Is It Common Practice for a Dentist to Ask a Patient if Gum Tissue Can Be Removed to Prep for a Crown?

I had a gum graft to two lower back teeth. The gum was healthy with no pocket. Recently, I was prepped for a new crown and discovered a little over 1/2 the gum transplant was removed. About a ½” of exposed root/tooth is above the gumline along the front; the back has about ¼” of tooth above the gumline. There was no decay. The dentist said he removed gum to make more room for the crown. He did not ask me about removing gum tissue. The previous crown was fine without gum removal. Is this a normal incident?

Doctor Answers 2

Crowns require adequate tooth to stay put

When a crown is placed on a tooth, there needs to be a certain amount of actual tooth structure to hold on.  When replacing a crown, we usually have no idea what is underneath and sometimes need to change plans to compensate.  Sometimes there is a build up underneath (large filling material replacing lost tooth structure) but the edge of a crown must be at least 4 mm beyond the edge of the build up.  If the build up was inadequate or the "ferrule" is less than 4 mm, then "crown lengthening" is needed.


Often we are talking mere millimeters.  More than that would require some bone removal as well.  What likely happened was what is called a gingivectomy, and the only time I ask permission to do it is if I plan to charge for it.  If there is no charge, there is an implied consent already, a "whatever it takes to do the crown," type of consent.  It is not a requirement, but it sounds as if you would like to know the details of each step in the process.

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Is It Common Practice for a Dentist to Ask a Patient if Gum Tissue Can Be Removed to Prep for a Crown?

Great gum health and the correct shaping are part of what makes a front tooth crown look great.

We are in an age of micro-aesthetics. Oftentimes there are small improvements that can be made when a crown is replaced. Typically a dentist is very conservative and makes only minor changes. These changes can actually improve gum health as well as really boost the overall results so they look amazing.

I suspect that what has happened with your gums and grafts is completely different from the back part of your mouth to the front part.

I suspect also that you might be concerned that he did not ask you for permission to do this. I think there could be some breakdown in the communication.

I would call him today and ask for a few minutes to talk through the issues. I suspect that with a good conversation about all of it, you may find that it was for your benefit and to improve your results. I suspect it will also help him know more about your concerns and the best ways to communicate with you.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.