Crown lengthening is a common periodontal procedure that involves reshaping the gum tissue and sometimes the underlying bone structure to expose more of the natural tooth. This surgical adjustment is performed to ensure optimal oral health and the successful placement of dental restorations. The procedure creates a healthier foundation for the teeth, addressing both functional necessity and aesthetic concerns.
Accessing and Restoring Damaged Teeth
A frequent reason for performing crown lengthening is to gain access to a tooth that has been compromised by damage extending below the gum line. When decay, a fracture, or excessive wear reaches the level of the gum tissue, a dentist cannot properly clean the area or place a secure filling or crown. The procedure exposes this compromised area, transforming a subgingival (below the gum) problem into a supragingival (above the gum) one.
Exposing more tooth structure is particularly important when preparing a tooth for a dental crown. A certain height of sound tooth structure, known as the “ferrule,” must be present above the gum tissue to act as an anchor for the crown. Without this structural support, the crown is far more likely to fail, leading to poor retention or a root fracture. Crown lengthening strategically removes tissue and bone to ensure an adequate ferrule (typically 1.5 to 2 millimeters of height), improving the long-term success of the restoration.
Maintaining Gum and Bone Health
Crown lengthening is performed to protect the “Biological Width,” a mandatory zone of soft tissue attachment surrounding every tooth. This zone consists of the junctional epithelium and connective tissue attachment, occupying approximately 2 millimeters of space immediately above the supporting bone crest. If the edge of a restoration, like a filling or a crown, invades this biological width, the body responds negatively.
Violation of this space triggers a chronic inflammatory response in the gum tissue. This persistent inflammation often manifests as localized gum bleeding, persistent redness, and discomfort around the restoration. Over time, the body attempts to re-establish the required biological width by pushing the adjacent bone away, a process that leads to irreversible bone loss. By surgically repositioning the gum and bone away from the restorative margin, crown lengthening re-establishes this crucial 2-millimeter space, preventing chronic inflammation and preserving the long-term health of the surrounding bone.
Correcting the Gummy Smile
Beyond the functional and health-related necessities, crown lengthening is also a highly effective procedure for cosmetic purposes, such as correcting a “gummy smile.” This condition, known clinically as excessive gingival display, occurs when an unusually large amount of gum tissue is visible above the upper teeth when a person smiles. Generally, a smile is considered “gummy” if more than three or four millimeters of gum tissue shows.
In these cases, the teeth are often the correct length but are simply covered by too much gum tissue, making them appear short or uneven. The aesthetic procedure involves carefully sculpting the excess gum tissue and sometimes the underlying bone to expose the full, natural height of the teeth. This re-contouring creates a more balanced and proportionate ratio between the gum tissue and the teeth, resulting in a significantly more symmetrical and pleasing smile line. The outcome provides a permanent correction, enhancing the overall harmony of the patient’s smile.
What the Procedure Involves and Recovery
The crown lengthening procedure is typically performed by a periodontist using local anesthesia to ensure the patient feels no pain. The surgeon first makes small incisions to gently lift a flap of gum tissue away from the tooth, providing direct access to the underlying bone. If necessary, a small amount of bone is carefully reshaped (a process called ostectomy) to create the required space for the new gum position. Once the desired amount of tooth structure is exposed, the gum tissue flap is repositioned lower down the tooth root and secured with small sutures.
Patients can expect some mild discomfort and swelling for the first few days following the surgery, which is usually managed with over-the-counter or prescription pain relievers. A soft diet is generally recommended for the initial recovery period to prevent damage to the surgical site. While the gums typically heal within a few weeks, the bone and tissue complete their final maturation over a period of about three to six months.