Crown lengthening is an operation for coping with an excessive gingival showing, otherwise called a gummy smile.
It appears a person with a gummy smile has short teeth. Their teeth are still the typical size but they are partly covered by excess gum tissue.
The crown is the part of the tooth that can be seen above the gumline. Many people ask for surgical crown lengthening while others allow the procedure to reveal decayed or missing areas of teeth.
A parodontist— a gum specialist — may perform a crown lengthening before they can fit a bridge or perform another dental restorative operation to reveal more tooth structure.
In this article, we describe what is involved in crown lengthening including how a person prepares, what they can expect during the procedure, and what is involved in recovery.
What is it?
People with gummy smiles usually have an exposed gum of more than 3 millimetres.
The procedure involves removing soft tissue and sometimes bone, in order to increase the clear amount of tooth.
The operation may be done by a periodontist on one tooth, multiple teeth or the whole gumline.
Dentists can practice crown lengthening to:
- address cosmetic concerns
- expose cavities beneath the gumline
- expose fractured areas of tooth
- expose more tooth structure before they can fit a device such as a bridge
The dentist will be vigilant to maintain ample gum to keep oral structures safe. They may describe the quantity of gum as biological width.
Crown lengthening surgery isn’t suitable for all. Anyone interested in the procedure should discuss it with their dentist, for cosmetic reasons.
How to prepare for the procedure
A person interested in crown lengthening should see a check-up with their dentist and discuss the suitability of the procedure.
Before the surgery, it is necessary to get healthy gums and good overall health. The American Academy of Periodontology recommends: to promote gum and teeth health;
- brushing the teeth regularly
- flossing at least once a day
- using mouthwash
- visiting the dentist annually for a comprehensive evaluation
Prior to the procedure, the periodontist performs a presurgical analysis to determine the gumline’s new location.
We will also evaluate the structures around the bones, gum and surrounding. This information helps them determine which surgical technique is best suited.
A parodontist— a dentist who specializes in gum health— removes excess gum tissue during a crown lengthening operation. Some general dentists can do this operation, too.
Many cases often require that the dentist cut or reshape the bone tissue to reveal more of the teeth.
Multiple crown lengthening methods are as follows:
- apically repositioned flap surgery
- surgical extrusion
We describe each in detail below.
The dentist should choose the most appropriate technique based on the origin of the excess gum tissue and the mouth condition.
Some factors that can influence the choice of technique include:
- aesthetic considerations
- the length of the tooth’s root, compared with its crown, called the crown to root ratio
- the proximity of the root
- the appearance of the root
- the presence of bone loss
- the position of the affected tooth or teeth
- the need for a filling or cap
A gingivectomy is gum tissue removal — using a scalpel, a laser, or an electrocautery. The person is being given local anesthesia.
Lasers will produce better results than scalpels, according to some research: people suffering from laser gingivectomy may have less discomfort, heal faster and experience less bleeding.
Electrocautery, meanwhile, can be just as powerful as lasers. This method includes using an instrument which is electrically heated.
The gums can recover rapidly from a gingivectomy according to a 2015 evaluation. The pain usually goes away within a few days to 1 week, and total tissue healing typically takes place within 4–6 weeks if the surgery only involves removing the gum tissue.
Apically repositioned flap surgery
It involves making an incision in the gums to create a tissue flap. Then the periodontist raises the flap to remove extra tissue and probably bone, depending on how much of the dent they want to reveal.
They instead reposition the flap toward the tooth root and use stitches to protect it as it heals. Often, they may put a dental dressing or bandage over the wound.
Surgical extrusion involves moving the tooth along the gumline to the desired location. This technique may be used by a parodontist when a tooth is broken under the gum.
They may use stitches when restabilizing the dent. Over time, these may dissolve, or require removal. Sometimes, the dentist may use wire or splint to secure the dent to the surrounding teeth.
Recovery will depend on the type of operation, and will be given detailed instructions by the dentist who performed it.
During the treatment the area is numbed in such a way that the person does not experience pain. Nevertheless, as anesthesia wears off the person can feel discomfort or pain.
Most people require anti-inflammatory drugs to alleviate pain and inflammation after the procedure, such as acetaminophen or ibuprofen.
Some swelling and bleeding after a lengthening of the crown may be expected for the first few days. For help with pain and swelling, the dentist may recommend applying a cold compress to the area.
Consume a soft diet during recovery, and rinse the mouth between meals with water. The dentist may also recommend a mouthwash with chlorhexidine for use twice a day after the surgery.
The pain and swelling will wane after the initial healing process, and the gums will continue to shrink.
If the dentist suits a brace, like a bridge, they may wait until healing is complete. Full healing in the back of the mouth may take 6–12 weeks, while healing at the front may take 3–6 months, according to the American Academy of Periodontology.
When to see a dentist
Not everyone is prepared for surgery that will lengthen the crown. Speak with a dentist, who can explain the suitability of the operation.
You may also refer a gum professional, called a parodontist.
Ask the dentist or parodontist after a lengthening of the crown if:
- there is significant inflammation or pain
- the bleeding does not stop
- any other possible signs of infection are present
If a person has a gummy smile and wishes to change it, they can speak to a dentist about the possibility of a crown lengthening.
The dentist can refer the individual to a parodontist— a gum specialist — or to another dentist who has gum surgery training.
Often, a person may need to undergo crown lengthening before a dentist can repair damage to the tooth or fit a brace, like a bridge. In this situation, the dentist will wait up to 6 months before installing the unit, to allow the gums time to heal fully.
Not everyone is suitable for crown lengthening and a dentist for general can provide details about their suitability.