Beverly Hills Periodontal Institute

Crown Lengthening And Gummy Smile Reduction

Crowns are tooth-shaped caps. They fit over natural teeth for structural or aesthetic reasons. These caps must be able to attach to an existing tooth. Crown lengthening may help. The procedure can be necessary if there isn’t enough of the tooth in place to hold the crown on its own. Our periodontist does it when you need to fix that tooth. In some cases, the part of the tooth that sticks out above the gum is not tall enough to support a filling or crown. This situation can happen when a tooth breaks off at the gum line. Crown lengthening decreases gum tissue and trims down bone when needed. Most of the tooth ends up over the surface of the gum.

Crown lengthening is a standard surgical procedure. You will need to visit a periodontist before doing it. You may need to get a professional tooth cleaning before the surgery.

Remember, patients also do it for aesthetic reasons. You may have questioned your periodontist about procedures to improve a “gummy” smile. Most of our patients do cosmetic crown lengthening because their teeth seem short. We restructure extra bone and gum tissue during the dental crown lengthening procedure. This procedure uncovers a more significant portion of the natural tooth. Sometimes people need crown lengthening to make a cosmetic dental procedure possible.

Crown Lengthening vs. Implant


A refurbished tooth has a different potential for long-term success. This success depends on the amount of coronal structure remaining. For example, if almost all the coronal structure remains, an implant is not advisable. Also, many patients prefer to keep and repair the damaged tooth. Often, restoring the tooth is much less expensive than removing and replacing it.

It’s important to understand that these two procedures are not usually given as options for each other. They both have different goals. Crown lengthening is the trimming of excess gum tissue and sometimes bone, which increases the length of your tooth. The implant, on the other hand, replaces a missing tooth or teeth. It becomes a working manmade root on which the periodontist builds a framework to replace the clinical crown.

If you have to choose between the two, have your dentist do a careful evaluation of the tooth with the issue. How badly is it compromised? Every clinical circumstance will be different. Your dentist will need to check several parameters. One of these is what the crown-to-root ratio will be if you perform crown lengthening. Removing the tooth and replacing it with an implant will usually be the better option if this ratio is less than 1:1.

Another factor to consider is how deep is the tooth fracture or decay. Is it so deep that it needs osseous surgery or a root canal? You’ll also need to see whether the tooth has enough structure left to support a crown. A further consideration is the dental status of the adjacent teeth. Will you need to re-treat a root canal that you did before? Will you need to remove bone to make a properly fitting crown? All these are factors to consider when deciding between crown lengthening vs. implant.

What’s the Difference Between a Gingivectomy and Crown Lengthening?

Are you having trouble deciding between a gingivectomy and crown lengthening? These are two related procedures. The dentist will choose one based on the ultimate goal, i.e., what the client is hoping to achieve.

Gingivectomy may be necessary if the gum has a position or contour. Some people have it done to improve the cosmetic appearance of the teeth. It exposes more crown and “lengthens” what is visible. Crown lengthening may involve trimming the bone that holds the teeth in place. A “crown” is what dentists call the “visible tooth structure.”

A gingivectomy is like crown lengthening. It accomplishes the same result without the removal of bone. For gingivectomy, the dentist only removes soft tissue. Sometimes there is surplus gum tissue, which a dentist can remove either with a scalpel or a laser. It involves restructuring the gums only.

Inadequate tooth structure or excess soft tissue can impair a final restoration. You can do a gingivectomy for cosmetic reasons, to remove excess unhealthy tissue. You can also do it to access decay below the gum line. Tried antibiotics or root planing and scaling to cure your periodontal disease? If these treatments don’t work, then your dentist can perform a gingivectomy. The procedure will trim and reshape loose, infected gum tissue. It will also eliminate hollows between the teeth and gums.

A crown lengthening involves redesigning the gums AND the bone around the tooth. Dentists do crown lengthening to enable the placement of a filling or crown. Gingivectomy is usually done for cosmetic reasons. Only a periodontist, who is a specialist in the tissue supporting and surrounding the teeth, can do crown lengthening.

Is Crown Lengthening Necessary?

Why is crown lengthening necessary? Dentists do crown lengthening to correct many dental conditions. Common conditions are:

  • Severe tooth decay or injury. Are your teeth damaged below the gum line? If there isn’t enough of it to hold a crown on its own, our dentist will perform a crown lengthening. Teeth affected by decay or broken teeth may prevent a cap from attaching. It doesn’t matter if the damage is a result of trauma (like a bad fall) or gum disease. Crown lengthening reveals more of the tooth’s surface. It also acts as an anchor for future restorative work such as veneers and crowns. It enables the dentist to repair the damage and to place a crown on the tooth.

  • Gummy smile. If the gums cover too much of the teeth, it’s known as a gummy smile. Crown lengthening may make your smile brighter, bigger, and more confident.

Is Crown Lengthening Safe?

Yes! Crown lengthening is a safe, routine procedure. It lasts between an hour and ninety minutes and is very common. A well-fitted crown allows for more comfort and better oral hygiene. Please follow all post-operative instructions provided to prevent any complications.

What is the Procedure for Crown Lengthening?

Crown lengthening is minor periodontal surgery. The principle is to be able to establish a ferrule around the root surface. A ferrule is a cap or ring, usually of metal, placed around a slender shaft to prevent splitting or to strengthen it. Another type of ferrule is a metal sleeve used for joining or binding one part to another. An example is the bristles and handle of a hairbrush. In the case of the teeth, crown lengthening exposes adequate tooth/root structure. It allows the crown material to grip.

The procedure comprises recontouring and removing small amounts of gum and bone tissue to uncover the part of the tooth needing treatment. The periodontist starts by numbing your mouth. He can combine this local anesthesia with mild sedation if you request it. Once your mouth is numb, he cuts and shapes the gums and the bone underneath. In this way, he reveals the part of your teeth hidden under your gums. Your teeth – and not your gums – are what people will see when you smile.

