| What Is It?
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 rare 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 will visit a periodontist for a consultation before the procedure. During
the consultation, the specialist will review your medical history and your
X-rays, and set a date for the surgery.
Your periodontist will instruct you on how to keep the area clean after
the surgery. You may receive a tooth cleaning before the procedure.
If the tooth needs a crown, your periodontist 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 the periodontist
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. The amount of time it takes
varies depending on the number of teeth that requiretreatmente. 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.
The periodontist 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 of filling. However, in most situations it will also be necessary
for the periodontist to remove some bone from around 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 the periodontist 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 a periodontal dressing — called an intraoral bandage — to
cover the surgical site.
Any temporary crowns will be removed before the procedure begins and replaced
afterward.
The periodontist will make incisions to remove the soft tissue and to provide
access to the tooth roots and the underlying bone. Bone removal allows more
of the tooth structure to be exposed. If this is necessary, the bone is removed
using a combination of hand instruments (like small chisels) and rotary instruments
(similar to the drill used to treat cavities).
After the soft tissue and bone have been removed, the incisions are sutured.
This will cause more of the tooth or teeth to be exposed. Some dentists use
a periodontal dressing to cover the incisions.
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 remove food particles
around the affected teeth with a toothpick or a water irrigator.
Follow-Up
For the first two days, use ice on your face to keep swelling down.
After the procedure, you will return to the periodontist in 7 to 10 days
to have the sutures removed, and then return again 4 to 6 weeks later for
a follow-up visit.
Your gums should heal for at least 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. You will visit your regular dentist to have the crown or filling
placed, and then again for a follow-up visit.
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 roots are covered with new temporary crowns.
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 periodontist will consider these
details during your consultation.
When To Call a Professional
Contact your periodontist 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
Additional Info
American Academy of Periodontology (AAP)
737 North Michigan Ave.
Suite 800
Chicago, IL 60611
Phone: 1-800-282-4867
Fax: 312-787-3983
http://www.perio.org/ ©2001-2007 Aetna All rights reserved. | 
