Crown lengthening is a minor periodontal surgical procedure that includes reflecting the gum, re-contouring the underlying bone and suturing back the gum at a newly established level. It is not cutting the gums away, as some may refer to. In order to fabricate a crown it is required to provide adequate tooth structure above the gum, to support the crown otherwise the crown will keep coming off. Even if you re-cement it a couple of times, it will never fit as well as the first time and it leaves open gaps that will lead to recurrent decay under the crown.
In cases where crown lengthening is indicated but it is not performed, persistent inflammation around the tooth and/or dislodgement of the crown is usually anticipated. No one cement can provide adequate resistance to dislodgement of crowns if it is too short.
I have provided some clinical examples of crown dislodgement when the remaining teeth structure were too short and crown lengthening was not performed prior to fabrication of crown. Dr. Noohi, being trained in both prosthodontics and periodontics, is in a unique position to make a proper diagnose, assess the risks and make a strategic treatment plan to save your teeth. Refer to the photos at the end of this page.
Crown Lengthening #19
Existing crown came off due to recurrent caries under the crown. Patient had to have a root canal treatment first. Crown lengthening was performed in order to fabricate a new crown.
Crown Lengthening #30
Crown lengthening #14 & #15
This young patient was referred to me by her dentist to restore her molars after root canal treatment was completed. Her short clinical crowns was an obstacle to secure stable crowns. I recommended crown extension procedure prior to crown fabrication and I assured her a 20 year longevity for the restorations, as long she keeps them clean. I was certain there was no way the crowns come off
Crown lengthening #13
In this case crown lengthening was indicated to provide biologic width and expose the decay below the gum before crown fabrication.
Crown lengthening #18
This patient was referred to me for Crown Lengthening, due to repeated dislodgment of the crown. In such cases re-cementing the crown is merely useless. There is no dental cement that can keep this crown on without modifying the tooth preparation and fabricating a new crown.
Crown Lengthening #28 & #29
This is a case where the two bicuspids had supra-erupted into the opposing empty space. In order to restore the arch in a proper way and equilibrate the occlusion (bite) the bicuspids had to be shortened, which would have made them too short to receive crowns. The implant had been placed prior to have a treatment plan which made the procedure more difficult.
Crown lengthening #20
Crown lengthening of the lower left side bicuspid (#20).
These photos present cases where crown lengthening should have been done prior to crown fabrication.
Another case where the crown consistently came off, and it’d been re-cemented by the doctor who had done it. Patient was frustrated and sought help at another office.
My message to you as a patient is, “do it once, but do it right”. You would pay less in the end, and won’t risk loosing your tooth.
All Ceramic Crown Came Off
This case was a college-aged male who had his teeth taken care of before traveled to Washington, DC for college. 3 months after the crown was cemented it came off and patient came to see me to re-cement it. As you can see there is no foundation to provide support for the crown. Patient was recommended other options prior to restore the case again.
Crown lengthening is not over-treating. It is a necessary procedure to prevent future failures. There are situations when extracting the tooth and replacing it by a dental implant is a better treatment. To find out what is the ideal treatment for you consult with Dr. Noohi.
Dr. Noohi is trained to perform all periodontal surgeries necessary to restore cases like this and more.
If your crown is constantly coming off and you are frustrated with having it re-cemented frequently, it may be the time to see a Prosthodontist.