Unless you're a dental trivia champion, the term "crown lengthening" probably isn't familiar to you. Even though it's perhaps a new term to you, a crown lengthening procedure is actually relatively standard. Think of it as the dental treatment you need to make the next dental treatment possible. Your dental professional may tell you that you'll need this procedure because you  don't have enough exposed tooth surface for them to place a crown or bridge appropriately. If so, you're probably very curious about what crown lengthening is. Let's go over why you may need it and what to expect from pre-op to recovery!

What is Crown Lengthening?

Crown lengthening surgery involves removing gum tissue, bone, or both to expose more of a tooth. It's done for therapeutic and sometimes cosmetic reasons.

Why Would I Need Crown Lengthening?

Imagine this: your dental professional has examined your teeth and determined you need a crown. But what if there is not enough tooth for a crown? A periodontist may then suggest a crown lengthening procedure to support a dental crown or tooth bridge. There are a few reasons why you may not have enough tooth for a recommended treatment:

  • Your tooth may have broken off at the gumline.

  • Your gumline extends too far along your tooth for it to receive the restorative treatment it needs.

  • Your tooth structure isn't strong enough for restoration.

  • A crown or filling has fallen off, and there is decay underneath.

Is There a Cosmetic Reason To Get Crown Lengthening?

According to the American Academy of Periodontology (AAP), a "gummy smile" is a common reason for getting a crown lengthening procedure. You may hear this term about short looking teeth. But did you know that "short" teeth aren't actually short? They may just have an excess of gum tissue! It's important to note that every smile is different, so some people are just born with more gum tissue. However, we believe you deserve to feel great about your smile! So we recommend having a conversation with your dental professional if you are self-conscious of your smile and would like to consider crown lengthening as a cosmetic option.

How Do I Prepare?

A periodontist will review your medical history and X-rays before setting a date for the procedure. You may also have a dental hygiene appointment done right before crown lengthening, as this will decrease your infection risk by clearing out any bacteria, plaque, and tartar.

If your dental professional performs a crown lengthening procedure to reveal enough tooth for a crown, there's a chance they will put a temporary crown on your tooth to protect it before surgery. This allows your periodontist to see how a crown will fit on your tooth once the tooth has "lengthened" and the gums around it have healed. After three months of healing, a final crown will fit onto your lengthened tooth.

Another way to prepare for crown lengthening and to determine if it's the best option for you is to consider the cost. The price of your procedure will depend on several factors, such as whether or not you have dental insurance, what type of surgery you're having performed, how many teeth need it, your location, and whether it's for a restorative or cosmetic reason. Dental Treatment Guide estimates crown lengthening costs between $1000 and $2,000, while Cost Helper Health estimates it between $1,000 and $3,000.

What Can I Expect From a Crown Lengthening Surgery?

There are three types of crown lengthening surgery: a gingivectomy, surgical extrusion, and apically repositioned flap surgery. Your dental professional will know which type of surgery is best for you, based on the following considerations, noted by Medical News Today:

  • The appearance of your tooth's root

  • The crown to root ratio

  • If there is any bone loss

  • Aesthetic considerations

  • The position of the tooth that needs crown lengthening

  • What type of reconstructive surgery is necessary (like a filling or cap)

Crown lengthening surgery is usually done with a combination of local anesthesia and a sedative. The amount of time your crown lengthening surgery will take will depend on the number of teeth that need treatment. It will also depend on if both bone and soft tissue need removal. You may only have one tooth that needs crown lengthening, but neighboring teeth are often also included in the treatment. This means that the tissues reshape gradually.

During a crown lengthening procedure, the periodontist first uses a scalpel, laser, or both, to make an incision (cut) in the gum tissue. The gum tissue is then pulled back away from the teeth to expose the roots and bones below. The periodontist removes the necessary area of bone and/or gum with scalpels, lasers, or other specialist tools, and then washes and disinfects the area with a salt water rinse. To finish the crown lengthening procedure, the periodontist positions the gum tissue back over the teeth and sutures (stitches) it in place. They might also place a surgical bandage over the area to protect it. 

What Comes Next?

You can take anti-inflammatory medication and use a cold compress to help with any pain or swelling after your surgery. While you recover, we recommend consuming soft, healthy foods and rinsing your mouth after meals. Staying away from hard, sticky, and sugary foods will guarantee you're only introducing the most gentle and nutrient-rich ingredients into your mouth, letting your teeth and gums heal.

During the first few days of healing, your gums will continue to shrink as the swelling comes down. If the crown lengthening procedure was on a tooth in the back of your mouth, full recovery might take 6-12 weeks. You can expect the healing timeframe to be 3-6 months if the crown lengthening procedure occurred in the front of your mouth.

Are There Possible Complications?

The two main complications, bleeding and infection, can occur after any surgery. If you experience any symptoms beyond the expected, such as bleeding that doesn't stop, signs of infection, or pain that doesn't lessen, call your periodontist. Specific to crown lengthening surgery, you should watch for:

  • Sensitivity to hot and cold: This should go away with time or when your periodontist places the crown on your tooth.

  • Appearance: The affected tooth may look longer than the teeth next to it after the tissue and bone removal.

  • Looseness: It's a possibility that removing bone from around a tooth can make it feel looser

Regardless of the reason for you needing or wanting this procedure, maintaining a vigorous oral care routine before and after surgery is essential for the best possible outcome. You should brush your teeth twice a day and clean between your teeth with floss, a water flosser, or another interdental cleaning tool.

You can take anti-inflammatory medication and use a cold compress to help with any pain or swelling after your surgery. While you recover, we recommend consuming soft, healthy foods like soups, smoothies, and yogurt, and rinsing your mouth after meals. Staying away from hard, sticky, and sugary foods will guarantee you're only introducing the most gentle and nutrient-rich ingredients into your mouth, letting your teeth and gums heal.

Everyone deserves a bright and healthy smile they're confident about. Whether your dental professional has told you that you'll need crown lengthening for a restorative dental procedure, or you personally feel it's a cosmetic surgery that will improve your smile, understanding the process is vital. Your dental professional can help you decide on the right course of treatment, so you feel confident showing off your healthy, gorgeous smile!