What Is Crown Lengthening?

Among the more common cosmetic dentistry procedures is crown lengthening, which aims to remove excess gum tissue around the teeth. This oral surgery can improve the appearance of a “gummy smile” and may be necessary prior to dental crown placement or other tooth restoration treatments. There are several kinds of crown lengthening surgeries, all of which require some preparation and recovery.

Whether it's to correct a cosmetic issue or to prepare for treatment, crown lengthening is well established as a safe and effective procedure. This article covers the goals of this treatment and common approaches to it, as well as what recovery looks like.

Goals of Crown Lengthening

Crown lengthening can be a cosmetic procedure as well as part of a dental treatment process. Whether applied for aesthetic reasons or for dental health, the primary goal of this surgery is to lengthen the exposed portion of the tooth by reducing the amount of gum tissue.

What Is a Gummy Smile?

One of the main reasons people get crown lengthening is to treat a gummy smile. Known clinically as “excessive gingival display,” this is when the gums above your teeth appear too large when you show them. Specifically, the condition is defined as having 2 millimeters or more of gum tissue, known as gingiva, visible.

Other Reasons for Crown Lengthening

Though taking care of a gummy smile is a common application of crown lengthening, this surgery may also be necessary for other kinds of dental treatment. These surgeries can treat:

• Uneven gumline: Crown lengthening can correct an uneven and unattractive gumline.
• Short teeth: It can add length when teeth are undersized to create a more natural smile and enhance your appearance.
• Cavities in the roots: When cavities form below the gumline, crown lengthening may be necessary to expose them before they can be filled. 
• To secure a dental crown: For fractured or severely decayed teeth, dental crowns—specialized caps—are placed over the existing structure. Crown lengthening is necessary prior to crown installation when that structure is insufficient.
• Correcting restorations: This surgery can correct when crowns or other kinds of dental restorations impinge on the gums.

How to Prepare for Crown Lengthening Surgery

Before your crown lengthening, you’ll need a thorough evaluation of your teeth, gums, and underlying bone.

Crown lengthening is typically done by A gum specialist (also known as a periodontist) typically performs crown lengthening, though an oral surgeon or general dentist may, as well.

A healthcare provider will evaluate X-ray images of your teeth and ask about your medical history, especially the medications you’re taking. A healthcare provider may ask you to temporarily stop taking certain drugs that can impact crown lengthening surgery.

The Crown Lengthening Procedure

Crown lengthening procedures are highly successful, both when applied for cosmetic purposes and as part of dental treatment. There are several different surgical approaches, each with specific applications, advantages, and disadvantages.  

Considerations: How to Choose a Procedure

There’s a lot that goes into deciding which crown lengthening procedure is appropriate for a specific case. Oral surgeons have to ensure the highest likelihood of success. Key factors in the decision include:

• Your aesthetic treatment goals
• The relative size of the clinical crown (the tooth above the gumline)
• The amount of space between the roots of teeth (that anchor them to bone)
• The structure of the roots
• Presence of bone loss at the root of the tooth (known as furcation)
• The positions of the teeth in the mouth
• The health of existing tooth structures
• The likelihood that the tooth restoration will be successful

Preparing for Consultation

Ultimately, the decision to undergo a crown lengthening procedure is yours to make. When consulting with an oral surgeon, don’t hesitate to ask about:

• The surgeon’s experience with the procedure
• The expected outcome and any risks that may arise
• What you can do to promote success
• What recovery is like
• Any specific instructions for preparation
• Alternatives to the treatment

Gingivectomy

A long-standing approach to crown lengthening, gingivectomy, involves carefully cutting away and removing gum tissue. Like the other surgeries, this is performed while you’re under local anesthetic, though you may take a sedative beforehand to help you relax.

The amount of time this treatment takes depends on the extent of the work needed. Multiple teeth can take more time, and in some cases, the surgeon will need to reshape the underlying bone. It’s an outpatient procedure, so you'll be able to go home afterward.

There are several steps:

• Preparation: After your mouth has been numbed, the oral surgeon will thoroughly clean the targeted gum tissue. This helps prevent infection. If you have a temporary crown, it’ll be removed.
• Extraction: With the surgeon working to prevent affecting surrounding structures, the gum tissue is carefully extracted, exposing the underlying tooth. Gingivectomy can be performed with a scalpel, using lasers, or electrocautery, which involves directing heat to remove unwanted tissue.
• Suturing: Before the sutures are applied to close the remaining gum, the oral surgeon will wash the area with saltwater. Bandages may also be necessary after surgery.

