In one of my recent cases, I used active intrusion of two maxillary central
incisors to reposition their gingival margins in an apical direction. These teeth
were then restored with porcelain laminate veneers, and the final result was
esthetically improved with regard to both clinical crown lengths and labial marginal
gingival levels. This case indicates to me that orthodontic treatment can
contribute to results that are difficult, if not impossible, to obtain by other
means of esthetic dentistry. Furthermore, a recent AJODO article1 from a team
in Hong Kong demonstrated that the labial gingival margin of a maxillary canine
substituting for a congenitally missing lateral incisor was moved almost 9 mm
incisally by means of orthodontic extrusion. These cases imply that the potential
of an orthodontist in improving gingival levels may often be overlooked by other
dentists. As far as I know, most research on orthodontic intrusion and extrusion
of teeth has dealt with tissue reactions other than changes of the gingival levels.
What is actually the present knowledge or state-of-the-art when it comes to
changes in crown lengths and repositioning of gingival levels associated with
tooth movements in the vertical plane? —Arni Thordarson, Reykjavik, Iceland
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