Identification, Evaluation, and Correction of Supracrestal Tissue Attachment (Previously Biologic Width) Violation: A Case Presentation With Literature Review

Abstract

The supracrestal tissue attachment (SCTA) is the new terminology for biologic width. SCTA is defined as the physiologic dimension of a solitary functional unit composed of junctional epithelium and connective tissue attachment. Its preservation is critical for the well-being of periodontal health. SCTA has been widely studied and scientific literature is indicative of its significance during the placement of restoration, including prosthetic crowns. This should be taken care of in cases of anterior teeth within the smile zone, where dental crowns are regularly placed subgingivally for aesthetic reasons. In addition, any violation of SCTA while restoring the dentition will present as gingival inflammation and pain, consequently, leading to failure of the clinical procedure.

Keywords: biological width; biological width violation; deep margin elevation; dental crown; ferrule; precision; rapid orthodontic extrusion; restorative margin; slow orthodontic extrusion; supra crestal fiberotomy.

Figure 1. Clinical images

A: Intra-oral picture showing gingival inflammation in teeth 35 region B: Intra-operative picture showing periodontal measurement during crown lengthening with apically displaced flap and osteotomy Image credit: Mohammad Nazish Alam

Figure 2. Intra-oral periapical radiograph showing crestal bone loss due to SCTA violation

SCTA: Supracrestal tissue attachment

Figure 3. Figure representing average dimensions of SCTA

SCTA: Supracrestal tissue attachment Image credit: Syed Wali Peeran, Tahir Bijli

Figure 4. Consequence of violations of SCTA

SCTA: Supracrestal tissue attachment Image credit: Syed Wali Peeran, Karthikeyan Ramalingam

Figure 5. Clinical images

A: Pre-operative image showing compromised crown height in teeth 37 B: Post-operative image of crown lengthening by gingivectomy on the lingual side and flap surgery on the buccal side Image credit: Syed Wali Peeran, Karthikeyan Ramalingam

Figure 6. Radiographs showing deep margin elevation method performed on the mesial aspect of teeth 15

A: Pre-operative radiograph B: Post-operative radiograph Image credit: Syed Nahid Basheer, Reem Hassan Kelani