Disadvantages of the Crown Lengthening Procedure

Introduction

Crown lengthening is a surgical technique used to expose more of a tooth’s visible structure by reshaping gum (and sometimes bone) tissue. While it plays a vital role in restorative and aesthetic dentistry, it isn’t without trade-offs. Patients considering this procedure should understand the potential drawbacks, risks, and limitations involved.

Key Disadvantages

Increased Tooth Sensitivity

Because more of the tooth surface (root or cervical area) is exposed, treated teeth can become more sensitive to hot, cold, or sweet stimuli. This sensitivity often decreases over time, but in some cases, it can persist and require desensitising treatments.

Unfavourable Gum or Bone Loss

To gain access to tooth structure, the procedure may require removal of soft tissue and/or alveolar bone. This can reduce periodontal support and potentially compromise the strength or stability of the adjacent teeth. In severe cases, it may negatively affect the crown-to-root ratio.

Aesthetic Concerns

After the procedure, the treated tooth might look longer than adjacent teeth, creating a mismatched or “stretched” appearance. Uneven gum contours, recession, or “black triangles” (gaps between teeth roots) may also become more visible in the smile zone.

Healing Delays & Risk of Infection

Any surgical procedure carries a risk that tissue healing may be slow or complicated by infection. Difficulty maintaining cleanliness, smoking, or compromised health may delay the recovery period or lead to inflammation, delayed closure, or soft tissue complications.

Bleeding or Post-Operative Discomfort

You may experience post-operative bleeding or oozing, particularly in the first 24 hours. Discomfort, swelling, and soreness around the surgical site are common and must be managed with pain control and careful care.

Risk of Surgical Failure or Suboptimal Outcome

If the procedure is not precisely planned or executed, the result may not expose sufficient tooth structure to support a crown or restoration. In such cases, the desired prosthetic outcome may fail—or require retreatment or extraction.

Reduced Future Options

If substantial bone is removed, it may limit your options later for dental implants or adjacent restorations. Also, excessive tissue removal around a tooth can make future procedures (root treatment, retreatment) more complicated.

Cost & Insurance Limitations

When crown lengthening is done purely for cosmetic reasons, many insurance or dental benefit plans may not cover it. So, the patient may bear full cost, which can be significant depending on the extent of surgery.

Who Faces Greater Risks?

Patients with thin gingival biotype (delicate gums)
Teeth already with marginal bone loss or poor periodontal support
Highly aesthetic (front) teeth where symmetry is critical
Those with systemic health issues affecting healing (e.g. uncontrolled diabetes, smokers)
Cases requiring extensive bone recontouring

Managing the Drawbacks

Detailed pre-surgical planning using imaging and measurements
Conservative tissue removal and minimal bone resection where possible
Meticulous suturing and flap design to optimise aesthetics
Strict post-operative instructions and monitoring
Use of desensitising agents, soft foods, and oral hygiene modification during healing
Regular follow-ups to catch complications early

Frequently Asked Questions

Will the tooth always look longer?

Yes, to some degree. The increased visible tooth height is inherent to the procedure. However, skilled periodontal planning can mitigate awkward appearance through careful contouring and symmetry.
How long does recovery take?

Initial healing often takes weeks, but full maturation of tissues may extend to 3–6 months depending on location and extent.
Can the sensitivity be permanent?

In many cases it fades over time, but if the root surface remains exposed permanently, sensitivity could persist and require management.
Is bone removal always necessary?

Not always. In some cases, only gum tissue is trimmed. When bone removal is required depends on how much tooth structure needs exposing and where the bone lies.
What happens if the procedure fails?

If insufficient tooth structure is exposed or complications occur, further surgery, retreatment, or in worst cases extraction may be necessary.