I have had crowns on my two front teeth for all of my adult life due to falling and breaking them. Recently one crown and tooth broke off at the gum line. Over the years (I am 56) my teeth had shifted and I had a small gap between my 2 front teeth that I hated. My dentist suggested making 4 crowns across the front and making each one slightly wider to close the gap. Since I had to have a new crown made I decided to have the other 3 crowns made. It wasn't until I was in the chair and he had the drill in hand that the dentist mentioned that he would need to make them a little bit longer in order to keep them proportionate. As he proceeded he said that my gums over the two teeth that had been capped for many years bled quite easily and he wanted to refer me to a peridontist to check the 'biological width.' The peridontist now tells me that he needs to cut away part of the gum and the bone and he thinks it would look better if he did all 4 teeth... at a price of $3,500! I am fuious and don't know where to turn. I want to know A. if I really need the procedure at all. B. I read that there is a risk if you have bone trimmed away that if you ever need an implant there may not be enough bone to hold an implant... then what would you do. C. what is a reasonable cost for the gum surgery. D. was it ethical for my dentist not to tell me about increasing the length when we first discussed my options for closing the gap between my front teeth. I feel very betrayed by a dentist that I have been seeing for over 40 years. Thanks for any advice you can give me.

My gums hurt just from reading your post. I would think they could drill holes in your jawbone and insert posts, rather than shave it. From what you have described I would not have this done without seeing at least two other specialists.

Being a dental hygienist I can tell you that what you are describing sounds exactly correct. Crown lengthening is a very common procedure, and only a millimeter or two of bone is removed, nothing that would interfere with an implant in the future if you should desire one. The removal of the gum tissue is called a gingivectomy, also quite common on tissue such as you described, I think if you have the procedue done, you will be quite pleased with the outcome! Good luck!

A) ASSUMING you keep good oral hygiene, but your 2 front teeth with the crowns somehow bleed easily like your dentist and periodontist said, then yes you need crown lengthening because your biologic width has been invaded. However, the 2 other teeth don't NEED it (functionally speaking)... just that they will aesthetically look better/more harmonized if you decide to lengthen them as well. It seems as though you will have to choose if you want to spend all that money for vanity and close the gap.
B) With implant, if you don't have enough bone structure, you can do a bone graft. They usually harvest the bone from your chin or hip to do that.
C) Depending on where you live, the price you quoted sounds typical. If you want to save money, maybe you can consider going to a dental school with a grad perio program. At my school, crown lengthening per tooth goes for about $400-500.
D) On this incident alone, I wouldn't say your dentist is being unethical... just not prepared. In school they try to teach us to "see ahead" and inform patients of all possible complications that may arise, but sometimes it's hard because dentistry is not so clear cut as the public may think. I'm not saying it's excusable, but if this is the first time in 40 years that you feel betrayed by him... then it was probably an honest case of miscommunication. You just need to tell him whether you still want him to close that gap, which would then entail all these other nuances.

Why a second prize, they post two questions and all of them are 3 or 4 years old.

I could not do that good if I tried,

Stlll closed