Also referred to as crown extension, crown lengthening is a standard surgical procedure, a minor periodontal surgery, which seeks to reveal more of the natural tooth above the gum for the crown to grip.
During this painless oral surgical procedure, the dentist re-contours the gum tissue, as well as the underlying bone, in preparation for cosmetic or restorative procedures, or simply to improve the health of your gums. The procedure can also be used to correct a “gummy” smile, which is characterized by excess gum tissue covering the teeth.
Crown lengthening is one of the most commonly required procedures in periodontal practice, yet it is often underutilized.
Image: Crown lengthening before and after photos
Crown Lengthening Indications
There are many uses and benefits of crown lengthening, with many of the patients who have undergone this surgery being greatly pleased with the outcome. Some of the reasons why your dentist may recommend a crown extension include:
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To support a filling or crown
Sometimes, there may not be enough of the tooth sticking out above the gum to support a filling or crown, like when:
- A tooth breaks off at the gum line
- A filling or crown falls out of a tooth and there’s decay underneath
In such instances, when there’s fracture or decay under the gum line, your dentist can recommend crown lengthening to help expose more of the damaged tooth in order to prevent the new crown from damaging bone and gum tissues once it is in place.
The procedure creates more space between the dental crown and the supporting jawbone, to keep the new crown from destroying bone and gum tissue once put in place. As such, this procedure will promote stability of the crown, retention, and resistance to fissure from the root.
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To preserve the health of the periodontium
Dentists usually try to maintain a minimum distance of 3mm from the crown margins to bone to enable proper soft tissue attachment. So, crown lengthening may be needed to adjust this biologic width, and:
- To eliminate chronic inflammation/irritation; pain and discomfort; and bone loss around an existing crown that may cause width impingement
- To adjust soft tissues and bone away from the proposed crown margins to prevent biologic width impingement after crown cementation
- To avoid worsening tooth prognosis while maintaining an appropriate crown-to-root ration of 1:1, and while minimizing the reduction of bone and soft tissue of the adjacent teeth
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For cosmetic purposes
Extra gum tissue not only makes the teeth look unnaturally short, but also increases susceptibility to periodontal infections. Crown lengthening to remove the excess gum tissue can help restore a balanced, natural, and healthy look, improving the aesthetic appearance of your smile.
Your cosmetic dentist may recommend crown lengthening to:
- Rectify a “gummy” smile, whereby teeth appear to be unnaturally short because they are covered with excess gum tissue. Too much gum cover also increases the risk of periodontal infections, which when removed, can restore a healthy, balanced, and aesthetically pleasing smile. In some instances, an uneven gum line can cause the teeth to seem irregular, so a dentist can correct this by reshaping the gum.
- Prepare the mouth area for cosmetic or restorative procedures to restore damaged teeth. Periodontal disease, trauma, and decay can severely damage one’s teeth. In instances where teeth are broken below the gum line, this procedure can be performed to enhance the health of the gum tissue.
What to expect during crown lengthening procedure
Before the procedure starts, the patient should visit a periodontist in order to have his/her medical history and X-rays reviewed, and to set a date for the surgery. Prior to the surgery, you may require professional tooth cleaning or a temporary crown, if your tooth needs one, to protect it and make the procedure easier.
The procedure itself is usually performed under local anesthetic, though the duration of the surgery depends on various factors including:
- Number of teeth involved
- Whether any bone will be removed
During the procedure, the periodontist will make a series of tiny incisions around the soft tissue to distance the gums from the teeth, and allow access to the teeth roots and surrounding bone. In some cases, only a small amount of gum tissue needs to be removed to expose adequate tooth structure for crown placement of filling. However, most situations require the removal of some bone from the area around the teeth roots.
Once enough tooth structure is exposed, the dentist washes the surgical area using sterile salt water, before stitching the flaps together. In some cases, an intraoral bandage may be used to cover the surgical area.
If the patient has temporary crowns, they are removed before the surgery and replaced afterwards.
Crown Lengthening Recovery Time
Once complete, the patient is given a chlorehexidine mouth rinse and prescriptions for pain medication. The area should heal completely in about three months, but before then, you should maintain a soft diet and avoid the gums when brushing your teeth.
As your gums recover, you’ll be able to resume routine activities. For the first two to three days, you should avoid intense activities. A physically demanding profession, hard lifting, or excessive exercise may slow your healing and increase bleeding.
Crown Lengthening vs Gingivectomy
A gingivectomy is similar to a crown lengthening procedure. It achieves the same objective without the need for bone removal. The dentist simply removes soft tissue during a gingivectomy. Surplus gum tissue can occasionally be removed by a dentist using a scalpel or a laser. It only includes gum restructuring.
If the gum has a position or contour, a gingivectomy may be required. Some people get it done to improve their teeth’s aesthetic look. It “lengthens” what is visible by exposing more crown. Trimming the bone that supports the teeth in place may be required for crown lengthening. The “visible tooth structure” is referred to as a “crown” by dentists.
A final restoration can be hampered by insufficient tooth structure or extra soft tissue. You can have a gingivectomy to remove excess harmful tissue for cosmetic purposes.
It can also be used to detect deterioration beneath the gum line. Have you tried antibiotics or root planing and scaling to get rid of your gum disease?
If these therapies fail, your dentist may recommend a gingivectomy. The surgery involves trimming and reshaping diseased, loose gum tissue. Hollows between the teeth and gums will also be removed.
Crown lengthening entails reshaping the gums as well as the bone surrounding the tooth. Crown lengthening is performed by dentists to allow for the installation of a filling or crown. The most common cause for gingivectomy is for cosmetic reasons.
Crown lengthening can only be done by a periodontist, who specializes in the tissue that supports and surrounds the teeth.
These are two methods that are related. The dentist will select one based on the ultimate goal, or what the client hopes to accomplish.
FAQs
What is the Duration of Crown Lengthening Procedure?
Crown lengthening is an outpatient procedure that is typically performed under local anesthetic. The duration of the procedure depends on the number of teeth being treated. But even when only one tooth is involved, the adjacent teeth are also involved so the tissues can be reshaped gradually. Procedures that involve the removal of soft tissue take less time compared to those also require the removal of the underlying bone.
Is Crown Lengthening Painful?
Crown lengthening is a relatively painless surgery. Patients do not experience any discomfort because local anesthetic is used. You may experience some pain when the anesthetic wears off, for which your dentist will prescribe pain medications.
Who is a suitable candidate for crown lengthening?
Your dentist may recommend crown lengthening if you have excessive gum tissue that is making your teeth look shorter than they actually are, usually for cosmetic reasons to improve the appearance of a “gummy smile.”
However, you should:
- Have healthy teeth and gums
- Be free from any active periodontal disease.
- Have enough tooth structure to support the procedure
- Have realistic expectations for the outcome.
A thorough examination by a dental professional is necessary to determine if crown lengthening is appropriate for you.
Final Thoughts
Improved periodontal health and a beautiful new smile are your keys to speaking, eating, and smiling with comfort and confidence. Your local dentist can help you learn more about crown lengthening and identify whether this is the right procedure to enhance the appearance, health, comfort, and function of your mouth.
