What is the difference between a gingivectomy and crown lengthening?

A gingivectomy removes and reshapes gum tissue only. Crown lengthening reshapes the gum and, where needed, the bone beneath it, so that a healthy band of gum can re-form at a new, higher level. Which one a tooth needs depends on how far the bone sits below the planned gumline, which is measured before the plan is final.

Will my gums grow back after a gingivectomy?

They can. Gum tends to re-form its natural height above the bone, so a gumline cut too close to the bone tends to creep back. Even after crown lengthening with bone removal, a 12-month study by Pontoriero and Carnevale found the gum margin moved back toward the tooth by about 3 millimeters on average, more in people with thick gum tissue. Planning for that is part of the procedure. Gum overgrowth caused by medication also tends to return unless the cause is addressed.

Is a gingivectomy covered by insurance?

Sometimes. Dental plans generally treat a procedure done for gum health, or so a tooth can be restored, differently from one done for appearance, and purely esthetic procedures are often not covered. The practice is out of network: it files the claim for you, and the plan reimburses you directly. You receive a written estimate before anything is scheduled.

Does a gingivectomy hurt?

It is done under local anesthetic, so the procedure itself should not be painful. In this practice's experience, procedures involving only the gum are followed by mild soreness for a few days, and those that also reshape bone take a few days longer. Over-the-counter pain relief is usually enough.

Can a gingivectomy be done with a laser?

Some offices use a laser to remove gum. This practice uses conventional instruments and does not offer laser treatment. Whether a new gumline holds depends mainly on where it sits relative to the bone, which is a planning question rather than an equipment one.

Gingivectomy vs. Crown Lengthening in Austin: Which You Need

In the Austin area? Dr. Verrett provides this care in North Austin. See Crown Lengthening and Gummy Smile Correction, or request a consult.

A dentist says the gum needs trimming before a crown can be made, or a mirror shows more gum than tooth, and two words start appearing in the treatment plan: gingivectomy and crown lengthening. They are sometimes used as if they meant the same thing. They are related, but the difference between them decides whether the result lasts. This article explains that difference, how a periodontist tells which one a tooth needs, and what to ask if a plan has already been proposed.

The Difference in One Sentence

A gingivectomy removes gum tissue; crown lengthening removes gum tissue and, where needed, reshapes the bone beneath it.

Both are done under local anesthetic, and both expose more of the tooth. What separates them is the bone, and whether it has to move for the new gumline to stay where it is placed.

Why the Bone Decides

Gum does not simply sit wherever it is cut. Around a healthy tooth, the gum attaches to the tooth over a fairly consistent distance above the bone. The 2017 World Workshop, convened jointly by the American Academy of Periodontology and the European Federation of Periodontology, named this zone the supracrestal tissue attachment, replacing the older term biologic width. It reported that restoration margins placed within this zone are associated with inflammation and loss of the tooth’s supporting tissue. The idea is decades old: in 1977 Ingber, Rose and Coslet set out the biologic width as a working concept for periodontics and restorative dentistry.

In practice, gum cut to a new height while the bone stays where it was tends to re-form its usual height above the bone. One of two things follows. The gum creeps back down over the tooth. Or, if a crown edge has been placed in that zone, the gum around the crown stays red, puffy and prone to bleeding.

This tendency is strong. In a study of 30 patients and 84 teeth, Pontoriero and Carnevale performed crown lengthening with bone removal and followed the teeth for a year. The surgery gained about 4 millimeters of tooth at first. Over the next 12 months the gum margin moved back toward the biting edge by about 3 millimeters, more so in patients with thick gum tissue. Even a correctly done crown lengthening has to be planned with some regrowth in mind. A gingivectomy that leaves the bone too close has less room still.

So the deciding question is a measurement. Is there enough distance between where the new gumline should sit and where the bone is? If there is, removing gum is enough. If there is not, the bone has to be reshaped as well. The gum is measured with a periodontal probe. Where precision matters, the bone is located directly by passing the probe through the numbed gum to the bone, a step called bone sounding, and checked against the X-rays.

When a Gingivectomy Is the Right Operation

Gum overgrowth caused by medication. Some medications make the gum thicken and grow over the teeth. In their review of drug-influenced gingival enlargement, Zoheir and Hughes name the three classes responsible: phenytoin, a seizure medication; ciclosporin, used after transplants and for some immune conditions; and calcium channel blockers, a common family of blood pressure medicines. The overgrowth is becoming more common because calcium channel blockers are so widely prescribed. Treatment starts with thorough cleaning. When surgery is needed to reduce the tissue, Mavrogiannis and colleagues concluded that scalpel gingivectomy remains the treatment of choice. The overgrowth often returns afterward, and changing the medication can help in selected cases. That decision belongs to the patient’s physician, not the dentist.

