Biologic Shaping: An Alternative to Extracting a Tooth with a Severe Fracture
Article and Clinical Photos by Daniel J. Melker, DDS
When a cusp of a tooth is fractured subgingivally
approximating the bone, extraction is a commonly
considered treatment, due to concern about the significant
bone removal required by other procedures to create
space for the biologic width. That being said, addressing
this primary concern of removing bone to create space for
the biologic width presents the alternative procedure of
The premise for traditional crown lengthening to preserve
a fractured tooth is that the surgeon must remove enough
bone, starting from the most apical portion of the fracture,
to create space for the biologic width. This method can
result in a significant loss of bone, tooth mobility and, if
the fracture is located near the furcation, a compromised
Biologic shaping offers an alternative to conventional crown
lengthening through removal of the fractured portion of the
tooth, allowing for a new biologic width to reform without
significant removal of bone. The case presented here
illustrates this technique.
Figure 1: Provisional crown placed after the buccal cusps of tooth
#30 fractured approximating the bone.
Figure 2: Removal of provisional crown to access the fractured tooth surface.
Figure 3: Reflected tissue verifying location of fracture into the furcation and approximating the bone.
Figure 4: Removal of fractured tooth surface using a coarse
Figure 5: Smoothing the tooth's surface using a superfine diamond bur (40 microns) to completely remove the old fractured portion of
the tooth surface.
Figure 6: Smoothing the root surface creates a parabolic architecture to mimic the soft tissue contours, allowing for a new biologic width to reestablish without having to significantly alter the bone.
Figure 7: After 12 weeks of healing and the establishment of the biologic width, a new crown was placed just coronal to the gingival
collar. Notice that the location of the new margin is in perfect harmony
with the adjacent teeth.
When performing traditional crown lengthening for a
fractured tooth, the potential need to remove excessive bone
to create space for the biologic width is cause for concern.
Conventional thinking is to locate the apical location of
the fracture and start removing bone from that point. With
biologic shaping, however, the fractured portion of the
tooth is removed first to preserve as much bone as possible.
This conservative procedure can avoid excessive removal
of bone and help preserve bone in the furcation area,
leading to long-term stability and a successful restorative