What is a Circumferential Supracrestal Fiberotomy?

CSFMy patients know that as a periodontist, I am in the profession of treating all gum related issues. Among the many periodontally related techniques that I perform, the circumferential supracrestal fiberotomy is especially helpful when used following orthodontic treatment.

Besides a tongue-twister, what is a circumferential supracrestal fiberotomy (CSF)? Put simply, a CSF is a surgical procedure used to prevent teeth that have been rotated due to orthodontic care, i.e. braces, from un-rotating back to their former position.

During orthodontic correction, the teeth shift and sometimes, rotate, causing the elastic gum tissue, called supracrestal gingival fibers, to become stretched and twisted during the rotational tooth movement. After braces are removed, this flexible tissue will try to morph back into its former position and may cause the teeth to relapse. Relapse, which is the shifting of the teeth back to their original position, is largely due to the force the tissue exerts on the root structure as the tissue resettles post-orthodontically.

The CSF is designed to prevent this relapse of the teeth to their original position prior to the corrective rotation (twisting) of the teeth that occurred during orthodontic treatment. The fibers act like a twisted rubber band; the force that the fibers exert as they attempt to untwist pulls the teeth back to their original position. CSF reduces the rotational relapse of orthodontically aligned teeth through the releasing of the connective supracrestal fibers that attach the tooth to the bone.

The CSF procedure is performed by creating an incision around the gingival crevicular region that surrounds each tooth. In other words, I make a small cut in the gum line in the upside-down u-shape area that surrounds each tooth, relieving each tooth structure from the pull of the fibrous tissue. Performed under anesthesia, the procedure is virtually painless. Furthermore, using the Waterlase laser technology, I can create a quick, clean incision that releases the tissue with ease.

To conclude, I perform the CSF technique following orthodontic treatment, releasing fibers from newly-adjusted teeth to prevent the teeth from rotating back to their original position in the gums. Afterward, new fibers begin to grow in alignment with the new position of teeth to ensure that the gums and teeth remain in their proper position.

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