The primary purpose of a crown lengthening procedure is to expose more of the natural tooth’s surface, either for aesthetic reasons or to better accommodate a dental crown. This can be done by trimming and reshaping the gum tissue around the tooth or by moving the tooth itself, and it might also involve removing a small amount of bone from the jaw. There are a few different procedures used for crown lengthening, and your dentist or periodontist will determine which of these procedures is best for your needs. These procedures are gingivectomy, flap surgery, and surgical orthodontic extrusion. Each may be done on a single tooth or multiple teeth, depending on patient needs. In some cases, while only one tooth needs crown lengthening, the dentist will perform a gingivectomy on a few teeth in a row so that the reshaped gingival area blends with the rest of the gums.
Orthodontic extrusion is a specific type of crown lengthening procedure that relies on orthodontic manipulation to gently force a surgically exposed tooth into the proper position, thereby exposing a larger portion of the tooth’s crown. As it involves orthodontic methods, this treatment takes months, though the surgery itself is brief. The more commonly used methods of crown lengthening involve manipulating and modifying the gums themselves, as well as the surrounding tissue when needed. The word “gingivectomy” literally means “surgical removal of the gingival tissue,” and the procedure is exactly what it sounds like. Flap surgery, in this case, involves creating a flap of gum tissue that’s lifted away from the bone so that the bone can be evaluated and, if needed, surgically modified while the gingival tissue is trimmed and sculpted. No matter which approach to crown lengthening your dental team is planning on, the surgery will be performed with local anesthesia and, if additional anesthesia is desired, a sedative. The duration of the procedure depends on how many teeth need treatment, the type of procedure being performed, and whether it’s necessary to remove bone or modify tissue other than the gingival tissue.
Once the surgical site is anesthetized, the periodontist will make a small incision in the gum tissue with either a scalpel, a laser, or a combination of tools. If it is only the soft tissue that needs to be modified, the periodontist will resculpt the gums before cleaning out the area with saline and stitching the gums back in place. If the periodontist has determined that the bone needs to be reshaped to prevent the gums from continuing to cover the tooth, they will make these modifications from the flap that’s exposing the bone, reshaping the tooth before cleaning and suturing the area. Once the gingival tissues are sutured back in place, they may be covered with a protective surgical bandage. A gingivectomy tends to take anywhere from 30 minutes to an hour, and flap surgery with bone modification takes about an hour to 90 minutes.
While crown lengthening procedures themselves are brief, it’s very important to give healing the time it needs. Your periodontist will give you specific instructions for aftercare, and you should adhere to them closely to ensure a painless, prompt recovery. Cold compresses and over-the-counter pain medications can help reduce discomfort in the days following crown lengthening, and adhering to a soft, mild diet keeps pain and irritation to a minimum while protecting the newly modified gums. Swelling will persist for a few days and should subside, along with any pain, within a week, though it can take anywhere from six weeks to six months for full recovery. Once the area has healed, any planned restorations, like crowns, can be placed, and you can start practicing your confident, symmetrical smile.
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