A Step-by-Step Guide to Virtual Crown Lengthening

If you have been following my Spear Digest articles thus far, you will recall the concept of Analog-Virtual Interchange. As I stated in my previous article, “5 Steps to Improving Case Acceptance,” AV Interchange is a treatment presentation that walks a patient from analog to digital and back to analog. It all boils down to communicating with patients in a very easy-to-understand graphic way.

In this article, I am going to show you another method that I’ve found helps improve case acceptance, this time solely utilizing the “V” portion of AV Interchange. I call it Virtual Crown Lengthening. This method of treatment presentation allows us to illustrate and communicate what can potentially be the results if and when we choose to do clinical crown lengthening to a patient.

Now, there are numerous pieces of costly software with which you can get very sophisticated – sometimes too much so. However, I’ve found that there’s nothing better than utilizing the simplest tools to immediately show the potential results to your patients. My tool of choice for Virtual Crown Lengthening is Powerpoint. As I explained in my last article, I’ve found the tools within Powerpoint to be simple and effective.

I am going to focus on a recent patient of mine who has short clinical crowns and a pretty gummy smile. She hates it. When she explained to me what she was looking to have done, I knew I had to find a way to readily explain to her how she could look if she has her central incisor the length that she should have them. And I knew I had to show her this in a way that would make her say, “Wow, how did that happen?!”

Before I jumped into Powerpoint, I took photos of the patient's mouth, both a retracted view and a natural smile view. Then I created two separate presentations. Below, I’ve broken down the steps for each one. A basic understanding of Powerpoint is required, though I’ve done my best to guide you through the process.

The Retracted View

1. Open Powerpoint and create a Blank Presentation.

2.  Delete the pre-added boxes.

3. Click on the Insert tab at the top and then click on Pictures. Find and select your retracted-view image, then click “Insert.” Remember, this is the retracted-view image of the six-inch area of teeth.

4. With the image selected, copy the image and paste the copy over the original (CTRL+C then CTRL+V works well here).

5. Select both images by holding the CTRL key and clicking on both. Now, in the “Picture Tools” in the “Format Tab,” click on the “Align” dropdown menu. Select “Align Left” and then “Align Bottom.”

6. Now, click away from the images and then select only the top image. Put the cursor at the top of the edge of the image and drag up to elongate the image. You’ve just virtually lengthened the crown.

7. Click on the “Animations” tab. Make sure the top image only is selected and then click on “Add Animation.” From the menu, go to the Enter box and click on “Fade.”

And that’s it! Now you can open up this presentation and show it to your patient. The fade allows them to get a better idea of the change they will see in their own mouth. Click play on the video below to see it in action.

Some of you may be asking,” How much did you elongate the image?” I only had to utilize the clinical criteria we’ve been talking about for years: a central incisor’s length-to-width proportion is within the 70-80 percent range. So I virtually lengthened the teeth until I reached the 70-80 percent length-to-width proportion. For example, if the length of the tooth is 10 mm, the width should be 7.5 mm. And we typically understand the crown of a maxillary central incisor to be within the 10-to-11 mm length. Utilizing those parameters, I measured the tooth on-screen and then distorted the image to get to that ideal proportion.

(Click this link to read more about how to approach problems of tooth proportion.)

The Natural Smile View

The retracted view for Virtual Crown Lengthening helps the patient understand what exactly is going to happen inside their mouth if they choose this treatment. However, what most patients are concerned about when they come in to discuss crown lengthening is esthetics. The best way to show them how they’ll look post-treatment is to create a Virtual Crown Lengthening slide using a natural smile image.

For my patient with short clinical crowns, I wanted her to see the impact of how she could look along with all the references – the maxillary lip, the lower lip and the occlusion. Using the steps below, nothing really changes other than the position of the gingiva.

Here’s how I did it for my patient:

1. Follow steps 1-5 of the Retracted View process.

2. Select only the top image. Now, use the “Crop” tool to cut out everything but the maxillary teeth as much as possible.

3. Click on the “Picture Effects” dropdown menu and then select “Soft Edges.” You may have to play with the settings a bit depending on the image, but I would start at about a 5 point.

4. Virtually lengthen the crown by dragging up from the top of the image; this keeps the lip layer same, but the crown is now lengthened.

5. Click on the “Animations” tab. Make sure the top image only is selected and then click on “Add Animation.” From the menu, go to the Enter box and click on “Fade.”

Click play on the video below to see this version of Virtual Crown Lengthening.

 A Glimpse of the Future

At this point, I wasn’t really worried about the actual treatment method, and you shouldn’t be either. It’s about showing the patient what her or his mouth will look like after treatment. We don’t want to overwhelm the patient with too much information – not yet, anyway.

The bottom line is that your patient has a visual, a visual that’s the next logical step after an animated image in a patient education video (which is a good place to start). Instead of imagining how it would look in their own mouth, we can give them a glimpse of a possible future in which they have the dental esthetics they’ve always wanted.

(Click this link to read more dental articles by Dr. Ricardo Mitrani.)

Ricardo Mitrani, D.D.S., M.S.D., Spear Faculty and Contributing Author