There are certain dental procedures that are not easily explained to our patients. People understand a filling, an extraction, and so on. But biologic width and crown lengthening are challenging concepts to put into words despite their importance. I often fumbled with my words for my first few years in dentistry, either confusing the patient or boring them to death.
"Epithelial layer? That's fascinating... please continue, doctor."
So you’re excavating decay on a tooth that is scheduled for a crown. Suddenly you notice that the decay extends far subgingivally. A deep subgingival margin and a bleeding sulcus hint that you are not taking an impression today. You sound to bone with your periodontal probe and discover there’s less than 2 millimeters from the margin of the preparation. It is officially crown lengthening time.
You understand the concepts of biologic width… but how to you convey this to the patient? If you’re like me, you don’t perform the procedure yourself; you refer to a periodontist. Now you have to also explain that the patient has to go somewhere else for this surgery and wait several weeks for the impression.
As I’ve discussed in another post, words will make or break you. Violating biologic width can be a difficult process to grasp for the patient, so I use a metaphor that gets the point across.
“Well, you have some deep decay there. Your decay is so deep that it actually runs beneath the gums and close to the bone. We can’t put a crown on this tooth the way it is. As far as your body is concerned, the crown is foreign material and your bone is inside your body. It’s like when you get a splinter. If you leave the foreign material inside your body, your body will attack it, causing discomfort. If we put a crown on this tooth the way it is, your body will attack it as if it were a splinter.
There’s a simple solution. I’m going to have a friend and colleague of mine change the shape of your gum and bone in that one area to create enough room. That way the crown will be outside your body and you won’t feel any discomfort.
It will take a few weeks for the gum to heal enough for me to take the impression. This is routine dentistry; nothing out of the ordinary. Once you’re all healed, I’ll get you fitted with a great crown.”
The splinter metaphor is familiar to the patient. They instantly grasp the concept of biologic width by recalling their experiences with splinters. They also immediately understand the need for crown lengthening since they know how uncomfortable a splinter in their finger can be.
I didn’t have to draw any diagrams or confuse them with fancy dental terminology. And the inflammatory process that occurs with a splinter in your finger is not that dissimilar from an invasion of biologic width, so the metaphor is not far-fetched.