Crown Lengthening. One of the most important, yet difficult to explain procedures
in dentistry. Think of it like a banana. Say you peel a banana half way and discover
a brown mushy spot mid banana extending down below the peel. In order to remove the
brown spot, you must first peel back to peel to expose it. In this analogy, the banana
is the tooth, the peel is bone, and the brown spot is decay. If you’ve got decay
that extends below the gum line to (or below) bone level, then you must first remove
bone (“pull back the banana peel”) to expose the lesion. This allows a more isolated,
clean field. The dentist, then, can cleanly place a filling, crown, or other type
of restoration without the obstruction of bone, bleeding, tissue, etc. The dentist
(me) is “lengthening” the “crown” of the tooth by subtracting bone. I’m not REALLY
lengthening the crown,
but increasing the exposed part of the crown by removing the surrounding bony support.
Secondly, bone does not like to be close to a crown or a filling. Technically,
there is a term “biological width.” This describes the safe distance of 2-3 mm between
bone and the restoration (crown or filling). If bone is too close, the tissue gets
red and bleeds. The
area can become inflamed and hurt. An overall unhappy situation. Crown lengthening
prevents this. Think of it like a bad wound. You must expose and clean the wound
and area around it before covering it up with a band aid (or in this case… a crown!!
Many dentists do not implement the crown lengthening procedure because:
A) They’re scared of it
B) They don’t know how to do it.
C) They don’t want the hassle/ loss of revenue/ logistic pain of sending the
case to a specialist.
D) They don’t even know the crown lengthening procedure exists.
If crown lengthening is ignored in a case that requires it, the patient is destined
to a lifetime of a bleedy, annoying crown. This will ultimately be blamed on a “cracked
root” or something unrelated. I have actually seen some of these cases, sadly, be
Crown lengthening is a MINOR surgical procedure. It is no worse than a simple
extraction or deep cleaning. I make a small incision next to the tooth, reduce a
small area of bone with a round diamond bur and place suture. Very Simple. Then,
after 2 weeks of healing, the crown or filling may be done.
The crown lengthening procedure takes about 30 minutes and will save a LIFETIME
of tooth problems. Furthermore, the “restoration” (crown or filling) is a cleaner,
quicker, and easy appointment for both the dentist and the patient. Yes, crown lengthening
is an extra procedure (time, expense, etc.), but saves you BIG TIME in the long term.
Now that you understand the basic principal of Crown Lengthening, it becomes clear
how this procedure can be used in cosmetic dentistry. The gums (or gingiva) is the
“frame” of the tooth. It outlines the teeth and the smile. It can make the teeth
look short, long, wide, thin, asymmetrical, or symmetrical.
Everyone wants their smile to look a certain way. Since the gums always sit a
specific distance from bone, then (similar to the “biological width” concept) the
bone position will dictate tissue position. The term “Cosmetic Gum Contouring” (Described
elsewhere in this website) refers to the manipulation of gum tissue (alone) into
a more esthetic position. BUT, if the bone position doesn’t allow the tissue to be
moved past a certain point, then Crown Lengthening must be implemented. Does this
make sense? You can’t move the tissue up to make a more esthetic smile if you’re
going to be exposing bone. Believe me, you’re not going to like the way your smile
looks with bone exposed!!!!! ; ) And Ouch!!
Therefore, the dentist must determine (usually by a technique called “sounding”
where the bone is in relation to current tissue position and in relation to the target
tissue position. With “Sounding”, I take a periodontal probe (a small pin shaped
ruler on a handle) and push it down to the the level of bone. The ruler-like markings
on the probe then tells me everything I need to know.
If bone does not interfere with my target tissue position, then I can do Cosmetic
Gum Contouring (please see “Cosmetic Gum Contouring” section of website) WITHOUT
having to do Crown Lengthening. Are all these crazy terms starting to make sense
now??? Ok. Take a breath!
Below are some before and after photos of cases where Crown Lengthening was needed
to move the tissue into a more esthetically appealing position. As you can see,
some of these movements were significant. Therefore, such a dramatic tissue change
could only happen in conjunction with the movement of bone.
In other cases, where minor tissue changes are needed OR in cases where its Tissue
Overgrowth that is causing the smile issue, then Cosmetic Gum Contouring may be done
without Crown Lengthening. These are much more straightforward cases and the desired
result can be attained much less invasively. Please see the (above) “sub section”
of the web site called “Cosmetic Laser Contouring” for a description of this procedure.