Crown Lengthening Surgery

Occasionally, tooth decay or old dental fillings extend under the gum line. When an attempt is made to treat such decay or when old fillings need to be replaced, the resulting restoration may extend too deeply under the gum line, resulting in a physical irritation to the gums. In addition, the resulting filling or crown margin (edge) is too deep for the patient to effectively keep plaque-free. Unfortunately, no amount of brushing, flossing or professional cleanings can resolve this problem. The gums remain inflamed, red or bluish red in color and prone to bleeding when touched, Sometimes the gums even bleed spontaneously. In order to prevent this from happening, crown lengthening procedures are performed which result in more of the tooth protruding from the gum line and thus allowing the dentist to properly restore the tooth.

In non-aesthetic areas, crown lengthening can efficiently be accomplished with a procedure known as osseous surgery for crown lengthening. This is a procedure, done in the office, under local anesthesia, where gum tissue and sometimes a small amount of jawbone is removed and reshaped around the tooth and blended into the neighboring teeth. If done properly, after healing, your dentist will have enough tooth protruding from the gumline to allow for proper restoration.

Orthodontic Forced Eruption Combined with Circumferential Fiberotomy

In aesthetic areas, where changing the gum line may not be desirable, an elegant and less invasive technique involves combining orthodontic forced eruption with circumferential fiberotomy. This technique requires a limited orthodontic appliance (braces) be applied to the tooth to be lengthened and to several of its neighbors. A gentle orthodontic force is applied to the tooth to “erupt” it further from the gum and jaw. To prevent the gum and bone from moving with the tooth, the gum around the tooth is numbed and the fine fibers connecting the tooth to the gum are released. The amount of discomfort afterwards is minimal (some have described it similar to having a “rougher cleaning”) and the amount of lengthening can be controlled to provide just what your dentist needs to properly restore the tooth. This technique is not commonly performed by others, but Dr. Melnyk has been successfully performing these treatments since the late 1980’s.

Select photo for before and after views

Note the puffy, redish-blue gums above the canine tooth! This is caused by the crown edge being placed too deeply under the gum line and too close to the gum attachment to the tooth.

Note the puffy, redish-blue gums above the canine tooth! This is caused by the crown edge being placed too deeply under the gum line and too close to the gum attachment to the tooth.

Left: Lower front teeth too short for crowninf. Right: 5 weeks after crown lengthening.

Left: Lower front teeth too short for crowninf. Right: 5 weeks after crown lengthening.

From left to right top: Broken front tooth. - Orthodontic appliance in place. From left to right bottom: Tooth extruded without changin the gumline. - Tooth restored with a new crown.

From left to right top: Broken front tooth. - Orthodontic appliance in place. From left to right bottom: Tooth extruded without changin the gumline. - Tooth restored with a new crown.

From left to right: Initial x-ray film. - Note how much the tooth was moved. - Tooth restored, bone filled in above the root tip.

From left to right: Initial x-ray film. - Note how much the tooth was moved. - Tooth restored, bone filled in above the root tip.