Crown Lengthening

Crown lengthening is a surgical procedure that recontours gum tissue and, when necessary, underlying bone to expose more of a tooth's visible surface. It is commonly used to correct a "gummy smile," improve gum health, or to create adequate tooth structure for a restoration. By reshaping the gum-to-tooth relationship, the procedure creates a more balanced and harmonious smile.

The procedure can be limited to a single tooth, applied to several adjacent teeth, or performed across the entire gum line depending on the clinical goals. When bone removal is required, the surgeon carefully adjusts the supporting structures to ensure long-term stability. Treatment plans are personalized to address both functional needs and esthetic concerns.

Crown lengthening is often recommended when there is insufficient tooth structure above the gum line to support a crown, onlay, or bridge. If a restoration margin would sit too close to gum tissue or bone, the risk of leakage, decay, and periodontal problems increases. Exposing additional tooth structure helps the laboratory and clinician place a restoration that fits securely and can be cleaned effectively.

In addition to restorative needs, crown lengthening can be necessary when decay or fracture extends below the gum line and access is required for proper repair. By creating a safe distance between the restoration margin and the bone, the procedure helps protect surrounding tissues. Your periodontist will evaluate tooth structure, bone levels, and the planned restoration to determine the ideal approach.

The procedure is usually performed under local anesthesia and may take about an hour for one or a few teeth, with longer appointments needed for more extensive treatment. Small incisions are made to lift and reshape the gum tissue, and, when indicated, a conservative amount of bone is removed to achieve the desired tooth exposure. Sutures are placed to secure the new gum position and a protective dressing may be applied to support healing.

Patients remain comfortable during the surgery and providers take steps to minimize bleeding and trauma to adjacent tissues. Follow-up visits are scheduled one to two weeks after surgery for suture removal and to check healing, and full tissue stability typically takes two to three months. Communication between the restorative dentist and periodontist is important to coordinate timing for final crowns or other restorations.

Yes — crown lengthening often improves the appearance of a smile by reducing excess gum display and creating a more balanced proportion of tooth and gum. Immediately after surgery teeth will look longer because the gum margin has been repositioned, and that change is usually the intended cosmetic outcome. Because healing changes tissue levels slightly over time, the final esthetic result is assessed after the site has matured.

To achieve a natural, symmetrical result the procedure may include shaping adjacent teeth and gums so margins align evenly across the smile line. Your periodontist will discuss esthetic goals, show general examples, and plan the timing of restorative work to complement the new gum contours. A conservative, individualized approach helps preserve healthy tissue while improving smile balance.

After the procedure patients should expect some swelling and mild discomfort that is manageable with prescribed or over-the-counter pain relievers and cold compresses during the first few days. Eating soft foods, avoiding strenuous activity, and following oral hygiene instructions helps protect the surgical site while it begins to heal. Smoking and poor blood sugar control can delay healing, so your provider will review risk factors and give personalized guidance.

Sutures are typically removed within one to two weeks and short-term changes in tooth sensitivity are common as the gum position changes. Practicing gentle brushing outside the surgical area and using any recommended rinses supports recovery and reduces infection risk. Full soft tissue healing and bone remodeling generally complete over two to three months, which is why many clinicians delay final restorative work until the site is stable.

Like any surgical procedure, crown lengthening carries risks such as infection, prolonged bleeding, swelling, altered tooth sensitivity, and the need for further adjustment if healing does not proceed as expected. Bone removal can affect adjacent teeth if not planned carefully, so detailed examination and imaging are important to minimize complications. Most risks are predictable and can be reduced through careful surgical technique and attentive postoperative care.

Your periodontist will review potential complications with you before treatment and outline steps to reduce risk, such as preoperative planning and follow-up visits to monitor healing. If you have systemic health concerns or take medications that affect bleeding or healing, those factors will be incorporated into the treatment plan. Open communication and adherence to postoperative instructions are key to achieving a successful outcome.

Good candidates for crown lengthening include patients with excess gum tissue that hides much of the tooth surface, teeth with decay or fractures extending below the gum line, and cases where restorative margins must be placed at a healthy distance from bone. A comprehensive periodontal examination, including radiographs, is necessary to determine whether crown lengthening is the appropriate option. Patients must also have reasonably healthy periodontal tissues or be willing to treat existing gum disease before elective esthetic procedures.

Certain medical conditions, smoking, and uncontrolled diabetes may increase surgical risk and affect candidacy, so your periodontist will evaluate your overall health and coordinate care as needed. In some situations alternative or adjunctive procedures such as orthodontic extrusion or restorative crown lengthening may be considered. The final recommendation is made after reviewing restorative needs, esthetic goals, and long-term oral health considerations.

Timing for final restoration varies, but clinicians commonly wait two to three months for soft tissue and bone to stabilize before placing a definitive crown or bridge. This healing period allows the gum margin to mature and reduces the likelihood of marginal gaps or esthetic changes after the final restoration is completed. Temporary restorations can maintain function and appearance while the surgical site heals.

For areas with higher esthetic demands the clinician may extend the healing interval to ensure predictable contour and color match with adjacent teeth. Your periodontist and restorative dentist will coordinate follow-up appointments and confirm tissue stability before proceeding with laboratory work. Clear communication about timing helps avoid premature restoration and supports long-term success.

Functional crown lengthening is performed primarily to expose tooth structure needed for restorative work so a crown or filling can be properly seated, while esthetic crown lengthening focuses on improving the appearance of the gum-to-tooth ratio across the smile. Although the surgical steps are similar, the planning and extent of tissue and bone adjustment differ based on whether functional access or cosmetic symmetry is the main objective. Understanding the primary goal helps the periodontist select the most conservative and effective approach.

In many cases both functional and esthetic goals are addressed together, but coordinated treatment planning with the restorative dentist ensures that the surgical outcome supports long-term dental health as well as appearance. Your provider will explain how the procedure will balance these goals and what to expect during healing and restoration phases. Patient preferences, periodontal health, and the planned prosthetic design determine the final treatment strategy.

At A R Periodontics, PC, Dr. Alan Rothstein and the team combine decades of periodontal experience with modern surgical techniques to deliver precise, minimally invasive crown lengthening when indicated. The practice emphasizes patient education, individualized treatment planning, and coordination with restorative dentists to achieve durable, esthetic results. Local anesthesia and careful tissue handling are standard to maximize comfort and healing.

Patients from Livingston and surrounding communities benefit from a focused periodontal approach that balances form and function while prioritizing oral health and long-term stability. Before recommending surgery the team conducts a thorough assessment, reviews alternatives, and outlines a clear follow-up plan so you know what to expect at every stage of care. If crown lengthening is appropriate for your situation, the office will guide you through each step, from planning to final restoration.