Crown Lengthening

Crown lengthening is a procedure to expose more tooth structure by removing some of the surrounding tissue. 

Crown Lengthening

Crown lengthening is a procedure to expose more tooth structure by removing some of the surrounding tissue. 

Table of Contents

What is Crown Lengthening?

Crown lengthening is a dental procedure that involves removing gum tissue and sometimes bone from around a tooth in order to expose more of the tooth’s surface. This is done for many reasons. If a tooth has decay that is deep below the gums, crown lengthening is needed to move the gum and bone away from the decay so it can be properly accessed and treated. If a tooth is broken or needs a crown but there is not enough tooth structure to support a crown, crown lengthening can be performed to expose more tooth structure above the gums for the crown to be bonded to. 

Crown lengthening may also be done for cosmetic/esthetic reasons, to improve the appearance of a “gummy” smile, or uneven gum levels. A gummy smile is often caused by “altered passive eruption”. Normally, teeth erupt into the mouth in two phases. Active eruption is when the tooth is physically growing out of the bone and into the mouth. Passive eruption is when the tooth is fully grown, and the gums and bone recede until only the root is inside the bone. Often times the passive eruption may not fully occur – this is called altered passive eruption. It causes the teeth to appear too short or the smile to be too gummy. Crown lengthening may be performed to remove excess gum and/or bone to restore your natural teeth, size, and shape. If desired, this may be combined with other cosmetic procedures such as veneers or crowns to maximize the esthetic result. 

What you should know before your Crown Lengthening Procedurein Orange County

Before crown lengthening can be performed, you will need a comprehensive consultation. Crown lengthening procedures can range from being a quick “prescription” surgery in which your general dentist refers you for lengthening on one or two specific teeth, usually when they are doing a crown and cannot access part of the tooth, to a full esthetic work-up for a smile makeover. For a prescription surgery, your dentist will refer you to us with specific instructions of what their final plan is and we will lengthen the tooth as needed. They will usually have already prepped your tooth for a crown and provided you with a temporary crown. The crown lengthening can often be performed the same day as the consult if that is what you prefer. For an esthetic case, an intraoral scan of your teeth will be completed as well as intraoral and smile photos. A mock-up of the final results can made with your input as well as your general dentists until everyone is happy with the planned result, especially if they are going to be placing crowns or veneers to further improve your smile. A surgical stent is fabricated from the mock-up to provide the extra precision for the crown lengthening procedure, and the mock-up will be used for the final restoration designs as well. 

What happens during your Crown Lengthening?

What kind of anesthesia is used?

Most of the time, we do crown lengthening procedures under local anesthesia. The area is numbed just like any other dental procedure. We also offer two additional sedative options. An oral sedative or anxiolytic can be prescribed for you to take an hour before the procedure, which will help calm you down and make you drowsy during the procedure. You may or may not remember the procedure afterward. Another sedation option we offer is “twilight” anesthesia. A board-certified dental anesthesiologist will administer medication through an IV line to make sure you are safely sedated and asleep during the entire procedure.

The surgical procedure

Once you are numb, measurements will be made from where the current bone levels are in relation to your gums and tooth. If you have a temporary crown, it will be removed before we start. Depending on how much lengthening is needed and taking into consideration esthetics as well as the quality and quantity of gum tissue you have, some gum tissue is usually excused, and then the gums are flapped/separated from the underlying bone. If it is a highly esthetically demanding case, the surgical guide/stent is used for the gum excision. Bone will be removed in a conservative manner, but enough to provide the access and length to the tooth, while restoring the biological width that was first measured. The bone is usually reshaped to allow the tissue to adapt better, and dissolvable sutures will be placed to reapproximate the flap. If you have a temporary crown, it will be recemented at the end of the procedure. 

How long is the Crown Lengthening appointment?

The crown lengthening procedure is usually a simple and straightforward procedure. The appointment is usually around 1.5 hours for a single area, but actual procedure is only around 30 minutes. Depending on how complex the case is, such as esthetic crown lengthening of multiple teeth for gummy smiles, then the appointment may be longer in duration.

Crown Lengthening recovery and results: what to expect

After the surgical procedure, you will have dissolvable stitches in the area. Depending exactly what stitches are used, they may fall off in around a week or we will remove them at your post-operative appointment. After the local anesthesia wears off, you may be sore or experience some aching in the surgical area. Any discomfort can usually be resolved with ibuprofen (Advil) or acetaminophen (Tylenol). Stronger pain medications are rarely needed but can be prescribed depending on your pain sensitivity. 

During the first two weeks of healing, it is important that the surgical site remains undisturbed. That means you will avoid chewing food or brushing the site. Except for specific cases, there are no real dietary restrictions – you don’t need a liquid diet or soft diet and can eat whatever you want as long as you chew on the other side. You will be given a mouth rinse to help keep the area clean.

We will typically see you for a post-operative check around 2-3 weeks. Any remaining sutures are removed at the appointment and we will clean the teeth. Depending on how the healing is, we will let you know when you can go back to your general dentist to get the final crown, usually after another 2 weeks (1 month after the crown lengthening procedure).

Our team of periodontists specialize in crown lengthening, and serve the communities of Orange County, including Orange, Anaheim, Fullerton, Anaheim Hills, Tustin, Placentia, Yorba Linda, Santa Ana, Villa Park and Garden Grove. Book your consultation today!