Crown lengthening is an outpatient procedure. You can leave the clinic right after you finish the surgery. After completing the operation, the periodontist will clean the area. He uses sterile salt water for this purpose.

The periodontist will use sutures and sometimes a surgical bandage. These tools are to help secure the new gum-to-tooth relationship. He will need to see you in fourteen days to remove the sutures and check your healing. The final treatment of the exposed tooth area does not occur for at least six weeks. This period is to allow for tissue maturation.

How Much Does it Cost for Crown Lengthening?

You should expect to pay between $__________ and $__________ for crown lengthening. Insurance should cover at least a part of the amount if the procedure is a medical necessity. An example of medical necessity is if you’re doing it to correct tooth decay. You’re less likely to get insurance coverage if you’re doing it for cosmetic reasons. The total amount you will end up paying depends on a few different factors, including:

  • Whether the procedure is cosmetic or done for medical reasons
  • The number of teeth you need to have lengthened
  • The amount of gum you need to have removed
  • If you need to remove bone

You may get a discount if you need lengthening for several teeth. The price will increase if you need more treatments, for example, a root canal. You’ll need a dental cleaning before the procedure, which will add $__________ to the final sum.

Do Gums Grow Back After Crown Lengthening?

Yes, there is a slight risk of the gum growing back after crown lengthening. The procedure is a predictable way of exposing more of your tooth. But the periodontist cannot guarantee that it will always be successful. After he raises your gum flap, he may discover surgery is not possible. This discovery will mean that he has to change the treatment plan.

We trim back the bone and then suture the gum back at a lower level. We remove enough bone to allow the gum to reattach to the tooth. If the tissue does grow back, we may need to remove it again.

Crown Lengthening Infection Symptoms

There is a possibility of infection, as with any surgery. It can affect the alveolar bone or the tissue at the incision site if not treated. One of the causes is when patients mess with the incisions. Another reason is poor dental hygiene during the recovery. If you experience the following symptoms, you may have an infection:

  • Extreme pain
  • Redness
  • Light-colored gum tissue
  • Fever
  • Pus accumulation
  • Severe swelling.

Some of the symptoms are common with surgery. It is essential to call the periodontist’s office if they do not resolve themselves after about a week. You’ll need to check for infection, especially if they get worse. The periodontist will prescribe antibiotics to stop the symptoms from getting worse. You may also experience excessive bleeding during the surgery. This bleeding may persist even a few hours after the procedure. The dentists will administer coagulants if you experience this symptom.

Another side effect is sensitivity to hot and cold foods. When we brush our teeth, the fluoride from the toothpaste shields the tooth. Fluoride makes your teeth less sensitive to ordinary food and liquids. The teeth uncovered by this procedure have not been insulated. They can be cold sensitive until they build up an insulating layer. This effect will go away after a few days.

Another result is that the affected tooth can seem longer than those around it. This new look can surprise some patients. They get surprised even if this lengthening was the intention when doing the surgery.

The procedure is not reversible. Cutting away bone tissue around a tooth may affect future operations, though. For instance, if later on, you wish to put in an implant, the decreased bone tissue may not be enough to support it. Another possible complication is the compromise of the structural support of the repaired tooth. If that happens, the tooth or those around it may feel looser than usual.

Throbbing Pain After a Crown Lengthening

It’s normal to feel some pain or sensitivity after crown lengthening surgery, which will usually subside with over the counter painkillers. Your dentist may need to prescribe antibiotics. As noted earlier, come in to see us if the pain is excessive, or if it doesn’t go away after you take painkillers.

Crown Lengthening After Care

Limit physical activity right after surgery. Light work is okay on the day following surgery. Eat soft, nourishing food, and avoid hot foods. Do not use a straw until the dentist tells you it’s okay to do so. Don’t use commercial mouth rinses. Instead, use a warm salt water rinse, or dab the treated teeth with a cotton swab. Avoid dabbing the gums. You can brush the areas of your mouth that were not affected by the procedure.

HOW DOES CROWN LENGTHENING WORK

Crowns are tooth-shaped caps. They fit over natural teeth for structural or aesthetic reasons. These caps must be able to attach to an existing tooth. Crown lengthening may help. The procedure can be necessary if there isn’t enough of the tooth in place to hold the crown on its own. Our periodontist does it when you need to fix that tooth. In some cases, the part of the tooth that sticks out above the gum is not tall enough to support a filling or crown. This situation can happen when a tooth breaks off at the gum line. Crown lengthening decreases gum tissue and trims down bone when needed. Most of the tooth ends up over the surface of the gum. Crown lengthening is a standard surgical procedure. You will need to visit a periodontist before doing it. You may need to get a professional tooth cleaning before the surgery. Remember, patients also do it for aesthetic reasons. You may have questioned your periodontist about procedures to improve a “gummy” smile. Most of our patients do cosmetic crown lengthening because their teeth seem short. We restructure extra bone and gum tissue during the dental crown lengthening procedure. This procedure uncovers a more significant portion of the natural tooth. Sometimes people need crown lengthening to make a cosmetic dental procedure possible.

The underlying bone is then gently contoured so that the gum tissue can be positioned in in the most esthetic position. Without proper bone contouring, the gum often bounces back to its original position, which would make it require a second corrective surgery. For this reason I do not recommend just using a laser for trimming the gum tissue without addressing the underlying bone.

For most patients, crown lengthening won’t require any additional post-operative care and any slight pain can be easily managed with Ibuprofen. While crown lengthening patients can return to work and begin eating soft foods the day after surgery, full recovery of the gum tissue generally takes one or two weeks.

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