Crown lengthening is a surgical procedure that removes gum tissue and bone, in most cases a small amount of each, and is designed to expose more of the tooth above the gum line. It is a common procedure, and a common dental procedure to be referred for, though most patients have never heard of it until they need a crown.
Patients arrive at it from two completely different directions. Some have been told by their dentist that a tooth broken near the gum line does not have enough tooth left to fit a crown. Others simply feel their teeth look too short. The surgery is similar. The reasoning behind it is not, so this page covers both separately.
Why The Bone Has To Move
This is the part most explanations skip, and without it nothing else makes sense.
Between the top of the bone and the bottom edge of any crown or filling, your body needs a consistent band of soft tissue attachment, roughly three millimeters of it. It used to be called the biologic width and is now more properly called the supracrestal tissue attachment. It is not optional. If a restoration is placed into that space, the body reacts: the gum stays inflamed, bleeds, and bone gradually resorbs until the space is re-established.
So when a dentist says there is not enough tooth for a crown, they usually do not mean there is nothing to work with. They mean that anything they could grip would sit inside that protected zone, and that tissue and bone need to be removed before they can place a crown on your tooth safely. Crown lengthening surgery moves the bone and gum down so the margin of the dental crown sits above that zone, where it belongs.
The same principle explains why removing gum alone will not hold. Trim the gum without addressing the bone and the tissue simply grows back to re-establish the distance it needs, usually within a few months. That is the difference between this procedure and a gingivectomy.
Functional Crown Lengthening
This is the restorative version, and it is the more common of the two.
Your dentist refers you when a tooth cannot be restored as it stands. These are the teeth that need crown lengthening before anything else can happen:
- A tooth fractured at or below the gum line
- Decay extending under the gum
- An existing crown that keeps coming loose because there was never enough tooth structure to grip
- A root canal treated tooth with very little natural tooth remaining above the gum
- Preparation for a filling or crown where the margin would otherwise sit too deep
The technical requirement your dentist is chasing is called a ferrule: a band of sound tooth structure, usually 1.5 to 2mm high, that the crown can wrap around and grip. Without it, the crown is essentially sitting on the filling material underneath rather than on the tooth, and it tends to fail.
Deciding you need crown lengthening on a molar or premolar is often the difference between keeping a natural tooth and losing it, which is worth weighing when you are told you need another surgical appointment before the crown you were already expecting.
Esthetic Crown Lengthening
The cosmetic version treats a different complaint: teeth that look short and square, with the gum sitting low across them.
In many of these cases the teeth are a normal size. They are simply partly covered, a condition called altered passive eruption, where the gum never finished migrating during development. Exposing the natural tooth beneath changes the proportions of the smile considerably.
Esthetic crown lengthening is also done to even out a gum line that sits at noticeably different heights across the front teeth, and as preparation before veneers or crowns so the restorations can be made to correct proportions rather than short ones.
Can Crown Lengthening Fix A Gummy Smile?
Sometimes, and this is where being straight with you matters more than being encouraging.
If your gums show because tissue covers teeth that are actually a normal length, crown lengthening addresses it directly and the result is permanent.
If your gums show because your upper lip lifts unusually high, or because the upper jaw is longer than average, crown lengthening will not fix it, and doing it anyway produces teeth that look long without solving the original complaint.
Where the lip is the cause, lip repositioning surgery can reduce how much gum shows, and we perform it. One honest caveat: in gummy smile cases the display tends to return over time. Not to where it started, but it rarely stays fully corrected. For that reason Botox is often the more practical way to manage it, though it needs repeating every three to four months.
A jaw discrepancy is different. That is skeletal, and correcting it calls for a surgeon with maxillofacial training. We would tell you that at the consultation rather than after, and we would make sure the right people are involved in your plan.
Working out which one you have takes a few minutes with photographs and measurements. Our gummy smile page goes through the causes in more detail.
What Happens During The Procedure
- Planning. We take X-rays and measure the amount of tooth structure sitting above the bone. This determines how much bone needs to come away and whether neighboring teeth are involved.
- Local anesthesia. The area is numbed. Sedation is available if you would prefer it.
- Lifting the gum. A small flap of gum tissue is lifted to give access to the bone underneath. This is an apically repositioned flap surgery.
- Reshaping the bone. A small amount of bone is removed around the tooth or teeth, re-establishing the space the attachment needs.
- Closing. The gum is repositioned lower and secured with a suture, sometimes with a dressing over the surgical site.
The crown lengthening procedure is one performed in an hour or less for a single tooth, longer where several teeth are involved. Keeping the surgical area clean afterwards can help prevent infection, and we will give you written care instructions before you leave. Where the appearance of the smile is the goal, adjacent teeth are usually included so the gum line stays even.
If your tooth has a temporary crown, it may need adjusting or replacing afterwards so it does not press on the healing tissue.
Recovery And Healing Time
Most patients are back to normal activity the next day, with some soreness for the first few days.
