Crown Lengthening Revisited

Focused Clinical Question: What are the key considerations in selecting the best approach to crown lengthening? Summary: Crown lengthening is a surgical procedure that involves manipulation of either soft tissue or both soft and hard tissue around a tooth or teeth for esthetic or restorative purposes. Esthetic crown lengthening is indicated in patients with excessive gingival display (known as a gummy smile) or gingival overgrowth, whereas restorative (or functional) crown lengthening aims to gain retention and resistance form of sound tooth structure above the alveolar crest level in cases of subgingival caries, subgingival restorative margins, or tooth fracture. Both aim to increase the amount of supragingival tooth structure for esthetic and/or restorative purposes. Conclusions: In selecting the type of procedure for esthetic or restorative (or functional) crown lengthening, the key considerations include assessment of the width of keratinized gingiva and distance of the cemento‐enamel junction or finished restoration margin to alveolar bone around the tooth/teeth involved. This article reviews and presents a decision tree in the use of both types of procedures. In addition, the subtle differences between esthetic and restorative (or functional) crown lengthening are highlighted.