Crown lengthening is a procedure to address an excessive gingival display, otherwise known as a gummy smile.
A person with a gummy smile appears to have short teeth. Their teeth are actually the typical size, but excess gum tissue partially covers them.
The crown is the part of the tooth that is visible above the gumline. Some people request crown lengthening for cosmetic purposes, while others need the procedure to expose decayed or broken areas of teeth.
A periodontist — a gum specialist — may perform a crown lengthening to expose more tooth structure before they can fit a bridge or perform another restorative dental procedure.
In this article, we describe what crown lengthening involves, including how a person prepares, what they can expect during the procedure, and what recovery entails.
People with gummy smiles typically have more than 3 millimeters of exposed gum.
The procedure involves removing soft tissue and sometimes bone to increase the amount of tooth that is visible.
A periodontist may perform the procedure on one tooth, several teeth, or the entire gumline.
Dentists may perform crown lengthening procedures 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 careful to preserve enough gum to maintain the health of oral structures. They may describe this amount of gum as biologic width.
Crown lengthening surgery is not appropriate for everyone. Anyone who is interested in the procedure for cosmetic reasons should discuss it with their dentist.
A person who is interested in crown lengthening should see their dentist for a check-up and to discuss the suitability of the procedure.
It is important to have healthy gums and good overall health before the surgery. To support the health of the gums and teeth, the American Academy of Periodontology recommend:
- brushing the teeth regularly
- flossing at least once a day
- using mouthwash
- visiting the dentist annually for a comprehensive evaluation
Before the procedure, the periodontist performs a presurgical analysis to determine the new location of the gumline.
They will also assess the teeth, gum, and surrounding structures. This information helps them decide upon the most appropriate surgical technique.
During a crown lengthening, a periodontist — a dentist who specializes in gum health — removes excess gum tissue. Some general dentists can also perform this procedure.
Certain situations require the dentist to also remove or reshape bone tissue to expose more of the teeth.
The following are different crown lengthening techniques:
- apically repositioned flap surgery
- surgical extrusion
We describe each in detail below.
The dentist will choose the most appropriate technique based on the cause of the excess gum tissue and the condition of the person’s mouth.
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 the removal of gum tissue — using a scalpel, a laser, or electrocautery. The person will receive local anesthesia.
According to some research, lasers may produce better results than scalpels: People who undergo laser gingivectomy may have less pain, heal more quickly, and experience less bleeding.
Meanwhile, electrocautery may be as effective as lasers. This approach involves using an electrically heated instrument.
According to a 2015 evaluation, the gums can heal from a gingivectomy quickly. Any pain usually goes away within a few days to 1 week, and complete tissue healing typically occurs in 4–6 weeks if the surgery only involves the removal of gum tissue.
Apically repositioned flap surgery
This involves making an incision in the gums to create a flap of tissue. The periodontist then lifts the flap to remove extra tissue and possibly bone, depending on how much of the tooth they intend to expose.
Next, they reposition the flap toward the root of the tooth and use stitches to keep it in place as it heals. They may also place a dental dressing or bandage over the area.
Surgical extrusion involves moving the tooth to the desired location on the gumline. A periodontist may utilize this method when a tooth is fractured beneath the gum.
When restabilizing the tooth, they may use stitches. These may dissolve over time or require removal. The dentist may also use wire or a splint to anchor the tooth to the surrounding teeth.
Recovery can depend on the type of procedure, and the dentist who performed it will give detailed instructions.
The area is numbed during the procedure so that the person does not experience pain. However, the person may experience discomfort or pain as the anesthesia wears off.
Some people require anti-inflammatory medication, such as acetaminophen or ibuprofen, to relieve pain and inflammation after the procedure.
Minor swelling and bleeding can be expected for the first few days after a crown lengthening. The dentist may recommend applying a cold compress to the area to help with pain and swelling.
During recovery, consume a soft diet and rinse the mouth with water after meals. The dentist may also prescribe a chlorhexidine mouthwash for use twice a day after the surgery.
After the initial healing phase, the pain and swelling will fade and the gums will continue to shrink.
If the dentist is going to fit a device, such as a bridge, they may wait for healing to complete. According to the American Academy of Periodontology, full healing in the back of the mouth may take 6–12 weeks, while healing at the front may take 3–6 months.
Not everyone is eligible for crown lengthening surgery. Speak with a dentist, who can describe the procedure’s suitability.
They may also provide a referral to a gum specialist, called a periodontist.
After a crown lengthening, tell the dentist or periodontist 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 should discuss the option of a crown lengthening with a dentist.
The dentist may refer the person to a periodontist — a gums specialist — or another dentist with training in gum surgery.
A person may also need to undergo crown lengthening before a dentist can repair tooth damage or fit a device, such as a bridge. In this case, the dentist may wait for up to 6 months before fitting the device, to give the gums time to fully heal.
Not everyone is eligible for crown lengthening, and a general dentist can provide information about its suitability.