing restoration (if shallow)
3. Chemical preparation (optional). I use a tetracycline (capsule content mixed
with saline to create a paste). Use the paste for 20 seconds on the root
surface and irrigate.
4. Intrasulcular incision (extend at least 1 tooth distal and 1 tooth mesial to the
area/tooth to be treated). Use a #15 blade. In the interproximal area there
are 2 options. Split thickness line angle to line angle or a triangular shap.
5. Start as a full thickness flap for 2-3 mm from the free gingival margin


6. Hold the flap with cotton pliers and use a new #15 blade for split thickness
flap. Once you extend into mucosa take care not to perforate the flap.
7. Create sufficient release of the flap to allow coronal reposition.
8. Ensure minimal tension and extension into the crown aspect.
9. Depending on the procedure (CT, allograft protocol)
10. Suturing: Prolene 5/0 with a continuous sling suture
11. Knot tails should be left extra long to prevent poking
12. Hemostasis with gauze (no apical pressure).
13. Post operative instructions and give soft brush
14. 1 week follow up

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www.surgicalmaster.com

All right reserved to Pranadent LLC

www.surgicalmaster.com

All right reserved to Pranadent LLC