Thursday May 3, 2001
Dear Dr. Mady: I had a root canal on one of my molars a couple of years ago and when my dentist recommended I crown the tooth, I declined due to cost. Now I bit something hard and cracked the entire side of the tooth off way below the gum. Do you think that it is too late for the crown and that I will just have to pull it out? - A chronic ice-cube chewer.
Dear ice-cube chewer: This is one of those situations where you probably will not know all of your options without having your dentist take a look at the extent of the fracture. If you merely fractured one or two of your molar's four cusps below the gum line, there is an excellent chance that the tooth is salvageable by a method known as crown lengthening.
Crown lengthening is a minor surgical procedure usually performed by a periodontal specialist where gum and sometimes bone tissue is removed and reshaped to expose more natural tooth for your dentist to work with. It is a very effective and predictable way of increasing the available tooth structure so that your dentist has more tooth to grab and work with, so to speak. It can be performed in the area of the fracture or even around the entire tooth in question and is commonly used to save teeth like the one you are describing.
Crown lengthening is also used for esthetic purposes such as reducing the amount of gums shown in a "gummy smile". This helps individuals with teeth that are of proper length but they are covered with too much gum tissue. It may also be used to even the gum line for a nicer smile.
The procedure itself is very basic for a trained professional. It involves freezing of the area first. After, incisions are usually made and the gums are gently pulled back to expose the bone support of your tooth. The area is then sculpted and reshaped to the desired and ideal shape.
At this point the gums themselves are modified if needed and then they are sutured back into the proper position to accelerate healing. The complete healing usually takes about three weeks and at that point if all is well, your tooth can be restored with the crown. After this, the damaged tooth will be protected. The tooth and restoration should be more maintainable and in a more cleansable area.
Whether you have crown lengthening to improve your smile or function of your teeth, or if it is to actually save a severely fractured or broken down tooth, you will benefit if you should have the good fortune of being a candidate. Good Luck!
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5
