What is the Crown Lengthening Procedure?
Some people have excess gum tissue that partially obscures the crowns of their teeth, making the smile appear excessively gummy while concealing potential dental issues. Crown lengthening is a periodontal procedure that aims to expose more of the tooth structure by adjusting the amount and position of the gum tissue. For some patients, this procedure is strictly cosmetic, designed to improve the appearance of a gummy smile. For other patients, the crown lengthening procedure is needed so that additional tooth structure, including damaged or decayed areas of the tooth, can be exposed before a crown or other dental restoration can proceed. Because many dental restorations, like dental bridges, rely on the natural teeth for support, crown lengthening helps give these restorations a more supportive base by exposing a larger part of the tooth structure, while also allowing areas of damage or decay to be treated before restorations are placed.
Crown lengthening can be performed on a single tooth, several teeth, or on an entire row of teeth, depending on the reason for the procedure and the desired results. If you’re interested in crown lengthening, either to improve the appearance of your smile or for another reason, you should start by seeing your dentist for a checkup and a consultation. Dentists recommend that crown lengthening patients are in good overall health and have healthy gums before beginning any procedure; if necessary, they may recommend dental fillings or periodontal treatment to restore the health of the oral cavity before crown lengthening.
The initial periodontal consultation involves an assessment of the teeth, gums, and other oral tissues and structures. This assessment helps the dentist decide which surgical technique to use and also helps them determine the optimal location for the gum line. Certain factors affect the choice of surgical technique, including aesthetic concerns, the ratio of the crown to the tooth root, the position of the affected tooth, the presence of bone loss, and the possible need for a crown or filling. There are three commonly used crown lengthening procedures: gingivectomy, apically repositioned flap surgery, and surgical extrusion.
Any crown lengthening procedure, no matter what type, is performed while the patient’s oral tissues are numbed by a local anesthetic. During a gingivectomy, the excess gum tissue is removed, either with a laser or a scalpel or through cauterization. Typically, the gums heal completely within 4 to 6 weeks, though pain resolves within a few days to a week after the procedure. For an apically repositioned flap surgery, the dentist makes an incision in the gums, creating a flap in the gum tissue. This flap is lifted, allowing the dentist to remove excess tissue and possibly bone, if needed. Once the tissue has been modified, the flap is repositioned, closer to the tooth’s root, and stitched into place. Healing times for apically repositioned flap surgeries depend on the amount and type of tissue removed; when bone is removed, healing can take longer. Surgical extrusion requires that the tooth itself be moved to the preferred location. This method is often used when a tooth is broken or fractured underneath the gum tissue. Dentists secure the extruded tooth with stitches and may also use splints or wires to anchor the tooth in place.
Crown lengthening isn’t a good idea for every patient, and only a dentist can tell you for sure if you’re a good candidate for the procedure. You may be referred to a periodontist, who specializes in procedures involving the gums, and you may also work with other dental specialists, depending on the reason for your treatment. Regardless of the reason, the collective goal is to restore the balanced appearance and healthy function of the natural teeth.