Alternatives to Crown Lengthening? I am scheduled for a crown (with crown lengthening) in a few days. I am waiting for 2nd opinion from my dental plan which probably won't arrive in time.
After reading about the gum destruction caused by CL (crown lengthening), and the possible problems of dental plans, I'm wondering if there's any alternative to crown lengthening.
I've had 14 crowns, several involving decay under gums, without CL. So I can't help but wonder if the dentist is padding or if the procedure is really necessary. I was also told that the tooth needed a preventive root canal, but I declined this. ... Visitor from CA
Without seeing your tooth clinically or an x-ray, it's a little hard to give you a difinitive answer over the Internet. If you have had 14 crowns with some involving decay under the gums of a few teeth, who is to say that some of your previous teeth could have benifited from some proactive gingival crown lenghtening. The number of crowns and past dental restorations you admit to indicates that you have a high succeptablitity to dental decay.
When a tooth decays below the gum, or if a tooth is so broken down that there is not much tooth structure left above the gum for proper retention, then periodontal crown lenghtening is an excellent way to lengthen the tooth to access the decay and to gain more tooth structure for the margin of the crown.
In crown lengthening, after the tooth is numbed, the dentist first flaps the gum tissue back a bit, and then carefully removes a little bit of the bone around the tooth. This is done to access the decayed areas, and to increase the length of the tooth below the gum to place the crown margin for increased retention of your new crown restoration.
When the tooth is too short due to past decay and breakdown or if decay extends down below the gum tissue, it can be a real problem if a dentist goes ahead and just tries to prepare too far down below the gum tissue.
There is a physiologic zone between the top of the gum tissue and the periodontal attachment near the osseous level of the jawbone. This area or space is called the biologic width. It is the delicate area where the gum tissue and periodontal ligament attach to the base of the tooth to protect the undelying bone against the harsh oral environment with all it's periodontal bacteria and toxins. When the periodontal biologic width is intact and the patient is keeping up with their routine brushing and flossing, the gums stay pink and healthy and do not bleed.
If however, the crowns or dental restorations are made too deep and invade this biologic width, the gums get red and inflammed and bleed very easily. The margin of the crown that sits way below the gum, irritates the delicate biologic width, and the body tries to re-establish the correct biologic width distance by trying to move deeper away from the offending crown margin.
The inflammatory process brings ossteoclasts (bone eating cells) into the area to eat away the bone tissue below the deep crown margins to essentially move the biologic width deeper to re-estasblish the proper distance between the deep crown margin and the periodontal ligament and jawbone. The periodontal biologic width cannot be invaded without adverse effects.
Unfortunately, some patients have poor treatment experiences and then have continued gum pain, inflammation and bleeding sore gums around new crown restorations for years to come. Crowns are sometimes prepared too far below the gum and invade this critical biologic width area.
Your dentist may have good reasons to be suggesting some crown lenghtening before preparing your tooth for a crown. Sometimes when the past decay and fillings are close to the nerve, or if the tooth is badly broken down, a dentist may suggest an intentional root canal to prevent future problems. Another treatment method intended to build underlying tooth structure strength is to bond a post down into one of the canals of the endodontiacly treated tooth.
As for alternatives, if the need for crown lenghtening is there, then this would be the best option for periodontal health. The use of flouride rinses and prescription grade flouride gel trays offer additional benefits for preventing decay especially with complex restorations.
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