Apically Repositioned Flap

The most common type of crown lengthening, apically repositioned flap surgery, also involves removing portions of gum. Like other kinds of oral surgery, apically repositioned flap surgery is an outpatient treatment performed with the patient under local anesthetic.

The oral surgeon first makes an incision into the targeted area, creating a flap of tissue. This is gently lifted up, and portions of tissue are carefully cut away. As with gingivectomy, portions of the underlying bone may need to be removed as part of the procedure.

When the treatment is complete, the gums are thoroughly cleaned and the flaps are closed with sutures.

Surgical Extrusion

Especially effective for badly damaged teeth, the goal of surgical extrusion PRN is to physically reposition teeth.

Alongside the surgery, it involves extrusion, which means using mechanical force to reposition the tooth. The chief advantage of this approach is that bone material rarely needs removing.

As with its counterparts, crown lengthening with surgical extrusion involves several steps:

• Preparation: Local anesthetic is applied to the gums, and the area is thoroughly cleaned. You may take antibiotics prior to surgery to help prevent infection.
• Incision: When numb, the gum tissue is carefully cut away from the targeted tooth structure.
• Extraction and repositioning: Depending on the case, the tooth and root are either taken out completely or pulled into the desired position with special tools.
• Reshaping: If the tooth is extracted, the surgeon will clean it out thoroughly and may need to perform apicectomy: removing small portions of the tip of the root.  
• Reimplantation and suturing: The extracted tooth is then reimplanted into a proper position and splinted to surrounding teeth for support for one to three weeks. The incisions are sutured shut and the area is thoroughly cleaned again.  

How to Recover From Crown Lengthening Surgery

Following any oral surgery, there’s a significant period of recovery, and this is certainly the case for crown lengthening surgery. Generally, it takes up to three to six months to fully recover, though the gums may continue to heal for up to nine months. Throughout this period, special care is necessary to ensure that there are no complications.

When the local anesthetic has worn off and for up to three days following treatment, you’ll experience pain, tenderness, and swelling in the gums, which may also bleed. You’ll also have sutures; these are taken out at a follow-up, seven to 10 days after surgery.

The oral surgeon will give you more exact aftercare instructions. Generally, here’s what you need to keep in mind after oral surgery:

• Pain medications: Your surgeon may prescribe or recommend you take pain medications, such as ibuprofen or Advil. This discomfort may last for up to a week.  
• Icing: To help with the facial swelling, apply a cold pack to the side of the face for 15-minute intervals until symptoms improve.
• Head elevation: To reduce swelling, keep your head elevated and upright for eight to 12 hours after surgery.
• Bleeding control: Keep any gauze given to you after surgery in your mouth for one to three hours. If you experience bleeding, apply damp gauze to the area for 20 minutes at a time, rinsing in between. Contact your dentist if the bleeding doesn’t stop.
• Keep dressings in: Don’t take dressings off for up two weeks following surgery.
• Rest: After the appointment, take the day off. You can resume light activity the day after surgery but get your provider’s OK before taking up contact sports.
• Rinsing: Don’t rinse your mouth for the first 24 hours after surgery. Subsequently, gargle with a solution of warm salt water (1/3 to 1/2 teaspoon of salt to 8 ounces of water) after every meal and before going to bed.
• Avoid straws: As your gums are healing, avoid using straws because the suction can open up wounds and affect sutures.
• Brush carefully: Brush with care and avoid affected areas until they’ve fully healed.
• Personal habits: Avoid smoking or drinking alcohol for seven to 10 days.

When to See a Dentist

Though crown lengthening surgeries have high success rates, there’s always a chance of complications. It’s important to track your progress and be mindful of signs that something may be off. Call your dentist if:

• The bleeding doesn’t stop after surgery and after efforts to control the bleeding.
• The pain and swelling continue to worsen after three days.
• Your bite is uneven.
• Your pain medications aren’t working.

Summary

Crown lengthening procedures help reduce the look of a "gummy smile." This surgery option can be achieved using different surgical techniques. It's important to talk to your dentist or oral surgeon to find the best approach. There will be recovery from any surgical approach, but the results can help people feel more comfortable and happy with their smiles.

A Word From Verywell

Alongside other oral surgeries, crown lengthening can be critical for restoring and revamping your smile. Well tolerated and highly successful, it has helped countless people achieve their desired results.

If you’re concerned about your gumline or are considering treatment for a damaged or decayed tooth, talk to your health provider.