Crowns help treat broken, fractured, and discolored teeth. They are also used in dental cosmetic procedures like implants or bridges. Crown lengthening makes sure that there is enough space on the teeth for the crowns to stick firmly.
Crown lengthening is also called crown extension. It is a short surgical procedure that requires about an hour to complete.
In this article:
- Is crown lengthening necessary?
- Crown lengthening procedure
- Crown lengthening: Healing stages
- Is crown lengthening safe?
- Alternatives to crown lengthening
- Common questions relating to crown lengthening
Is crown lengthening necessary?
Crown lengthening includes reshaping the gum of a target tooth. This reshaping prepares the teeth for various aesthetic and functional restoration procedures.
The reshaping exposes more areas of the teeth for effective dental treatments. You may require crown lengthening if:
- You have a gummy smile
- The tooth is decayed below the gumline
- The tooth is broken, and not enough surface is left for a crown to bond
- You need a bridge for missing teeth, but adjacent teeth are too small
- You had a root canal, and your tooth is decayed
In some cases, crown lengthening may require cutting a part of the bone to expose more of the tooth.
Treating a gummy smile falls under the esthetic crown lengthening category. You do not need to do it unless you are not satisfied with your smile.
Crown lengthening procedure
Preparing for the surgery
Preparing for your crown-extending surgery involves meeting with your doctor. You will talk about the following during the meeting:
- Any health issues you may have
- If you are under medications
- Any anxieties you may have regarding the surgical procedure
- The surgical procedure and the type of instruments to be used
- Caring for your mouth
- The risks of the procedure
Your doctor will tell you if your current medications will interfere with your gum surgery and if you must stop taking them.
It is routine work for your doctor to examine your mouth and do some x-rays to better understand your teeth and bone during this time.
Your doctor will be able to tell you exactly how much gum will require removal to get an optimal result from the procedure.
This meeting is an opportunity for you to ask questions regarding the procedure. You can ask if there is an alternative to the surgery for you.
The surgery step by step
- Your doctor will place temporary crowns on your teeth. This is to protect your teeth until the procedure begins
- If you have a crown on the target tooth, it will be removed
- If you are anxious about the surgery, the doctor will apply a local anesthetic to your gum. Other forms of sedation are also available. You may request the one you like. This will already be decided in your meeting with the doctor
- Your doctor will reshape your gum using specific surgical instruments. A laser tissue removal system is in fashion and may be used in your case
- The doctor will make some small cuts in the gum to separate it from the tooth
- While treating only one tooth for gum reshaping, doctors may reshape the gums of the adjacent teeth. This helps make the reshaping even with other teeth
- If you need bone resection, your doctor may use hand chisels and high-speed rotary instrumentation
- The surgery site will be bandaged with mouth-friendly material to stop bleeding and infection.
Once the procedure is complete, the doctor will prescribe pain medication and specific mouthwash.
Crown lengthening: Healing stages
Two days after surgery
- Do not engage in heavy physical activity that may increase blood pressure in your body. Follow this guidance at least three days following the surgery
- Take the pain medication as prescribed. Once the anesthesia stops working, you may feel pain at the surgical site
- Use the mouthwash as prescribed to avoid bacterial infection (do not use mouthwash in the first 24 hours)
- Avoid consuming hot food for at least a day to let the gum heal. Your teeth will be sensitive to extremely cost or hot food during this time
- You can go to work a day after the surgery
Two weeks after surgery
- Do not remove the bandage without clear instructions from your doctor. The bandage may stay in your mouth for up to two weeks. Contact your doctor if your mouth bleeds during this time
- Avoid drinking or smoking for up to two weeks
- Your doctor will remove your bandage in two weeks
Four weeks to three months after surgery
- After four to six weeks, the doctor will allow you to wear your permanent crowns
- The decision will be based on the condition of your surgical site
- Your surgical site may take two to three months to completely heal.
- Drink plenty of water
- Eat soft and healthy food
- Take the antibiotics as directed
- Do not try to feel the surgical site by pushing the bandage
- Do not try to see the surgical site by pulling your lips outward
- Have appointments with your doctor for a post-surgery examination
Is crown lengthening safe?
