Crown lengthening is a surgical procedure designed to adjust the level of gum tissue, and sometimes the underlying bone, to expose more of a tooth’s structure. This process effectively increases the visible portion of the tooth, known as the clinical crown. The overall goal is to provide a functional or aesthetic benefit by creating sufficient tooth exposure. The procedure does not actually make the anatomical tooth longer, but rather reveals more of the existing tooth that is covered by soft tissue.
Defining the Need for Crown Lengthening
Crown lengthening falls into two primary categories: restorative (functional) and aesthetic (cosmetic) applications. Functional crown lengthening is often required when a tooth lacks the necessary height to securely hold a final dental restoration. This situation can arise if a tooth is fractured below the gum line or has extensive decay extending beneath the gingival margin. The procedure ensures that the restorative margin can be placed on sound tooth structure, a requirement for long-term success.
A lack of sufficient exposed tooth structure can also violate the “biologic width,” which is the specific measurement of soft tissue attached to the tooth above the bone. If a crown margin is placed too deep and invades this space, it can cause chronic inflammation, bone loss, and discomfort. Functional crown lengthening repositions the soft tissue and bone to re-establish the correct biologic width, promoting periodontal health and providing a stable foundation for the restoration.
Aesthetic indications focus on improving the appearance of the smile, most commonly by correcting a “gummy smile.” This condition occurs when excessive gum tissue covers the teeth, making them appear unusually short or square. The aesthetic procedure repositions the gum line to reveal the full dimension of the teeth, creating a more balanced and proportionate smile. Another cosmetic application is correcting uneven gum contours, where the gum tissue heights are asymmetrical across the front teeth.
Dental Specialists Who Perform the Procedure
The procedure is typically performed by dental specialists with advanced surgical training. Periodontists are the primary specialists who perform this surgery, as their training focuses specifically on the soft tissues and bone structures supporting the teeth. They possess a deep understanding of the biologic width and the precise measurements needed to ensure a healthy outcome.
A periodontist’s specialization involves three years of additional education beyond dental school, emphasizing the diagnosis and treatment of periodontal diseases and the placement of dental implants. This expertise makes them well-suited for both functional cases, which often involve complex bone recontouring, and aesthetic cases requiring meticulous soft tissue sculpting. The periodontist collaborates with the patient’s general dentist or prosthodontist to ensure the surgical outcome supports the final restoration.
Oral and maxillofacial surgeons also perform crown lengthening, particularly in more complex cases or when the procedure is part of a larger surgical treatment plan. Their advanced training in surgical techniques allows them to manage significant bone removal or cases involving multiple teeth with high precision. The periodontist is typically the first choice due to their specialization in the periodontium.
Some general dentists may perform less complex crown lengthening procedures, often limited to soft-tissue-only recontouring, known as a gingivectomy. However, if the procedure requires the adjustment of the underlying alveolar bone, known as osseous surgery, the case is usually referred to a specialist.
The Crown Lengthening Process and Post-Operative Care
The crown lengthening procedure is typically performed in a dental office setting under local anesthesia. The surgeon begins by making small incisions to separate the gum tissue from the tooth and the underlying bone. The soft tissue is then gently lifted, creating a flap that provides access to the bone.
The surgeon carefully removes a small amount of bone tissue surrounding the tooth root using specialized burs or hand instruments. This step is performed to reposition the bone crest further down the root, ensuring the correct distance is maintained between the bone and the new gum margin. Once the necessary tooth structure is exposed, the gum tissue is repositioned at a more apical (rootward) level.
The soft tissue is secured in its new position with fine sutures, and a protective dressing may be placed over the surgical site. The procedure typically takes less than an hour, though this varies depending on the number of teeth involved.
Swelling and mild discomfort can be controlled with prescribed or over-the-counter pain medication and the application of ice packs. Patients are instructed to maintain a soft diet for the first week and to avoid chewing on the treated side to protect the surgical site. Gentle oral hygiene is paramount, usually involving a specialized rinse and avoiding direct brushing of the surgical area until the sutures are removed.
Sutures are typically removed seven to ten days after the surgery during a follow-up appointment with the surgeon. While the soft tissue heals quickly, the bone and gum margin require approximately three to six months to fully mature and stabilize. It is only after this maturation period that the patient’s general dentist or prosthodontist can proceed with the final restorative work, such as placing the permanent crown.