What Is a Crown Extension?

Medically Reviewed by Robert Brennan on September 06, 2023
4 min read

A crown extension, also known as a crown lengthening surgery, can be used to improve a “gummy” smile. It reshapes your gums to expose more of your teeth, so your teeth look longer.

Read on to learn more about how a crown extension is performed and what the benefits of getting a crown extension are.

When you get a crown extension, part of your gums and sometimes even bone will be recontoured to expose more of your tooth. This will make your teeth look longer to give you a broader smile.

Crown extensions aren't just used to change a “gummy” smile. Your dentist may also recommend a crown extension if a tooth that's too short can be restored using a crown or bridge. A crown extension will expose more of the tooth so it can be restored.

In addition, if your teeth have inaccessible cavities that are buried within the gums, a crown extension will enable your dentist to fill these cavities. 

Who shouldn’t get a crown extension? The dentist may decide that a crown extension is not for you if:

  • You have teeth with short roots
  • Your teeth are mobile, which means they have inadequate bone support
  • Your teeth don’t have enough keratinized gingiva, the bit of flesh where your teeth meet the wet part of your gums
  • Furcations would be exposed due to a crown extension
  • Adjacent teeth would be destabilized due to a crown extension

Before you get a crown extension, your periodontist — a dentist who specializes in gum health — will use x-rays to determine the properties, sizes, and shapes of your gums and teeth. You should talk to your dentist to clarify any questions you have at this stage and discuss what kind of results you would like to have.

If you also plan to have a crown installed on your tooth, the dentist will determine the crown margins at this stage.

Treatment Options. There are three treatment options for crown lengthening procedures: surgical, laser, and electrocautery. 

All three methods cut out excess gum tissue to expose more of your tooth. The surgical method uses a scalpel or knife, while the laser method uses lasers to do this.

Electrocautery is a process where a current is passed through an electrode to generate heat. Once the electrode is heated, the dentist will then use it to destroy bits of your gums so more of your tooth will be exposed.

These methods may be used in several techniques for crown extensions, including:

  • Surgical extrusion using periotome
  • Gingivectomy
  • Apically displaced flap

Your periodontist will decide which is the most appropriate based on how much gum tissue you have and the condition of your teeth.

Surgical extrusion using periotome. Surgical extrusion using periotome can treat teeth with damaged crown structures due to cavities and fractures. This method of crown extension involves moving your tooth to where you want it to be on your gum line. The periodontist will then stabilize the tooth with stitches.

Gingivectomy. On the other hand, a gingivectomy may be more suitable if you have more than three millimeters of gingival or gum tissue. If you don’t have enough gum tissue, gingivectomy is not recommended since it could expose the bone.

Apically displaced flap procedure. This procedure is also known as the apically positioned flap. You need to have at least four millimeters of sound tooth structure exposed before the surgery. It involves making an incision and creating a flap of tissue in your gums so the periodontist can remove extra tissue and even bone so more of your tooth will be exposed.

Recovery time depends on the kind of crown extension procedure you had. Your periodontist will speak with you ahead of the procedure to explain what will be done. After the procedure, they will let you know what you need to do to fully recover.

You are fully numbed during the dental procedure, but you’ll start to experience some degree of pain or discomfort after the local anesthesia fades. 

You’ll also have some degree of swelling and bleeding after your procedure. This can last a couple of days, so your periodontist may prescribe anti-inflammatory medication such as ibuprofen to help with the pain and swelling.

To minimize complications, you should use a chlorhexidine mouthwash twice a day to maintain oral hygiene.

As your gums heal, they’ll stop swelling and the pain will go away. If the surgery was performed at the back of your mouth, it may take six to 12 weeks to fully heal. On the other hand, if the procedure was done at the front of your mouth, it may take three to six months to fully heal.