Crown lengthening is a standard dental cosmetic procedure. However, you may face the following if the tissues do not heal as expected:
- Nerve damage
- Tooth Sensitivity
- Slow healing
- Damage to tooth enamel
- Gum disease
- Pus discharge from the surgical site
- Mouth trauma
Much depends on your doctor’s expertise and how you care for your mouth after surgery. Stick to your doctor’s instructions. Consult your doctor before starting a new medication.
Alternatives to crown lengthening
Extraction of the impacted tooth
You may choose not to undergo crown lengthening surgery by extracting the affected tooth. In that case, you must fill the space with a bridge or implant and a crown.
Leaving a space between your teeth is not wise, as adjacent teeth may slide into it, further complicating the situation.
Deep margin elevation
This is a treatment that uses a two-matrix system. If the surgical lengthening of the crown is not possible in your case, this system can help. Maybe you do not have enough money to bear the cost of surgery. Maybe you have a medical history that does not allow gum reshaping surgery.
If your impacted tooth has an implant beside it, reducing your gum will also affect it. Margin elevation will save you from such troubles.
STM crown attachment
Instead of lengthening the crown by removing the gum, this procedure rebuilds the affected tooth with restorative materials and secures the crown with single or double composite posts. In this case, the longer the composite posts are, the better the retention of the crown.
Orthodontic forced eruption
It is a cost-effective procedure and does not require surgical removal of bone tissues. The compromised tooth is forced out about two millimeters in it using specialized brackets.
The procedure requires a fiberotomy method to separate the gum from the tooth. Fiberotomy stops the tooth from going back to its original position.
Biologic shaping aims to modify the tooth surface to make restoration procedures effective. Under this procedure, your bone tissues will be removed only when necessary and biologically compatible.
How bad does crown lengthening hurt?
Your doctor will apply anesthesia to your gum before initiating the surgical process. You may feel slight pain once the anesthesia wears off. But your doctor will prescribe pain relievers to kill that pain. Take ibuprofen or Tylenol as advised by the doctor. Then, if there is no infection or other dental or bone complications in your mouth, the rest of the healing period should be painless for you.
Doctors generally provide the two following anesthesia to a crown-lengthening patient if they deem that the application of the local anesthesia is not enough:
- Nitrous Oxide
- Oral conscious sedation.
Then, if you need anything stronger than that, you can request the assistance of an anesthesiologist.
Local anesthesia is the safest type of anesthesia. It is an injection of a numbing agent at the surgical site. You may need several injections if more than one tooth requires crown lengthening.
The anesthesia used for you will depend on your age, health condition, and how complicated your surgery will be.
Crown lengthening is like any other dental procedure and is highly successful. But, like any other procedure, it has its drawbacks. For example, removing too much bone will further compromise the decayed or impacted tooth, creating opportunities for infection and bone loss.
You may need about an hour for the procedure. But that is just an estimate since the condition of your impacted tooth and the purpose of the procedure will dictate exactly how long the surgery will take. Add to that the healing process, which requires approximately three months.
A simple removal of gum tissue will not be a permanent procedure. Gums will grow back once the tissues heal. But a permanent result can be achieved by shaving off the bone, which may already be a part of your treatment plan.
A crown lengthening surgery requires four to six weeks to heal. The healing period may be as long as three months in some cases. It depends on your body’s capacity to heal. That is, how healthy you are and how well your immune system works. Then your doctor will examine your teeth before allowing you to wear your permanent crowns.
Timothy J. Hempton, DDS, John T. Dominici, DDS, MS, ‘Contemporary Crown-Lengthening Therapy: A Review.’ Journal of the American Dental Association, VOLUME 141, ISSUE 6, P647-655, JUNE 01, 2010
Healthline. ‘Crown Lengthening.’
Dentistry Today. ‘Gaining Crown or Bridge Retention: An Alternative to Surgical Crown Lengthening.’
Perioimplant Advisory. ‘An alternative to surgical crown lengthening: Margin elevation using a two-matrix system.’
Lepore Dentistry. ‘Biologic Shaping.’
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