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Crown Lengthening Surgery
What Is It?
Crown lengthening is a surgical procedure performed by a dentist to expose a greater height of tooth structure in order to properly restore the tooth prosthetically. This is done by incising the gingival tissue around a tooth and predictably removing a given height of alveolar bone from the circumference of the tooth or teeth being operated on.
This common procedure involves the removal of gum tissue, bone or both to expose more of a tooth's structure.
What It's Used For
Crown lengthening is done when a tooth needs to be restored, but there is not enough tooth structure above the gum line to support a filling or a crown.
This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue or bone.
In some cases, a condition called gummy smile — when an unusually large amount of gum tissue shows around the upper teeth — can be treated using crown lengthening.
Preparation
You may receive a tooth cleaning before the procedure.
If the tooth needs a crown, your dentist may have a temporary crown put on the tooth to protect it. This also makes the crown-lengthening procedure easier because the tooth is already prepared for the crown, and your dentist can see precisely how much soft tissue or bone will need to be removed.
Once the area has healed completely — in about three months — your dentist will prepare the tooth again, and make a new temporary crown before making the final crown.
How It's Done
This procedure is done under local anesthesia, alone or in combination with nitrous oxide, laughing gas which helps you relax and feel more at ease. The amount of time it takes varies depending on the number of teeth that require treatment. Although your problem may involve only one tooth, crown-lengthening surgery typically includes neighboring teeth so that the tissues can be reshaped gradually. If only soft tissue is removed, the procedure probably will take less time than if both soft tissue and bone are removed.
Your dentist will make incisions to "flap" the gums away from the teeth. This provides access to the roots of the teeth and the surrounding bone. In some cases, by simply removing a little gum tissue when the incisions are made, enough tooth structure will be exposed for your dentist to place a crown or a filling. However, in most situations it will also be necessary for your dentist to remove some bone from around the crown and the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).
Once your dentist is satisfied that enough tooth structure is exposed, the surgical area will be washed with sterile salt water and the flaps will be stitched together. At this point, your teeth will look longer because the gums are now sitting at a lower level then before the surgery. Some dentists use an intraoral bandage called periodontal dressing to cover the surgical site.
Any temporary crowns will be removed before the procedure begins and replaced afterward.
You will be given prescriptions for pain medication and a chlorhexidine mouth rinse. Your dentist will review oral-hygiene instructions, and ask you to follow a somewhat soft diet. You can brush the teeth in the area that was worked on, but you should avoid the gums. You can carefully remove food particles around the affected teeth with a soft interproximal toothbrush or toothpick.
Follow-Up
For the first two days, use ice on your face to keep swelling down.
After the procedure, you will return to your dentist in 10 to 14 days to have the sutures removed, and then return again 6 to 8 weeks later for a follow-up visit.
Your gums should heal for about three months before the tooth is prepared for the final crown. If you don't wait this long, the gums may shrink as they heal and the margins of the crown could show, or other problems could develop.
Risks
As with all surgical procedures, there is a risk of prolonged bleeding during crown lengthening, as well as a risk of developing an infection after the procedure. Additionally, many patients will experience sensitivity to hot and cold because the roots of the teeth are now exposed. This will go away when the tooth is covered with new temporary crowns. Eventually in some cases the sensitivity to hot and cold will last for a few months. In rare cases sensitivity will last indefinitely.
Because of the tissue and bone removal, the affected tooth may look longer than adjacent teeth. However, this is only a cosmetic consideration.
Removing bone from around a tooth can loosen it. In addition, if the tooth is ever lost, the removal of bone could reduce the chances of successfully placing a dental implant in that area. Your dentist will consider these details during your consultation.
When to Call a Professional
Contact our Dentist if:
• You have bleeding that doesn't stop
• You have pain that cannot be controlled by medication prescribed by your dentist
• You think the area might be infected
• You have excessive swelling or discharge from the surgical area
• The protective dressing becomes loose or is displaced
• Lymph nodes beneath your lower jaw or in your neck become swollen
GUMMY SMILE/Crown Lengthening
When you smile, do your teeth look short because they’re concealed
by too much gum tissue?
Do you have a gummy smile?
Do you have an uneven gum line?
Or is there insufficient tooth structure available for a needed
dental restoration?
Crown lengthening can beautifully frame your teeth and create the perfect setting for cosmetic restoration
Dr. Nasser Antonious has extensive training and experience in periodontic
plastic surgery and crown lengthening. He pays meticulous attention
to detail with an artist’s touch. This is crucial since minute details can
dramatically affect the final outcome.
Prior to crown lengthening, Dr Antonious will discuss your treatment goals and what to expect.
During the treatment, excess gum and supporting tissue is gently sculpted with a laser or electrosurgery unit and other microsurgical procedures, on one or more teeth to create a more perfect frame and natural broad smile. Local anesthetic is used to ensure a painless treatment, and recovery is rapid and comfortable.
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