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I had a root canal on Fri and went back to the dentist on Mon for a temp crown and fitting for a permanent crown. The dentist took out the temp crown that the endodontist had used and grinded away most of my tooth. After that, she drew me a diagram, told me that I needed a crown lengthening and referred me to a periodontist, and informed me that she would not put on a crown if I didn't have a crown lengthening ($750 procedure which my insurance does not cover). The billing person in the dental office referred me to another dentist (in the same office) who also said I needed crown lengthening, but he said he would do the procedure free of charge.
My questions are:
1. Is a crown lengthening really necessary? My gum line is fairly high on this tooth and I think having it higher wil look odd. Also, $750 is a really high cost to a grad student. It was NEVER mentioned by my dentist or anyone else when the cost of a root canal and crown were discussed.
2. Is it possible that I need a crown lengthening because the dentist grinded away too much of my tooth structure? She left very little tooth. She never discussed how much she would be removing or anything related to size prior to grinding my tooth.
3. Is a dentist qualified to do a crown lengthening? Or is it better to go to a periodontist?
4. Where can I find more information regarding crown lengthening pros and cons, both critiques and recommendations?
Let me start by saying I am a licensed general dentist and I am currently practicing. I want to give some insight into the crown lengthening procedure and why it is done. When a tooth is in need of a crown, the tooth is "prepared" or cut down to a certain shape, leaving a precise margin, or border around the gumline of the tooth. A crown will then fit over the prepared tooth, encircling it 360 degrees. The margin of the tooth is where the crown meets the natural tooth. This usually happens right at the gumline, or just below it, in order to conceal that margin. That same margin MUST be on healthy tooth structure. A lot of times when a tooth has a large cavity, the cavity will invade an area on the tooth that will make it impossible to leave a clean, cavity-free margin at or just below the gum. Therefore, the margin must be deeper on the tooth, down below the gum, sometimes several millimeters. This usually cannot be determined until after the tooth is prepared and the decay is cleaned out. (Hence the reason it may not have been explained prior to starting the procedure).
Think of the tooth and surrounding components for a minute...You have the tooth (2 parts, a crown part and the root). The root is burried and surrounded by bone. On top of the bone is the gum, all of which encircle the tooth. There must be a distance of AT LEAST 2 mm, preferably 3 mm of space from the height or top of the bone that surrounds the tooth and the margin of the crown. This distance is called the Biologic Width. When there is not at least 2mm of space (deep cavity involving the margin), crown lengthening is then indicated. The crown of the tooth must be lengthened somehow... The CL procedure removes some of the bone surrounding the tooth, and in essence, lengthens the crown of the tooth, (or lowers the gumline) creating that 2 mm of Biologic Width.
Why is that needed? If you don't maintain that 2 mm of Biologic Width, the invasion of that width will be a constant source of inflammation, ie. bleeding, red, constantly irritated gum tissue. It will bleed when you floss. And, (more importantly for a front tooth)...the gums will recede on their own and expose that new crown's margin, possibly jeopardizing the new crown.
So, crown lengthening allows for a clean margin of tooth while simultaneously preventing future irritation and preserving the biologic width.
Does every tooth that needs a crown need crown lengthening? Absolutely not.
Ok folks.. an answer from a periodontist here, in practice for over 30 years. The usual indication for crown lengthening, is when there isn't enough "sound" or solid tooth structure available above the gum line to secure a long lasting crown or other restoration. Often the tooth structure that is removed by the dentist initially, is decayed or soft, leaving the remaining tooth at or below the gum surface. Failure to do the procedure often leads to recurrent (or new) decay getting in under the crown and the need for additional work, or worse, loss of the tooth. The $750 fee is not out of line in most parts of the country. In NYC where I am located and rent and overhead is sky high, the fee is closer to $1200.
Just to be fair.. let a dentist answer this question. As a dentist I am always trying to save teeth AND people money. I am not hear to suck every penny out of people. Many times I do free work because too many people just don't want to prioritize their spending on their teeth. That being said, crown lengthening is only justified when enough tooth structure is not present for a crown. When a person comes to me with a badly broken down tooth, many times the amount of tooth structure that is sound is hard to evaluate at the root canal visit. I always tell people when it is a close call. Often it is hard to tell if you need crown lengthening or not until after the root canal is finished and the cast post and core or crown procedure is scheduled. We use digital radiographs ( x-rays), and I don't like doing the procedure; however, sometimes you need to do this or the crown will not fit at all or a person may have a chronic periodontal problem. Western society is filled to the brim with decay, believe me.. there is so much work to restore people. Dentists don't have to create work.
I have been told that I need a crown lengthening too. I already have a crown and have had it for a few years. I don' t understand why I need it because my gums are not inflamed or irritated. My pain is in the tooth when I chew. The dentist and Periodontist said that this procedure will fix it. Has anyone had this kind of pain before and been told that a crown lengthening will take care of it?
No root canal. I told the dentist about some sensivity to heat and cold on the tooth. He told me that since the pain went away relatively quickly, it did not need a root canal. He said that if the pain lasted for a while, I may need a root canal.
Usually if a tooth is sensitive to heat and biting it indicates a problem with the nerve. Did the dentist take an xray to check for infection at the tip of the root?
I've never heard of crown lengthening being needed because of sensitivity to chewing.
Neither the dentist nor the periodontist took an x-ray. I think my dentist stated that there could be some decay under the crown. I think after your helpful information, I should get a 3rd opinion. Do you suggest the opinion from a Periodontist or another dentist?
Thank You!!
I'd go see another general dentist. If there is decay under the crown, crown lengthening will not help the discomfort you are having. Perhaps the crown should be removed, decay fixed and new crown placed?? An xray should be taken to be sure the tooth is not dying.
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