Crown lengthening: more tooth for a crown or a smile

What is crown lengthening?

Crown lengthening is a procedure that exposes more of a tooth by reshaping the gum around it and, when needed, a small amount of the bone beneath. The goal is to leave enough sound tooth structure above the gumline for a crown to fit and hold securely.

It differs from gum contouring, which reshapes gum tissue alone for looks, without touching bone or preparing a tooth for a crown. Crown lengthening can serve a restorative purpose, a cosmetic one, or both at once.

Why would you need crown lengthening?

The most common reason is a tooth broken or decayed near or below the gumline, leaving too little healthy structure for a crown to grip. A tooth can also look too short if the gum sits higher than it should, even without damage.

Some patients need it on several teeth at once to even out a gumline that looks uneven or shows too much gum when smiling. Your dentist typically identifies the need while planning a crown and refers you for the gum and bone work first.

What happens during crown lengthening?

The area is numbed with local anesthetic. The gum is then reshaped, exposing more of the tooth. If there isn't enough space between the gum and the bone, a small amount of bone is also reshaped, so the crown's edge will later sit on healthy tooth.

The same kind of access used in periodontal surgery applies here. When bone needs to be reshaped, piezoelectric surgery, an ultrasonic instrument, may be used to shape it while sparing the surrounding gum.

Once reshaping is complete, the gum is stitched into its new position so it heals at the level planned for the future crown.

How long does crown lengthening take to heal?

Initial soreness and swelling usually settle within a week or so, similar to other minor gum surgery. Cold sensitivity in the treated tooth is common during this time.

The final crown waits until the gum and, if it was reshaped, the bone have fully settled, often about six weeks to three months. Front teeth, where appearance matters most, are often given the longer end of that range so the gumline settles into its final shape.

Your dentist and Dr. Comeaux typically coordinate on timing, so the crown is made once the gum has stabilized.

What are the risks of crown lengthening?

The tooth often looks a little longer afterward, and cold sensitivity for a while is common. These are expected outcomes of exposing more tooth, not complications.

Reshaping bone leaves less root supported within bone, which can matter for a tooth's long-term stability, especially if several teeth are treated or the tooth already had bone loss from gum disease. Less commonly, the treated tooth can become more sensitive to biting pressure for a time.

For a tooth with little bone support to begin with, crown lengthening can tip the balance toward a shorter useful life for that tooth. That is part of why alternatives are worth discussing first.

What are the alternatives to crown lengthening?

Orthodontic extrusion, which gently pulls a tooth up with braces before a crown is made, avoids removing bone but takes months and needs a tooth healthy enough to move. It is considered for select teeth rather than most.

Removing the tooth and placing a dental implant is a reasonable alternative when a tooth is broken down so far that lengthening would leave it with little support left. Which option makes sense depends on how much healthy tooth and bone remain.

What affects the cost of crown lengthening?

Cost depends on how many teeth are treated and whether bone needs to be reshaped along with the gum. Your exam and your dentist's crown plan together determine the scope.

• How many teeth need crown lengthening
• Whether bone reshaping is needed in addition to gum reshaping
• Coordination with your dentist's crown or restoration plan
• The healing time before the final crown can be made
• What your dental plan covers, which varies by plan

Care at Perio One

At Perio One, crown lengthening starts with an examination of the tooth, the gum and the bone beneath it. Dr. Randal Comeaux, DDS, Diplomate of the American Board of Periodontology, explains in plain language how much reshaping a tooth needs and what to expect.

We coordinate closely with your general dentist, who plans and makes the final crown once your gum has healed. Referrals are welcome, and every plan considers whether crown lengthening or an alternative best serves the tooth.

3D cone beam CT imaging is used when bone needs to be evaluated closely before treatment.

What to expect

1. Referral and examination

   Your dentist refers you, and we examine the tooth, gum and bone to plan the reshaping needed.

2. Your plan, explained

   Dr. Comeaux explains what will be reshaped and why, and answers your questions.

3. Numbing

   The area is numbed with local anesthetic before the procedure begins.

4. Reshaping

   Gum, and bone if needed, are reshaped to expose enough healthy tooth structure.

5. Early healing

   Soreness and swelling settle over about a week as the gum heals into place.

6. Waiting period

   The gum and bone settle fully over roughly six weeks to three months before the crown is made.

7. The final crown

   Your dentist takes an impression or scan and fits the finished crown.

Sources

• American Academy of Periodontology: Surgical procedures
• Cleveland Clinic: Gum contouring
• MouthHealthy (American Dental Association): Crowns

This page is general education, not a diagnosis. Your periodontist will recommend care after an examination.