Definition and Overview

Crown lengthening is a type of dental surgery that general dentists and periodontists perform with the goal of exposing a greater part of the tooth. To do so, the surgeon must remove some of the gum tissue and bone surrounding the tooth. This procedure can be done by itself when a person has excess gum and bone tissue covering a big part of his teeth, or as a preliminary procedure when a tooth that needs to be treated or repaired is obscured or does not protrude enough to support a dental crown or filling. In the latter case, a dental crown or filling is placed after the crown is sufficiently lengthened.

Who should undergo and expected results

A crown lengthening procedure, when done by itself, is beneficial for people who have what many call a “gummy smile”, which is when a person has more gum tissue surrounding the teeth, usually those in the upper jaw. Having a “gummy smile” makes teeth appear shorter because the upper half is obscured by gum and bone tissue.

The most common use of the crown lengthening procedure, however, is when a person needing a dental restorative treatment such as a crown or bridge does not have sufficient exposed tooth structure to support a restoration. This procedure adjusts the level of the gums and bones to expose more of the tooth, so that it can hold a restoration in place.

This procedure is also performed to give dentists better access to decayed or damaged tooth, such as a tooth that is broken below the gum line, during the actual treatment procedure.

How the Procedure Works

Crown lengthening can be performed by dental surgeons and periodontists. It is performed at the dentist’s office while the patient is under local anesthesia. The time it takes tends to vary on a case-to-case basis, and is determined by the following factors:

• The purpose of the procedure – Repairing a gummy smile can take a long time since all the upper teeth have to be lengthened one by one. However, even in cases wherein only one tooth has to be treated, the neighboring teeth usually need to be included in the lengthening process.
• The type of tissue that needs to be removed – If only soft tissue has to be removed, the procedure won’t take long. However, if the dentist also has to remove some bone tissue, the procedure will naturally take longer.

The procedure works by making small incisions in the gums surrounding a tooth. Once enough tooth structure has been exposed, the dentist will wash the area with sterile water and stitch the gums back together. If necessary, a bandage may also be placed. Post-procedural care typically involves icing the area for the first few hours to make the swelling go down, as well as a mouth rinsing solution and pain medications, which the patient has to take for a given period of time.

Around a week after the procedure, the patient may have the stitches removed. Follow-up visits are also usually scheduled 4 to 6 weeks after the procedure. This visit is intended to make sure that no complications arise.

Patients are given instructions on how to clean the teeth while the surgical area is still recovering, which may take as long as three months. Patients need to brush their teeth as usual, but they need to carefully avoid the gums in the surgical area. If there are food particles stuck, these should be carefully removed using a toothpick or water irrigator. If the crown lengthening is a preliminary procedure, the actual treatment, such as a restoration, should be placed only after the full healing period of three months to ensure best results. This is because gums tend to shrink during the healing process; thus, if a crown is placed too early, the gums may continue to shrink even after the procedure, causing the edges of the crown to become exposed.

Possible risks and complications

Potential risks of the procedure include:

• Bleeding – In case of excessive bleeding or bleeding that does not seem to stop or subside, the patient must go back to the periodontist immediately.
• Infection – Signs of a post-surgical infection may include increasing pain, severe swelling, and a discharge from the area. At the onset of these symptoms, patients should also return to the dentist’s clinic immediately.
• Tooth sensitivity – This is a normal effect of the procedure since the root of the tooth becomes exposed. Tooth sensitivity may reduce in intensity or even completely dissipate over time.

There are also some complications or long-term implications following a crown lengthening procedure.

One possible complication is when the bony support of the repaired tooth, which also affects the support of the adjacent teeth, is compromised. This means there is a possibility that the tooth or those surrounding it will feel looser than normal.

Also, since the procedure is irreversible, removing bone tissue around a tooth may impact future procedures the patient might require. For example, if a patient eventually wishes to have a dental implant placed, the reduced bone tissue might not be sufficient to accommodate an implant.

Reference:

• American Academy of Periodontology

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