Contemporary dental treatment must result in true oral health, incorporating comfort, function and aesthetics. The key to a successful outcome with long-term stability is the establishment of an accurate diagnosis and subsequent development of a .comprehensive treatment plan. The astute clinician will recognize underlying skeletal variations that may not be corrected by periodontal and restorative procedures alone. Understanding the cause of the condition to be treated will facilitate selecting and sequencing procedures that will produce a stable result. Attention should be given to facial symmetry, face height, lip anatomy, profile and smile line when performing the extraoral examination. Intraorally, important considerations include condition and dimensions of the teeth; height of the anatomic crowns versus height of the clinical crowns; thickness, width, position and contour of gingival tissue; root anatomy; and topography of the alveolar bone. The integrity of the dentogingival junction must be observed by ensuring adequate biological width. Harmony must exist between soft and hard tissue and between the periodontium of adjacent teeth. Often a combination of orthodontic extrusion and surgical crown lengthening can be employed to minimize the need for resective therapy on adjacent teeth, improve the crown-root ratio and facilitate a more aesthetic outcome. Orthodontic extrusion is also invaluable as a means to regain lost height of interdental papillae. Margin placement during tooth preparation for full coverage restorations should be guided by the position of the cementoenamel junction; hence, interproximal margins, particularly on anterior teeth, will be more coronal than buccal and lingual margins. This will help ensure adequate biological width and maintenance of healthy, intact interproximal papillae. When periodontal surgical procedures are performed in anterior areas, it is necessary to defer placement of final full coverage restorations for approximately 6 months in order for the level of the gingival margin to stabilize. In patients with particularly thin buccal alveolar bone and gingiva, it may be prudent to monitor maturation of the healing tissue for a longer period of time, and in patients with relatively thick buccal alveolar bone and gingiva it may be reasonable to place final restorations less than 6 months following periodontal surgery. Effective daily plaque control and periodic recall are essential to maintain long-term stability. By following the guidelines outlined in this chapter, the clinician will promote a stable, comfortable and functional periodontium and provide the patient with an optimal aesthetic result.