- Use an ice pack for the first 24 hours to limit swelling
- Avoid hot foods and drinks while the anesthetic wears off, and for the first day
- Rinse with warm salt water from the day after, gently
- Stick to soft foods and chew away from the teeth that were treated
- Take over-the-counter pain relief as needed, unless we prescribe something specific
- Keep up your oral hygiene elsewhere in the mouth, avoiding the surgical area directly
- Sutures usually come out in seven to ten days
Some sensitivity to hot and cold on the treated tooth is normal for a few weeks after the procedure, because more of the root is now exposed. It usually settles, and protecting your oral health during that period is mostly a matter of keeping the area clean.
When The Final Crown Can Be Placed
This is the question dentists and patients most often get wrong, and rushing it is the most common cause of a disappointing result.
The gum margin continues to settle for months after surgery. Place the final crown too early and the tissue may recede further afterwards, leaving a visible margin, or creep back up over the crown edge.
We generally wait around three months before the final crown is made for a back tooth, and closer to six months in the esthetic zone where a millimeter of movement is visible. Your dentist can place or adjust a temporary crown in the meantime. It is a frustrating wait, and it is shorter than redoing the crown.
Alternatives Worth Knowing About
Crown lengthening is not the only way to expose more tooth, and it is not always the best one.
Orthodontic extrusion. The tooth is gently pulled upward over several weeks using orthodontic force, bringing tooth structure above the gum without removing bone. It takes longer, but it avoids sacrificing bone support on the neighboring teeth, which matters in the front of the mouth.
Extraction and a dental implant. Where crown lengthening would leave too little root in bone, or would compromise the adjacent teeth, replacing the tooth is sometimes the more durable answer. We would rather tell you that than perform surgery on a tooth with a poor long-term outlook.
Doing nothing yet. If the tooth is comfortable and the restoration is holding, waiting is occasionally reasonable.
When Crown Lengthening Is Not Advisable
Removing bone around one tooth means removing it from the neighbors as well, since bone does not come away in isolation. That trade-off is acceptable in most cases and not in all.
We would advise against it where the roots of adjacent teeth sit very close together, where removing bone would expose the split between the roots of a molar, where the tooth would be left with too little root anchored in bone to be stable, and in the front of the mouth where the cosmetic cost to healthy neighboring teeth outweighs the benefit to one damaged one.
What Affects The Cost
Cost depends on the scale of the surgery rather than a flat rate per tooth. What drives it:
- How many teeth are treated, one tooth or across the smile
- Whether bone is being removed or only gum tissue
- Whether the goal is restorative or cosmetic, which affects insurance
- Whether sedation is used
- Any temporary restoration work needed in the meantime
Insurance treats the two versions differently. Functional crown lengthening performed so a tooth can be restored is often a covered benefit. Esthetic crown lengthening usually is not. We will check your plan and tell you which category applies before you commit to anything.
We’ll give you an exact cost as part of your treatment plan at your consultation.
Frequently Asked Questions
How painful is crown lengthening? You should not feel pain during it, as the area is fully numbed. Afterwards, most patients describe it as comparable to having a tooth out, with soreness for a few days handled by over-the-counter pain relief.
Do gums grow back after crown lengthening? Not to where they were, because the bone underneath was reshaped and the tissue follows the bone. Minor rebound in the first few months is normal and is exactly why the final crown should wait. This is the key difference from gum removal alone.
Is crown lengthening worth it? When it is the difference between keeping a tooth and extracting it, almost always. For cosmetic cases the answer is more personal, and whether to consider crown lengthening depends on whether the gum is genuinely what is bothering you.
Who can perform crown lengthening? A periodontist performs crown lengthening routinely, and some general dentists do it too. The judgment about how much bone to remove, and what that costs the neighboring teeth, is the part that benefits from specialist training.
What happens following crown lengthening if I still need a crown? Your restoring dentist places a temporary crown, then makes the permanent crown once the tissue has settled. We coordinate the timing with them directly.
How long does the procedure take? Usually under an hour for a single tooth. Longer where multiple teeth are treated.
Do you get stitches? Yes, in nearly all cases, and they typically come out after seven to ten days.
How long after crown lengthening can a crown be placed? Around three months for a back tooth, closer to six in the esthetic zone. A temporary crown covers the gap.
Will my teeth look different afterwards? Yes, and in cosmetic cases that is the point, since the aim is to improve your smile. In restorative cases the change is usually modest and often not visible when you smile.
What are the risks? Sensitivity, some gum recession on the treated and neighboring teeth, and rarely infection. The tooth may look longer than its neighbors if it was treated in isolation, which is part of why we plan across several teeth in visible areas.
Schedule A Consultation
If your dentist has said there is not enough tooth for a crown, or your teeth look shorter than you would like, come in and we will look at what is actually going on. We will measure the tooth against the bone, tell you whether crown lengthening will get you where you want to be, and go through the alternatives honestly, including when we think a different approach would serve you better.
Call our office at (347) 493-2439 or schedule your consultation online.
