GUMMY SMILE TREATMENT
WHAT IS IT?
This common procedure involves the removal of gum tissue, bone or both to expose more of a tooth's structure.
WHAT IT IS USED FOR?
Crown lengthening is done when a tooth needs to be restored, but there is not enough tooth structure above the gum line to support a filling or a crown.
This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue or bone.
Crown lengthening is also frequently used to support cosmetic dental procedures. It is especially useful in cases where the gum extends too far down the length of the teeth causing them to appear unnaturally (gummy smile) short. This can also increase their vulnerability to periodontal disease. Removal of this "extra" gum tissue can restore a natural look and thus improve a smile.
You will visit for a consultation before the procedure. During the consultation, the specialist will review your medical history and your X-rays, and set a date for the surgery.
We will instruct you on how to keep the area clean after the surgery. You may receive a tooth cleaning before the procedure.
If the tooth needs a crown, we may have a temporary crown put on the tooth to protect it. This also makes the crown-lengthening procedure easier because the tooth is already prepared for the crown, and we can see precisely how much soft tissue or bone will need to be removed.
Once the area has healed completely (in about three months) we will prepare the tooth again, and make a new temporary crown before making the final crown.
HOW IT IS DONE?
This procedure is done under local anesthesia. The amount of time it takes varies depending on the number of teeth that require treatment. Although your problem may involve only one tooth, crown-lengthening surgery typically includes neighboring teeth so that the tissues can be reshaped gradually. If only soft tissue is removed, the procedure probably will take less time than if both soft tissue and bone is removed.
We will make incisions to "flap" the gums away from the teeth. This provides access to the roots of the teeth and the surrounding bone. In some cases, by simply removing a little gum tissue when the incisions are made, enough tooth structure will be exposed for us to place a crown or filling.
However, in most situations it will also be necessary for us to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).
Once we are satisfied that enough tooth structure is exposed, the surgical area will be washed with sterile salt water and the flaps will be stitched together. At this point, your teeth will look longer because the gums are now sitting at a lower level then before the surgery. Sometime we use a periodontal dressing (called an intraoral bandage) to cover the surgical site.
Any temporary crowns will be removed before the procedure begins and replaced afterward.
You will be given prescriptions for pain medication and a chlorhexidine mouth rinse. We will review oral-hygiene instructions, and ask you to follow a somewhat soft diet. You can brush the teeth in the area that was worked on, but you should avoid the gums. You can remove food particles around the affected teeth with a toothpick or a water irrigator.
For the first two days, use ice on your face to keep swelling down. After the procedure, you will return to us in 7 to 10 days to have the sutures removed, and then return again 4 to 6 weeks later for a follow-up visit. Your gums should heal for at least three months before the tooth is prepared for the final crown. If you don't wait this long, the gums may shrink as they heal and the margins of the crown could show, or other problems could develop. You will visit us to have the crown or filling placed, and then again for a follow-up visit.
As with all surgical procedures, there is a risk of prolonged bleeding during crown lengthening, as well as a risk of developing an infection after the procedure. Additionally, many patients will experience sensitivity to hot and cold because the roots of the teeth are now exposed. This will go away when the roots are covered with new temporary crowns.
Because of the tissue and bone removal, the affected tooth may look longer than adjacent teeth. However, this is only a cosmetic consideration. Removing bone from around a tooth can loosen it. In addition, if the tooth is ever lost, the removal of bone could reduce the chances of successfully placing a dental implant in that area. We will consider these details during your consultation.