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.
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.