Crown lengthening is a process wherein your dentist removes a part of your gums and sometimes a bit of your bone to lengthen your crown.
Why do you need crown lengthening?
1. To fix your teeth
If you do not have enough tooth to support a restoration/ filling or an artificial crown, you need a crown lengthening. For instance:
- When your tooth fractures at the gum line
- When your crown detaches from your tooth, and there is a decay underneath
- You have deep cavities below your gums
- When your crown may not stay longer
In the cases mentioned above, your dentist needs to prepare your tooth so that it can hold your crown. Experts say you should have at least 3 mm of tooth between your bone crest (bone lining of your tooth) and the margin of an artificial dental prosthesis/ crown.
2. To enrich your smile
Your gums cover some of your teeth, and they are usually not visible when you smile. However, in some people, a lot of gums cover their teeth, especially their upper teeth, and are visible when they smile. Dentists call it a gummy smile. You can correct your gummy smile with crown lengthening, you can also correct your uneven gums.
The procedure of crown lengthening
Periodontists (gum specialists) are the experts at crown lengthening. During the procedure they will have a look at your medical tests, X-rays, and conduct an oral examination, and assess the following:
- The anatomy of the tooth which will undergo crown lengthening
- The type of tooth, it’s roots, shape of roots and the position of their furcation. Few teeth such as molars have multiple roots. Furcation is the point where the root bifurcates into more roots.
- The anatomy of soft tissues around, including the attachment of your facial muscles
- The width of your gingiva
- Interdental bone width
- The quantity and quality of bone present in between your teeth
In case you have a fracture or a dislodged filling, your dentist will give you a temporary crown. The temporary crown makes the process easier for your periodontist as he/ she will know exactly how much to lengthen. Most of the times, you need a professional tooth cleaning, one week before the surgery, to minimize the chances of post-surgery infections.
If you need a root canal treatment (RCT), it’s done before the surgery. RCT is a procedure wherein your dentist cleans the decay which has spread deep to the pulp of your tooth and seals it with a suitable material. If you have a supporting medical history (no high blood sugar levels etc.), you will receive an appointment for the surgery. Your dentist does your crown lengthening, and it may take three months to heal.
At the beginning of the treatment you receive a local anesthesia. The time taken for the whole procedure depends on the number of teeth which need the crown lengthening. However, even if you have to lengthen a single crown, you need also to lengthen the neighboring crowns, especially if it’s your front tooth so that the change looks gradual/ natural.
If your dentist needs to remove only the gum tissue, the procedure is faster than removing both the bone and the soft tissue.
Once the anesthesia starts working, your dentist places cuts which separate your gums from your tooth. The extent of separation depends on the amount of tooth that you need to expose. In most of the cases, your dentist needs to remove some bone around your roots. However, sometimes, your dentist needs to expose a little more of your roots so as to make sure your crowns are firmly seated. After which your dentist washes your exposed tooth with saline / salt water.
Your dentist needs to pay special attention to the gingival level as well as interdental papilla / gingiva in between your front teeth.
After the procedure, your dentist stitches your gums. You may also receive a bandage which helps your gums heal faster. Your dentist glues temporary crowns and prescribes a mouth wash and pain reliever medicines.
You need to follow a soft diet. Apply ice on your face, in the area where you had the gum surgery. It will reduce bleeding and swelling. Brush your teeth but avoid your gums. You can clear the food near your gums by using a toothpick or using a water irrigator.
After 7 to 10 days, visit your dentist. If your gums have healed well, your dentist removes the sutures/ stitches. Visit your dentist again after 4 to 6 weeks for a follow up visit. Your dentist makes sure your gums have healed over a period of three months and then proceeds with making a crown.
Since your gums shrink after they heal. If you do not wait enough, the edges of your crown start showing up when your gingiva shrinks.
How much does a crown lengthening cost?
Even though the costs vary from case to case, the usual cost is around $1500-$2000 for one tooth. You might get some discount if you need lengthening for multiple teeth. Depending on your location, prices might be somewhat lower.
Price also depends on the amount of gum to be removed. If some of your bone needs to be removed, that will also increase the price.
If you need additional treatments, e.g. root canal, this will increase the price. Note: you'll probably need some dental cleaning before the procedure, this usually adds $50-$200 to the final sum.
Call your periodontist if:
- Your bleeding doesn’t stop
- Your pain reliever medicine isn’t working
- Your bandage is loose or falls off
- You notice excessive swelling or feel a discharge from the operated area
- You feel the wound may be infected
- You feel tender lumps/ enlarged lymph nodes in your neck or your lower jaw
Risks associated with crown lengthening
The procedure may carry few risks such as
You may feel sensitivity in your teeth, especially with hot and cold. It will disappear with time, especially after you have a well-designed crown in place.
The tooth that has undergone surgery may look longer than the other teeth. However, if you have lengthened the adjacent teeth, it will not be seen as a distinct change.
A major challenge with the prepared tooth is, in case it becomes loose due to removing excess bone, it may fall off in future. When it does, it will be difficult to replace that tooth with an implant. An implant is an artificial tooth root which feels like your own. Your dentist places the implant via surgery, and once it heals, your dentist places a tooth like structure on it.
If you underwent a crown lengthening to fix your tooth, once your gingiva is healed, your dentist prepares your tooth again, and you will receive a new crown. Meet your dentist every six months, and more often if you feel any issues.