The part of the tooth that is seen above the gum is called the clinical crown. When not enough of the clinical crown is showing, the gum must be moved down the root to expose more tooth structure. This is called crown lengthening.

There are several situations in which crown lengthening is commonly performed. First, is to improve the appearance or esthetics of short teeth or a very “gummy” smile. Another common reason for crown lengthening surgery is to allow your restorative dentist better access to more tooth structure to either make a crown or remove decay. Finally, a restoration such as a filling or crown may go below the gum line and get too close to the bone supporting the tooth and violate what is known as the “biologic width” or space needed for healthy gum and bone interaction. When this happens the gums become chronically inflamed and sore and frequently bleed. Crown lengthening in this case will reestablish a healthy distance between the edge of the restoration and the bone.

If the dentist is unable to reach decay that is deep under the gum, the tooth will be lost. As a rule, simply trimming back the gum is not sufficient, because that would expose the bone and the gum tissue would grow back to it’s original position. Rather, we as your periodontist must reflect a flap, trim back the bone to allow for access to the decay, and then suture the gum back at a lower level. Sufficient bone must be removed to allow room below the decay for the gum to reattach to the tooth.

Most crown lengthening procedures are very straightforward, and there is little or no post-operative discomfort. Sometimes a dressing is placed to help protect the surgical area acting like a “band-aid”. The sutures and dressing (if placed) are removed after about 1-2 weeks. Teeth that have had crown lengthening can sometimes initially be more temperature sensitive but this usually resolves with time.

If a crown is to be placed on a back tooth, the restorative dentist should ideally wait 4 weeks following crown lengthening before making final impressions. This ensures adequate healing in the area. If the tooth is in an esthetic (front) area, the wait is usually longer, 4-6 months, in order to ensure that the gum, which shrinks slightly as it re-attaches to the tooth during healing, is in its final position. If the margin of the crown is placed at the gum level before final healing and additional shrinkage occurs, the results may be unsightly. A temporary crown can be placed 6-8 weeks after surgery if the patient desires to cover the exposed root during this healing period.

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