Gum overgrowth during or after braces. Gum enlargement during orthodontic treatment is common enough to have its own literature. It is managed with better cleaning around the brackets, and with gingivectomy when that is not enough. A 2023 systematic review by Maboudi and colleagues compared the two approaches. Here the bone is usually in its normal position. The problem is extra gum, which is exactly what a gingivectomy removes.

A gummy smile when the bone is already in the right place. Many gummy smiles come from the gum never fully moving up the tooth as it erupted, a condition called altered passive eruption. In 1977, Coslet, Vanarsdall and Weisgold classified it by two measurements: the width of the gum, and how far the bone sits below the point where the enamel ends. When the gum band is wide and the bone sits at its normal distance, the excess gum can simply be removed. When the bone sits at or near the end of the enamel, removing gum alone does not hold, and the bone has to be reshaped too. A 2018 review in Periodontology 2000 by Mele and colleagues frames the goal in those terms: re-establishing the normal relationship between the gum margin, the bone and the enamel, for health as well as appearance.

A single lump or growth on the gum is a different situation. It needs a diagnosis, not just removal. In one case treated in this office, a growth present for ten years was removed and sent to a pathologist, and the area was grafted so the gumline healed evenly.

When a Gingivectomy Is Not Enough

A tooth broken or decayed below the gumline. A crown needs sound tooth to grip, and its edge has to sit clear of the attachment zone above the bone. When a tooth has broken at or below the gumline, trimming the gum exposes the break for a while. But the crown edge then ends up in the attachment zone, and the gum either grows back or stays inflamed around the crown. The bone usually has to be moved to make room. That is functional crown lengthening, described on the crown lengthening page.

A gummy smile with the bone close to the enamel. As above, when the bone sits at or near the end of the enamel, the gum has nowhere new to attach. The new gumline needs a matching bone edge beneath it.

Thick gum tissue. Because thick tissue tends to rebound more, a plan that would work on thin gum may need more room built in.

When It Is Neither

Not every gummy smile is a gum problem. In a 2023 review in the Journal of Dentistry, Tatakis and Silva identified two main soft tissue causes of excess gum display. One is altered passive eruption, treated with esthetic crown lengthening. The other is an upper lip that rises unusually high when smiling, treated with a different operation on the lip itself, lip repositioning surgery, which this practice does not perform. Excess gum display can also come from how the upper jaw grew. And teeth that look short because they are worn are a problem with the teeth rather than the gum, usually addressed by the dentist. Removing gum fixes none of these last three. A consult should identify the cause before anyone recommends a procedure, and should say so when the answer is not gum surgery.

If You Have Been Told You Need a Gingivectomy

These are fair questions to ask about any plan:

Where is the bone on each tooth, and has it been measured?
Where will the new gumline sit, and can I see it planned before anything is done?
Is this for gum health, for a crown, or for appearance?
What happens if the gum creeps back, and how is the plan built to prevent that?
If a crown is involved, when can my dentist start on it?
How is the procedure coded for insurance, and what will my plan likely cover?

A second opinion is reasonable for any surgery, and it is particularly worth having for the upper front teeth. There, a gumline placed in the wrong position is hard to correct afterward. Getting a second opinion describes what to bring and how the visit works. Often it ends by confirming the first plan.

Recovery

Both procedures are done under local anesthetic, with sedation available. In this practice’s experience, a procedure involving only the gum is followed by mild soreness for a few days, and one that also reshapes bone by a few days more. Sutures come out at one to two weeks. After crown lengthening for a crown, the practice’s usual guidance is that the dentist can start on a back tooth after six to eight weeks. On a front tooth, the gum keeps settling for three to six months before the final crown margin is set. Those intervals are practice experience rather than published thresholds. Does periodontal surgery hurt? and what to eat after periodontal surgery cover the first days in more detail.

Cost and Insurance

What either procedure costs depends on how many teeth are treated, whether bone is reshaped as well as gum, and whether you choose sedation. A reliable figure therefore comes from a written estimate after an exam, not from a phone quote. Insurance depends on the reason for the procedure. Plans generally treat surgery done for gum health or to allow a crown differently from surgery done for appearance. The practice is out of network: it files the claim for you, and your plan reimburses you directly. What treatment costs and does insurance cover it? explain how that works.

Gingivectomy and Crown Lengthening in North Austin

Dr. Andrew Verrett is a Diplomate of the American Board of Periodontology and the only doctor at Austin Periodontal Associates. He performs both gingivectomy and crown lengthening at the office on North Mopac. He chooses between them by measuring where the bone sits on each tooth, and shows patients the planned gumline before treatment. He uses conventional instruments rather than a laser. Crown lengthening describes the procedure as it is done here, and this gummy smile case shows a result. Request a consult or call (512) 346-6097.

Gingivectomy or Crown Lengthening? How to Tell Which You Need