Crown Lengthening - Procedure, Recovery & Who Needs It?

What is Crown Lengthening?

Crown lengthening is a surgical procedure that exposes more tooth structure by removing the surrounding gum tissue or bone. It can also recontour the gum tissue or bone.^{1, 2}

Crown lengthening helps give your dentist enough tooth structure to work with during restorative procedures, like fillings or fitting a dental crown or bridge. You may also get this procedure for cosmetic reasons to improve the look of your smile. 

Who Needs Crown Lengthening?

People with a gummy smile, or one that shows a high amount of the upper gum tissue, may undergo crown lengthening surgery. This can help remove excess gum tissues or raise the gum line to make teeth appear longer. 

This surgery also might be necessary if more of a tooth’s structure needs to be exposed for restorative dental procedures, like fitting crowns or filling cavities. 

You may have insufficient space or structures on a tooth because of:³

• Cavities or tooth decay
• Tooth erosion 
• Tooth malformation
• Fractures
• Excessive tooth reduction
• Genetics
• Periodontal disease

Crown Lengthening Procedure

Before undergoing a crown lengthening procedure, you’ll need to do a few things to prepare. You should also know what to expect before and after the procedure. 

How to Prepare

Your dentist will take X-rays of the area that needs surgery. They may also fit you for a temporary crown or filling to protect your tooth until surgery. 

Before surgery, your periodontist will review your X-rays, examine your teeth and gums, and come up with a surgical plan.  

It’s important to tell your periodontist about any medications you’re taking and any health conditions you have. They will review your medical history and determine any special precautions you may need to take. 

Having healthy gums before surgery is important. Practice good oral hygiene, such as brushing the teeth twice daily and flossing daily before the surgery.

Procedure Steps

Before any of the procedures start, your surgeon will administer local anesthesia to numb the area they will be working on.⁴

During crown lengthening surgery, you may undergo one of the following:

• Gingivectomy
• Apically repositioned flap
• Surgical extrusion using periotome

Gingivectomy

This procedure involves the removal of excess gum tissue using a scalpel or laser. In some cases, a surgeon may instead use electrocautery, an electrically heated surgical instrument, to remove the gum tissue. At the end, your periodontist will pack the surgical site with periodontal dressings.⁵ 

Most people heal around 1 month after surgery and can receive permanent restorative procedures as needed at that time. 

Apically repositioned flap surgery

Your periodontist will make cuts in your gum line to create a flap of tissue. They will then lift this flap and remove excess gum tissue or bone, reposition the flap over your teeth, and stitch (or suture) it in place.

Most people need to heal for around 2 to 4 months before undergoing permanent restoration procedures.

Surgical extrusion using periotome

Your periodontist will insert a special tool called a periotome into the periodontal ligament, the space between the tooth socket and roots. They will then use the periotome to move the tooth where it needs to be and use sutures or stitches to hold the tooth in place.⁴

Most people have their stitches or sutures removed 10 days after surgery. But in some cases, a doctor will use sutures that dissolve naturally over time.

You’ll normally have your final crown placed 1 to 3 months after surgery so the area has time to heal.

What are the Risks of Crown Lengthening?

All surgeries carry some risks. But some of the most common risks associated with crown lengthening surgery include:

• Excessive bleeding
• Infection
• Uncontrollable pain
• Excessive tissue or bone loss
• Loose teeth
• Teeth that look longer than others
• Sensitivity to hot and cold 

Aftercare & Recovery 

Most people experience pain after crown lengthening surgery once the local anesthetic wears off. Your doctor will tell you how to manage your pain. In many cases, they’ll advise you to alternate ibuprofen or acetaminophen as needed and to use a chlorhexidine mouthwash twice daily. 

You can also apply a wrapped ice pack or cold compress to the impacted area in 20-minute intervals, several times daily.⁶

After surgery, you’ll also need to eat soft or semi-soft foods for a day or two. You should also rinse the mouth out well with water after eating and brush carefully. Avoid hot or spicy foods, tobacco products, and alcohol while you recover. 

Depending on the type of procedure you had, it may take between 1 to 4 months to fully heal. After you heal completely, you’ll be able to undergo treatment for permanent restorations.

Outlook

The outlook for people who receive crown lengthening surgery depends largely on the extent of the surgery, why it was performed, and how successful it was. 

In one study from 2019, the survival rate of teeth that underwent restorative treatments and crown lengthening was 82.2% after 5 years and 51% after 10 years.⁷ 

In the same study, teeth that underwent crown lengthening surgery and restorative treatments were 2.3 times more likely to be extracted than teeth that only underwent restorative treatments. 

Discuss the risks and benefits of your specific case with your dentist and surgeon. 

Summary

Crown lengthening surgery removes excess gum tissue or bone. It allows dental surgeons to perform restorative procedures, like fitting crowns or bridges or filling cavities. Someone may also undergo this surgery to make the teeth look longer if they have a gummy smile.

The success of crown lengthening surgery depends on the extent of the surgery and the overall health of your teeth, bones, and gums. But many people that have restorative treatments after undergoing lengthening surgery are able to keep their teeth for several years.