Indications for Surgical Crown Lengthening of a Decayed Tooth

Indications for crown lengthening from a restorative standpoint include ensuring the necessary tooth length for successful restoration, access (eg, removal of subgingival caries), finishing tooth preparation, and impression making. The procedure also provides stable gingival margins around the tooth and can likely prevent irritational gingival inflammation.

Surgical crown lengthening can provide additional crown length for restorative procedures on a severely decayed tooth. The most common indications for the surgery include restorative and esthetic concerns (Table 1).¹ Preprocedural considerations include (but are not limited to) the crown-to-root ratio, maintaining the integrity of biologic width, healing time, and favorable outcomes following restoration.

In a multidisciplinary model, where the restoring dental provider refers the patient to a surgeon, the restoring dental provider should evaluate all factors (Table 2) that might affect the dentition’s prognosis. Such consideration can help the referring dental provider and surgeon develop a treatment plan and establish the sequence of the procedure.

Generally, the restorative dental provider can collaborate with the surgeon to determine the amount of tooth structure to be exposed during the surgery. The ultimate goal is to achieve a fully functional and physiologically sound dentition and occlusion — and only by thoroughly considering all presenting factors can a determination be made that crown lengthening is suitable for a particular case.

Reference

1. Fugazzotto PA. The Role of Crown-Lengthening Therapy. In: Fugazzotto PA. Periodontal–Restorative Interrelationships: Ensuring Clinical Success. Hoboken, NJ: John Wiley and Sons, Inc; 2011:31–87.

This information originally appeared in Goel A, Mott DA, Wilkerson C, and Ellzey AT. Concepts and considerations for surgical crown lengthening. Decisions in Dentistry. 2021;7(1):36–39.