Crown lengthening is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures.  In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue.  Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue.  This treatment can be performed on a single tooth, many teeth or the entire gum line, to expose a pleasant, aesthetically pleasing smile.

Reasons for crown lengthening

Crown lengthening is a versatile and common procedure that has many effective uses and benefits.  The vast majority of patients who have undergone this type of surgery are highly delighted with the results.

Here are some of the most common reasons for crown lengthening:

• Restoration of damaged teeth – Periodontal disease can cause severe damage to the teeth, as can trauma and decay.  Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
  
  
• Cosmetic uses – Extra gum tissue can make teeth look unnaturally short, and also increase susceptibility to periodontal infections.  Removing excess gum tissue can restore a balanced, healthy look and thus improve the aesthetic appearance of the smile.
  
  
• Dental crowns – Crown lengthening serves to provide more space between the supporting jawbone and dental crown.  This prevents the new crown from damaging gum tissues and bone once it is in place.

What does crown lengthening involve?

Crown lengthening is normally performed under local anesthetic.  The amount of time this procedure takes will largely depend in how many teeth are involved and whether a small amount of bone needs to be removed, in addition to the soft tissue.  Any existing dental crowns will be removed prior to the procedure, and replaced immediately afterwards.

The dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth.  Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping.  Separating the gums provides the dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown.  In other cases, the dentist will also need to remove a small amount of bone from around the teeth.  The bone is usually removed using a combination of special hand instruments, and rotary instruments.  The rotary instruments roughly resemble the drill that is used in cavity treatment.

When the dentist is satisfied the teeth have sufficient exposure, the wound will be cleaned with sterile water and the gum tissue will be sutured with small stitches.  The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

The dentist will secure the surgical site using an intraoral (periodontal) bandage, which serves to prevent infection.  Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize.  The surgical site will be completely healed in approximately two to three months.

Example:  Crown lengthening to save damaged teeth

In this case, the patient had extensive dental decay.  As a result, the teeth are very short--you can barely seen any real tooth structure!  Crowns placed in this situation would not be able to stay on, resulting in numerous trips to have them re-cemented.  Utimately, the only way to save teeth like these is through crown lengthening.  In addition, a gum graft was placed to improve the long-term strength and health of the teeth. 

4 weeks later, the teeth are longer, healthier and are nearly ready to have impressions for crowns.  People generally return to see their dentist for the crowns at least two months after crown lengthening.

Example:  Combination of crown lengthening and gum grafting

The person in this photograph presented with a concern to improve her smile. A consultation was performed and we worked with the patient's dentist to develop a treatment plan.  The gum line was altered through crown lengthening (gum lift) and gum grafts to create a symmetrical and harmonius smile line. 

The patients general dentist put the final package together with new crowns and the final result is a beautiful smile. 

Example:  Another combination procedure and braces (orthodontics) was used to transform this smile. 

This patient also presented with concerns to improve his smile.  In working with his general dentist and orthodontist, a plan to use crown lengthening and gum grafts to improve symmetry and oral health was put into action. 

The general dentist placed new crowns to help transform the smile.  These crowns were placed about 3 months following the periodontal combination procedures.  The gum grafting covered the exposed roots and strengthened the gum line for decades to come.  The general dentist was able to place normal length crowns versus having long and unsightly crowns. 

If you have any questions about crown lengthening, please ask your dentist.