Modern crown lengthening isn’t just about exposing tooth structure—it’s about knowing the exact indications and avoiding contraindications to ensure lasting, predictable results.

Crown lengthening is more than a surgical trick to “make teeth longer.” In modern dentistry, it is a carefully planned procedure that blends biology, function, and esthetics. Exposing adequate clinical crown height while maintaining the biologic width preserves natural teeth. It also improves restorative outcomes and meets patient expectations¹.

Why Crown Lengthening Matters

• Short clinical crowns often lead to poor retention, weak ferrule, and challenging margin placement.
• The biologic width (now called supracrestal tissue attachment) averages 2.04 mm, composed of:
  • Junctional epithelium: ~0.97 mm
  • Connective tissue attachment: ~1.07 mm
• To avoid inflammation, bone loss and compromised esthetics maintain at least 3 mm between the restoration margin and the alveolar bone¹.
• Crown lengthening re-establishes this biologic harmony, creating a predictable foundation for restorations.

Indications You’ll See in Daily Practice

• Subgingival caries or fractures – for complete removal and restorative access^1,2.
• Inadequate crown height – to achieve ferrule and prevent fracture^1,2.
• Excessive gingival display / altered passive eruption – for esthetic correction⁴.
• Margin relocation – moving restorative margins into biologically safe zones³.
• Special cases – root surface perforations, cervical root resorption^1,4.

Contraindications to Keep in Mind^1,5

• Unfavorable crown-to-root ratio (<1:2).
• High furcation involvement – may expose furcations after surgery.
• Thin gingival biotype – risk of post-op recession.
• Non-restorable teeth – extraction is a better option.
• Inadequate tooth-to-arch alignment – may compromise occlusion or restorative outcomes.
• Risk to adjacent periodontium or aesthetics – Potential adverse effects on adjacent tissues or esthetic outcome.
• Inadequate attached gingiva – complicates flap design, stabilization, and suturing.
• Significant vertical maxillary excess – may require orthodontic treatment or orthognathic surgery.

Beyond the Surgery

• Oral hygiene is the real key: Without plaque control, even the most technically perfect crown lengthening will fail.
• Respect esthetics: Especially in the anterior zone, crown lengthening must balance biologic gain with patient appearance.
• Patient-centered decisions: While implants are common, many patients want to retain their natural dentition. Crown lengthening often makes this possible.

Bottom line

Crown lengthening is not just a mechanical procedure. It’s a biologically respectful, evidence- based approach that enables restorations to last longer, look better, and function predictably.

References

1. Qali M, Alsaegh H, Alsaraf S. Clinical considerations for crown lengthening: a comprehensive review. Cureus. 2024 Nov 3;16(11).