What is crown lengthening and how it is done?

crown lengthening

Crown lengthening involves the surgical recontouring of gums to expose the sound area of the tooth and allow reattachment of the gum lining and intervening connective tissue to a new position on the root. 

Who does the crown lengthening surgery?

A restorative dentist or periodontist performs a crown lengthening procedure. 

Is crown lengthening painful? 

No, it isnot painful because it is done after numbing the gums so that you won’t feel any pain during the procedure. However, some discomfort may be felt after the anesthetic wears off. Your dentist will prescribe you pain medications to control that pain.  

Which patients are eligible for a crown lengthening procedure

Crown lengthening can be carried out with one or more teeth depending upon the individual scenario.

If you have a gummy smile, then all the teeth in the aesthetic zone require crown lengthening followed by veneers or a bridge. However, a cavity or a tooth broken at the gum line requiring a filling or crown may need a crown lengthening procedure. It is important to note that not every tooth is a candidate for crowning lengthening surgery.

Moreover, chronic gum inflammation secondary to the placement of a filling or crown that impinges on biological width (described see below) may also be treated with crown lengthening procedures.

Which factors limit the crown lengthening surgery

If you have short roots, you can’t have a crown lengthening procedure. The root exposure will disrupt the crown-root ratio of the tooth, exerting more pressure on the crown and leading to mobility and loosening of the tooth. 

Considerations before crown lengthening surgery

Anatomical considerations

The combined width of the gum lining (junctional epithelium) and the underneath connective tissue attached to the tooth above the bone should be 2mm. This combined thickness of tissue is known as biologic width. 

The biological width is a constant feature in human teeth and is suggested as an immutable therapeutic parameter. Any impingement of biological width will result in attempts by gum tissue to reattach to the original dimension through the resorption of the underlying bone. If the bone is too thick to resorb, it results in chronic gum inflammation.

Moreover, the junctional epithelium is one cell thick, and cells are loosely connected. Thus, insufficient space for the soft tissue attachment to the tooth will not effectively seal the tissues from the external environment. Also, the area is prone to damage by regular mechanical oral hygiene practices.

Bone sounding 

The level of bone and quality of bone is determined before opting for the crown lengthening procedure. The degree of crown elongation, the thickness of the soft tissues, and the position of the bone will decide if the procedure requires bone removal or not. The cases with more significant soft tissues lying above the bone requiring mild exposure of the root are treated with only soft tissue removal without bone removal. 

Bone removal makes the surgery more complex, with greater complications in the longer run. 

Techniques involved in crown lengthening surgery

Gingivectomy

For crown lengthening with excessive soft tissue requiring no bone removal, a gingivectomy procedure can be carried out. 

The gingivectomy involves numbing the gums with a local anesthetic injection and removing gum tissue using a scalpel or laser. This procedure removes excess gum tissue and gives a more symmetrical and aesthetically pleasing smile. The soft tissue takes 4-6 weeks to heal. 

Apically repositioned flap with bone recontouring

For crown lengthening, where the removal of gum tissue will influence the dimension of biological width, a two-step surgery with bone removal is required.

In such cases, the gum tissues are removed, and the provisional crowns of desired crown length are placed during the first surgery.

Due to the violation of biological width, the gum tissues will try to reestablish the dimension upon removal. However, the body doesn’t respond to bone resorption immediately, and bone contouring can be scheduled separately after the gum healing. 

Later, a full-thickness mucoperiosteal flap is reflected to gain access to the bone, preserving the interdental gum tissue. Bone removal at a later stage prevents gum recession and open embrasure spaces. 

The margins of the provisional crowns serve as a template and guide the dentist during the bone contouring. The flap is repositioned at a pre-operative level, and the wound is closed and stitched. 

When to Call the dentist’s office 

It is normal to have mild discomfort and minor bleeding after the surgery. However, if you experience excessive bleeding or throbbing pain after crown lengthening, call the dentist’s office. 

Crown lengthening vs. implant – Which is better?

Crown lengthening is carried out to retain and preserve a natural tooth that cannot be saved without exposing its root. 

The implant is a prosthesis placed at the site of a missing tooth. The implant body resembling the root of a tooth, fuses with the surrounding jaw bone, thus stabilizing the implant in its place. A crown is finally placed on it.

Read more: The truth about dental implants – 11 facts you need to know

The dentist always tries to save the natural tooth in the best possible way, so crown lengthening is suggested for the teeth fractured at or slightly below the gum level or to uncover the sound tooth structure to place a crown. The fractured teeth restored with crown lengthening shows a high clinical success rate over the years (6 years and over). 

On the contrary, implants are reasonable when a tooth can’t be saved and needs removal. 

Read more: When is a tooth beyond saving?

How much does crown lengthening cost 

It will cost you around $300 to $600 for a single tooth, but if multiple teeth require surgery, it may cost around $1000 to $4000. 

What are the alternatives for crown lengthening?

If you want to avoid crown lengthening surgery, you can either opt for the following:

Crown lengthening recovery 

Recovery time

Crown lengthening recovery takes time, depending upon the extent of surgery. Usually, it is recommended to limit your physical activity after the surgery for the first 24 hours. Also, keep your head elevated by placing an additional pillow under your head to avoid any build of fluid (swelling) at the surgery site. 

Ice application

After the surgery, it is advised to place an ice pack wrapped in a cotton cloth on the side of the surgery over the face for 15-20 mins. Repeat the procedure 2-3 times with 20 mins intervals. Cold therapy reduces pain, inflammation, and facial swelling.  

Medications

 Your dentist will prescribe you pain medication for pain control. Ibuprofen 400mg 0r 600 mg 6 hours is effective for mild to moderate pain following the procedure. 

Take the antibiotics as instructed if your dentist has prescribed them.  

Dietary guidelines

 Eat a soft and protein-rich diet for a few days after the surgery. Gradually switch to the regular diet as the gums begin to heal.  

Oral hygiene instructions

 Don’t brush your teeth at the surgery site until your dentist tells you. Clean the other areas of the mouth as usual.  Rinse your mouth with an antibacterial mouthwash in the morning and evening to keep the surgical site clean from food particles. 

Conclusion 

Crown lengthening is the surgical reshaping of the gums to expose the sound area of the tooth and allow reattachment of the gum lining and intervening connective tissue to a new position on the root. 

It is done to correct a gummy smile, cavity, or fractured tooth at or slightly below the gum line. However, if you have short roots, this surgery is not for you as it can disturb the crown-root ratio leading to the loosening of the tooth. 

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