Crown lengthening is required when further exposure of a tooth is necessary. This may be for functional or esthetic reasons (see Cosmetic Periodontal Surgery).
Functional crown lengthening is necessary due to inadequate biologic width. The biologic width is the natural distance between the gum line and the underlying supportive connective tissues and bone. When cavities or fractures of teeth extend deep below the gum tissue, crown lengthening is necessary to provide access to treat these areas and ensure that the new dental restoration (filling or crown) does not violate the biologic width which can induce gingival inflammation and soreness.
The procedure involves recontouring and removing small amounts of gum and bone tissue to expose the area of tooth requiring treatment. When the procedure is completed, sutures (resorbable and nonresorbable may be used) and occasionally a surgical bandage are placed to help secure the new gum-to-tooth relationship. You will need to be seen in 14 days to remove the sutures and evaluate your healing. Final treatment of the exposed tooth area does not occur for at least 6 weeks to allow for tissue maturation. During this period a provisional (temporary) restoration may be in place for function and/or esthetics.
A “gummy smile” with teeth that appear short or have uneven gum lines may benefit from esthetic crown lengthening or a gingivectomy. The initial short appearance may be due to incomplete exposure of the natural crown (enamel) of a tooth or wearing of teeth. This may be hereditary and is commonly seen in parents, their children and among siblings. Tissues, generally only on the visible (front) side of the mouth, are removed to expose and/or even the gum lines. Sometimes only gum tissue needs to be removed (ie. gingivectomy); however often both gum tissue and bone must be removed (ie. crown lengthening) to ensure that the tissue stays where it is positioned. Resorbable sutures are used to close the area(s) and a 14 day follow occurs to assess healing. Any additional treatment to the teeth in these areas usually requires at least 6 weeks of tissue maturation to insure the stability of the new gum levels prior to any restorations. Provisional (temporary) restorations are often used during this waiting period.