You've heard of a crown (and might even have a few in your mouth), but what is a clinical crown? It's the visible portion of the tooth that is not covered by tissue. This portion can include enamel as well as cementum (the surface that covers the root) if your gums are receding. Your crowns are critical for chewing, keeping your teeth clean and allowing for dental restorations.
Clinical Crowns Come in All Sizes
The apparent size of your teeth depends on the appearance of everything around them: your jaws, facial bones, lips and gums. The clinical crown of your teeth can often appear longer or shorter based on how healthy your gums are, and a variety of cosmetic procedures can adjust its size and appearance.
Sometimes, if tooth decay goes below the edge of the gumline or a tooth breaks below the gums, your dentist won't have sufficient tooth structure to insert a crown or bridge. The American Academy of Periodontology reports that in these cases, a surgical procedure called dental crown lengthening is needed to lower the edge of the gum and underlying bone of the tooth or adjacent teeth.
Crown lengthening exposes the damaged or diseased tooth, allowing the dentist to better repair and restore the area. It can also be used cosmetically to adjust the appearance of a "gummy" smile, says Spear Education. While crown lengthening to allow for a safe prosthetic is a restorative procedure, lengthening for appearance's sake is a patient's cosmetic choice.
Teeth that appear too long or uneven can also be adjusted with tooth contouring and enamel reshaping. It won't remove large parts of a tooth, but enamel reshaping can be used to smooth the edges of teeth, sand off chipped areas and even make small bite corrections, writes the American College of Prosthodontists.
Crown Changing Treatments
Procedures that change your crowns' appearance are usually done by a periodontist, a dental specialist who specializes in gum treatment. A study published in the Journal of Pharmacy & Bioallied Sciences compared three crown lengthening surgical techniques and their clinical results:
- Gingivectomy, which is the surgical removal of excess gum tissue.
- Gingival flap surgery involves bone recontouring and repositioning of the gum with stitches.
- Surgical extrusion (pulling the teeth into a new position) using a specialized instrument called a periotome.
All three methods aim to lengthen the clinical crown while maintaining the width and contour of the attached gum, or gingiva. The researchers of the study favor the surgical extrusion technique, because it is less invasive and provides a better aesthetic result, especially when the tooth is located in the front of the mouth.
Crown lengthening treatments are usually performed in the specialist's office under local anesthesia. You might experience some swelling for the first few days after the surgery, which can be treated with ice packs and an aspirin-free over-the-counter pain reliever. Your dentist might direct you to use a specific mouthrinse or eat soft foods while your new gumline heals.
Complete recovery and gum regrowth usually takes about three months, at which point your dentist will be ready to place any implant or denture you might need. Whether it's to heal a broken tooth or reshape a gumline, your dentist is your best authority on procedures that change the appearance of your clinical crown.