When a tooth breaks or decays at or below the gumline, there often isn’t enough of it showing for a crown or filling to hold, or for the gum to stay healthy around the restoration’s edge. Crown lengthening can make room for it: a periodontist lowers the gum and, often, a little of the bone so more of the tooth is exposed and it can be restored. If your dentist has said a tooth needs it before a crown, here’s why, what happens on the day, and how long you’ll wait for the final crown.
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Why a Tooth Needs Crown Lengthening
A tooth usually needs crown lengthening because decay, a break, or the edge of an old filling sits below the gumline, leaving too little tooth above the gum to restore.
It’s most often used to save a tooth like this in an otherwise healthy mouth, and the tooth itself has to be restorable. A dentist may recommend it when a tooth is too short to hold a crown, or when a cavity or filling sits below the gumline.
There’s a second reason, and it’s about the gum. Between the top of the bone and the edge of the gum, the gum attaches to the tooth in a narrow band, typically 2 to 3 millimeters tall. Clinicians used to call it the biologic width; the current term is supracrestal tissue attachment. If a crown or filling edge is placed inside that band, it can lead to long-term gum inflammation and recession. Crown lengthening re-creates enough room for the attachment above the bone, so the crown’s edge can sit where the gum stays healthy.
Is Every Tooth a Good Candidate?
No. The root has to be long enough to lose a few millimeters of bone without leaving the tooth poorly supported, and a longer-looking tooth has to be acceptable to you.
It may not be possible if the edge of the restoration would reach the point where a back tooth’s roots divide, or if too much bone would have to be removed. Your dentist weighs the exam findings against your own concerns, and how much sound tooth is left above the bone guides whether the tooth is restored or removed.
On a front tooth, where a change in the gumline shows, a dentist may weigh other options. One is orthodontic extrusion, which gently pulls the tooth up over several weeks and then holds it there for weeks to months; it avoids removing bone but takes longer. Another is removing the tooth and replacing it with an implant.
What Happens During the Crown Lengthening Procedure
Crown lengthening is gum surgery done with local anesthetic: the gum is lifted, bone is reshaped if needed, and the gum is stitched back at a lower level.
- Before the surgery. There’s usually a consultation first to review your medical history and X-rays. Your dentist may place a temporary crown beforehand, which protects the tooth and helps judge how much tissue to remove.
- Numbing. The area is numbed with local anesthetic.
- Lifting the gum. The periodontist gently moves the gum back to see the root and the bone.
- Reshaping. Sometimes removing a small amount of gum is enough. In other cases, some bone around the root is removed and smoothed, following the root and blending into the neighboring teeth so the gumline stays even, until there’s room for the gum attachment below the planned crown edge.
- Closing. The gum is stitched back at the new level, and a temporary crown is put on, or put back on, to protect the tooth while it heals.
Everett, WA
Told a tooth needs crown lengthening?
We can look at the tooth and explain what treatment would involve.
How Much Does Crown Lengthening Hurt?
You’re numb for the surgery, and afterward some soreness and slight swelling are normal.
Like any mouth surgery, it can cause some bleeding, swelling, and bruising afterward. After gum surgery in general, pain tends to be worst about five to six hours later. If you’re anxious about dental treatment, nitrous oxide or oral sedation may help, and both are available from our periodontist.
Healing and the Wait for Your Final Crown
Expect to wait at least about three months for the gumline to settle before the final crown, and sometimes up to six months for a front tooth.
| Stage | When |
|---|---|
| Stitches come out | Usually a week or two after surgery |
| Temporary crown | At least six weeks, and until the final crown is ready |
| Final crown, back tooth | After at least about three months |
| Final crown, front tooth | Sometimes up to six months, where appearance matters |
The wait matters. In the months after surgery, some of the gum can creep back up the tooth, mostly in the first three months, and a final crown placed too soon may trigger inflammation. Your dental team will give you instructions for the days after surgery and for looking after the temporary crown.
Questions about crown lengthening? Call our Everett dental office to talk it through.
Trade-offs and Risks
The main trade-off is appearance: the treated tooth, and often its neighbors, will look longer, because the gum settles at a lower level.
- Small gaps between teeth. The gum between the teeth no longer reaches as far as it did, so the final crown is shaped to close the space.
- Neighboring teeth. Bone is often reshaped around them too, so they can show some gum recession as well.
- Sensitivity. Some root may be exposed as the gum settles lower, which can make the tooth sensitive and more prone to root decay.
- Less bony support. Removing bone can weaken the support of the tooth and its neighbors, and rarely it can leave too little bone for a future implant at that spot.
- Front teeth. Treating one side of the upper front teeth may need matching surgery on the other side to look even.
Thin gums are more prone to recession than thick ones. Complications after gum surgery are uncommon, and infections are rare. Smoking is linked to poorer results, and diabetes to more complications such as slower healing.
Crown Lengthening and Crowns at Icon Dental Center
At our Everett office, crown lengthening is done by our periodontist, Dr. Betsy Mosquera, who does all periodontal surgery here. Once your gums have settled, the crown itself comes from our general dentists: ceramic crowns made in a dental lab from fully digital impressions, so they aren’t same-day.
Common Questions About Crown Lengthening
Does crown lengthening go all the way around the tooth?
In the standard technique, bone is removed all around the tooth, following the root, and then blended into the level of the neighboring teeth so the gumline stays even.
Do gums grow back after crown lengthening?
Some of the gum can creep back up the tooth in the first few months, which is one reason the final crown waits. How much varies, and thicker gums tend to grow back more.
Can a general dentist do crown lengthening?
A dentist may recommend it, but it’s usually done by a periodontist, a dentist with three years of extra training after dental school who does gum surgery.