Coronal elongation or clinical crown lengthening
Dear doctor, as an elderly person, I was surprised to have a cavity. Furthermore, my dentist says that before I can get it fixed, I will need a procedure called "coronal elongation or clinical crown lengthening". Can you explain what this is?
Dear Sir,
Some people think that tooth decay only affects the chewing surfaces of teeth and is mainly found in children. However, cavities can occur on all vulnerable tooth surfaces and can be a problem for people of all ages; in fact, some studies show that older people have a higher rate of tooth decay than children. And because of gum recession, older people can develop cavities at or just below the gum line, which can be more difficult to treat.
If you have a cavity under the gum, it cannot be filled in the usual way because the gum tissue covers the area to be treated. In such cases, a minor surgical procedure called "coronal elongation" may be necessary. The crown is the visible part of the tooth. So, as the name suggests, clinical crown lengthening exposes more of the tooth surface, giving the dentist more tooth structure to work with.
When decay goes below the gum line, a crown lengthening procedure can reposition the gum tissue further away from the biting surface of the tooth, so that the cavity can be filled. It can also be used to treat other dental conditions - for example, to restore a broken tooth near the gum line or to place a crown or bridge on teeth that have too little healthy tooth structure. A prosthetic crown will not fit properly if there is not enough tooth surface to cling to. An ill-fitting crown can damage gum tissue, leading to eventual bone loss, or allow decay to occur underneath the crown, leading to further dental problems.
In addition to dental restorations, crown lengthening is popular in cosmetic dentistry. This procedure - sometimes called a "gum lift" - can improve the aesthetics of people who feel that their teeth are too short or that too much gum tissue shows when they smile. Having uneven gums can also make even straight teeth look uneven. By altering the visible gum to tooth ratio and gum contour, clinical crown lengthening can greatly improve a "gummy" smile, make teeth appear longer and straighter, and improve symmetry.
Before the crown is lengthened.
When the upper teeth appear too short, a "gummy smile" can be corrected by periodontal plastic surgery to remove excess tissue and lengthen the teeth.
After periodontalcrown lengthening establishes a more aesthetically pleasing tooth length, porcelain veneers can help create a beautiful smile.
Adjusting the gum line for a better smile is not always a purely aesthetic endeavour: when there is too much gum tissue, an individual may be more susceptible to gum infections.
Crown lengthening is performed by some general dentists or by periodontists: dentists who specialise in treating the gums and other supporting structures of the teeth. The procedure is usually carried out in a dental surgery using the type of local anaesthetic you would get for a normal tooth filling, sometimes in combination with a sedative drug.
After anaesthesia, your dentist begins the procedure by making small incisions in the gum, which allows a small 'flap' of tissue to be removed. The underlying bone tissue is reshaped to properly support the gum tissue in its improved position. The tissue flap is then repositioned and sutured in place, following the contours of the gum line. This exposes sufficient tooth surface to restore the proper size of the teeth for an attractive and very natural look.
Coronal elongation, like all types of minor surgery, has associated risks such as bleeding and infection. Your dentist will give you post-operative instructions to minimise these risks. For the first few days after the procedure, your dentist may advise you to stick to soft foods, avoid vigorous physical activity and use an ice pack if necessary. You may need prescription or over-the-counter pain medication, and you may be prescribed an antibiotic to reduce the risk of infection. Any initial pain you may experience will diminish within a few days of the procedure.
If a dental restoration is required, it will not occur on the same day as the crown lengthening. Firstly, the gums will be allowed to heal for 6 to 12 weeks. This ensures that the gums are in their final position so that the dental restoration looks natural.
The clinical crown lengthening procedure is considered irreversible, as it usually involves the removal of some bone. For this reason, it is important to consider and discuss all current and future treatment options.
Whether for functional reasons (to help restore your oral health) or aesthetic reasons (to improve appearance), crown lengthening can save a tooth - or even save your smile. If you're wondering if this might be right for you, ask your general dentist or periodontist.
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