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Periodontal Surgery for Crown Lengthening
Crown lengthening is a surgical procedure designed to increase the amount of tooth structure visible above the bone and gum. It is necessary when a tooth has fractured close to or below the gum line or when a filling margin or cavity is too far under the gum line for access to properly restore the tooth.
Usually a single tooth cannot be crown lengthened just by removing some of the gum and bone around that tooth alone, and adjacent teeth may need to be included. The bone supporting your teeth has a very specific architecture as it molds around the roots and between adjacent teeth. This is also necessary in order for the gum tissue to have a proper contour which in turn makes it easier for the patient to clean around the gums and teeth. \therefore, with any gum surgery, attempts are always made to preserve or to re-establish these bone and soft tissue contours.
With crown lengthening, it will be necessary to gain access to the bone around both the tooth requiring the actual lengthening as well as several adjacent teeth. This is accomplished under local anaesthesia by temporarily moving the gum away from the teeth. An incision is made on both sides of the teeth, usually starting at the back tooth in the area and proceeding two to three teeth forwards, depending on the access needed. Then gum is then carefully moved away from the teeth to expose the roots and the bone surrounding the teeth. The roots are thoroughly cleaned and evaluated for any additional problems. If no problems are present, the required amount of bone is removed from around the tooth in question and also from adjacent teeth. This is necessary because the specific shape and architecture of the bone must be sloped to blend in with the adjacent teeth. Sometimes the amount of crown length that can be achieved must be compromised because of the presence of root problems or anatomical limitations. These situations will be presented to the patient.
After the bone has been re-shaped, the gum tissue is sutured back to cover the bone. This means that more tooth structure is now showing above the gum both on the tooth in question and on at least the teeth on either side. This is also known as increased recession and the gum will usually not grow back over to cover the roots or teeth back to the previous gum level. This is generally not an esthetic concern with the exception of the upper front teeth in which case, alternatives will have been discussed with the patient.
It is also possible that there may be some increased root sensitivity due to the recession. This is usually temporary with good oral hygiene and application of topical desensitizing agents. Some patients may notice an increased but temporary looseness of the teeth post-surgically. This should return to pre-surgery levels after several weeks. Healing of the surgery site will be greatly improved if the patient maintains good oral hygiene and does not smoke. The fillings, crowns, or bridgework can usually proceed about 4-6 weeks after surgery.
Take Care of Yourself Before Periodontal Treatment
- Eat a nutritious meal the night before and the day of the appointment
- Avoid the use of alcoholic beverages
- If taking full dose aspirin (325mg) for medical reasons, please discontinue one week prior. Low dose aspirin (81mg) is fine.
- One hour prior to the appointment:
-Take Ibuprofen (Advil or Motrin) if recommended
- 600mg for an adult
- 200mg for a child (12 years and under)
OR
- Tylenol #1 for a child (12 years and under)
-You should plan on resting for the remainder of the appointment day