I have a 70-year-old patient with an unremarkable medical history who presented to my office complaining of "swollen gums" since her all ceramic crowns were placed two years ago:

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The radiographs were inconclusive.

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I could palpate irregular crown contours and questionable margins, and periodontal charting showed generalized 4-5mm pockets in this area, which I believed were pseudopockets. I informed the patient that an exploratory flap procedure would be necessary to assess potential causes, and she consented. The patient declined referral to a periodontist, which is OK with me because I am comfortable with many surgical procedures. I initiated therapy with PerioSciences gel for two weeks, which reduced the inflammation significantly.

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Since this patient was a thick biotype, I opted for a two-phase surgery. First, using the Waterlase MD, I performed a gingivectomy to the desired gingival height based on FGTP principles.

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I then advanced a full thickness flap from 5-12, which exposed irregular boney topography with nodular exostoses beginning at the facial gingival crests and extending 2-3mm apically in various areas as well as substantial interproximal fibrotic tissue.

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I recontoured the bone to "normalize" appropriate boney anatomy and debrided the fibrotic tissue, sending in a specimen for biopsy.

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I closed with interrupted interproximal vertical mattress sutures and dismissed the patient with post-op instruction, an Rx for Pen VK and ibuprofen.

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QUESTION: Would you bill this as osseous crown lengthening or gingivoplasty with exostosis removal?

Obviously, the restorative needs must be addressed. I believe that this chronic inflammation is due to a history of biologic width compromise. Any thoughts?

Thank you!

Kevin