Crown Lengthening and Gummy Smile Correction

Two Reasons for the Same Procedure

Functional crown lengthening. A tooth breaks or decays at or below the gumline. There is not enough tooth above the gum for a crown to hold onto, and a crown placed too close to the bone risks lasting inflammation of it. Removing a small amount of gum and bone around the tooth exposes sound structure, so your dentist can make a crown that lasts. This is one of the most common procedures general dentists refer to us. The 2017 World Workshop convened jointly by the American Academy of Periodontology and the European Federation of Periodontology replaced the older term biologic width with supracrestal tissue attachment for this zone of gum above the bone, and reported that restorative margins encroaching on it are associated with inflammation and loss of periodontal supporting tissue. The term it retired came from a 1977 paper in which Ingber, Rose and Coslet set out the biologic width as a concept in periodontics and restorative dentistry.

Esthetic crown lengthening. The teeth are a normal length but the gum covers too much of them, so the smile shows a band of gum. Reshaping the gumline, and the bone edge under it when necessary, reveals the full tooth and gives an even, natural contour. Often done on the six or eight upper front teeth at once. The proportion being aimed at is a well-documented one: surveying 454 smiles in 1984, Tjan, Miller and The found that an average smile shows approximately the full length of the upper front teeth. The American Academy of Periodontology describes the same procedure in its patient material on cosmetic periodontal surgery: excess gum tissue is removed to expose more of the crown of the tooth, and the gumline is then sculpted. Gummy smile.

What Happens

1. Consult. For a functional case, we review your dentist’s plan and the X-ray and confirm the tooth is worth restoring. For an esthetic case, we measure tooth proportions, the lip line, and the bone position, and show you what the result will look like.
2. The procedure. Local anesthetic, with sedation available. The gum is contoured and, where needed, bone is reshaped with fine instruments. Thirty to ninety minutes. Sutures placed.
3. Healing. Sutures out at one to two weeks. Your dentist proceeds with the crown after six to eight weeks on a back tooth, and three to six months on a front tooth.

Recovery

Mild swelling and soreness for two to three days, soft food for a few days, and careful brushing away from the site. Esthetic cases look better within two weeks and keep settling for three to six months; that window is this practice’s own observation rather than a published finding. The published evidence on whether the result holds is reassuring but thin: a 2023 systematic review and meta-analysis by Smith and colleagues in the Saudi Dental Journal found crown-lengthened sites holding up much like the untreated teeth beside them at three and six months, on only four controlled trials, with the authors calling for more evidence.

For Referring Dentists

Send the tooth number, the intended restoration, and a current periapical. We return a report with the new margin position and a ready date. Referral information.