Is crown lengthening bullshit? (sorry periodontists)

Current fourth year dental student. I never even knew crown lengthening was a thing until getting into dental school.

At my school, hearing the words β€œcrown lengthening” is an absolute disaster for us and our patients. When a patient finds out they need endo, buildup and crown, that is a lot for them to take in. Then they hear they need crown lengthening, which prolongs placement of the final restoration and is an added fee, patients opt to extract their tooth.

Trying to explain why crown lengthening is needed is hard enough, then telling the patient the procedure costs as much as the crown and will require additional visits and more time for adequate healing is actually exhausting. I just lost the experience of endo and a fixed unit, and the patient lost their tooth. Not to mention, at my school, it takes FOREVER for a patient to get CL (for the very few who opt to get it. My perio department sucks). I once sent a patient to perio for CL in May and I restored the tooth in September. I’m surprised the patient hung on for that long honestly.

In the dental offices i shadowed at, the general dentists talk about just drilling down the bone when prepping the tooth. It sounds like a sloppy alternative, and there is no doubt you will get phenomenal results with true crown lengthening, but won’t the chances of losing the patient (have the patient walk out) increase if you tell them they need an additional procedure and additional fee to restore their tooth? I thought about learning how to do crown lengthening at some point through CE courses in the future so as to not refer out, but the patients still won’t like the additional fee and wait time for healing and I’d be scared of losing the patient.

Also, if you violate the biological width , won’t the bone level recede and the biological width simply re-establish itself (in other words the body does it’s own natural crown lengthening)? I brought this up to periodontist at the school and they say bone level is more predictable through CL.

I’m trying to get some ideas on what you guys do and what your experiences have taught you. I would love to do things right, but I also don’t want patients to walk out and don’t want treatment to take much longer than need be.

Edit: thank you all so much for sharing your opinions and experiences on the matter. It’s been insightful and you really got me thinking about it. I’m not sure what I’ll end up doing in practice in the future, but I promise to do the right/best I can

... keep reading on reddit ➑

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πŸ“°︎ r/Dentistry
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πŸ‘€︎ u/placebooooo
πŸ“…︎ Jan 21
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Do I need surgery on my gums to raise them? One periodontist of mine says I do and the other says I don't
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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/PariahTheDumbass
πŸ“…︎ Jan 13
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Periodontist says 5 of these teeth need gum transplants. Want second opinion. reddit.com/gallery/scl2bu
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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/Impossibruh
πŸ“…︎ Jan 25
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Periodontist vs General Dentist for an implant?

I need to get a tooth extracted and an implant placed, and am looking at my options. Many general dentists also do implants. But should I look for a periodontist to handle it instead since they are a specialist?

I only visited one periodontist and it seemed to cost more than my quote from my dentist. I am going to get more quotes. I can afford it either way.

I guess I don't know how big of a deal or involved an implant procedure is. Will I have more peace of mind if I go with a periodontist, knowing they're more likely to get it right?

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/mbler
πŸ“…︎ Jan 01
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Should I see a periodontist to check my gums before I get ortho treatment just to make sure their healthy? reddit.com/gallery/rw72jf
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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/DocFijiWater
πŸ“…︎ Jan 04
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Recommendations for periodontists to do dental implants- Dallas, Mckinney, Sherman

Looking for recommendations for dentists who do a good job with dental implant.

I feel like google reviews for dentists are pretty sketch (like they’ve figured out how to get rid of bad reviews), so I wanted to ask on here.

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πŸ“°︎ r/Dallas
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πŸ‘€︎ u/kelly1113333
πŸ“…︎ Jan 07
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I had a periodontist appointment this week. They plan on on doing some scaling and root planing(plus some surgical gum grafting). Would this really address a bone loss issue that's said to be close to that of 60 year old for a person in his 20s?

Shouldn't there also be bone grafting as well to really ensure that the teeth won't loosen while being straightened later at some point?

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πŸ“°︎ r/Toothfully
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πŸ‘€︎ u/ACSpectator
πŸ“…︎ Dec 24 2021
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Has anyone's ortho sent them to a periodontist for gum evaluation before starting?

I have recently met with 2 orthodontists for an initial consultation for invisalign. I had braces as a kid, but never wore my retainers, plus had wisdom teeth come in (since removed). My bite is good (on my molars) but I have crowding in the front, especially on the bottom. I also have a small head/face, so my jaw and mouth are small.

First ortho raised no issues, wanted me to come back in for a scan and start treatment right away. But I wasn't vibing with the office so much, and I already had an appointment with a second ortho, so I held off. Second ortho has great vibes, is higher rated, and less expensive. BUT she said she's worried that I have some gum recession and that between the crowding and small jaw/gum area in the front, she wants me to see a periodontist about my general gum health and get their opinion on whether or not I need to have a gum graft before doing invisalign. Basically, she's worried my front teeth will be unstable if we move them forward in my jaw/gums without some assurance from a periodontist first.

I go to the dentist regularly, and have never had a dentist or anyone mention gum recession. In fact, at my last appointment I asked my dentist about invisalign and she told me to go for it. The first ortho I saw likewise did not mention this as a possible issue.

I'm going to the periodontist tomorrow, but I'm just curious if anyone has had experience with gum recession or treatment on their invisalign journey?

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πŸ“°︎ r/Invisalign
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πŸ‘€︎ u/tapas_swissmiss
πŸ“…︎ Dec 07 2021
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Periodontist is recommending SRP, but I just had this procedure 6 months ago through my general dentist.

Just looking for some basic advice.

My periodontist does not want to budge on his prognosis. I feel that it’s too soon for another four-quadrant SRP. Especially at $300/quad it’s no small amount to pay if I don’t absolutely need it done.

Xrays here: https://reddit.com/r/askdentists/comments/rm0h7o/how_it_started_vs_how_its_going_preinvisalign/

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/veotrade
πŸ“…︎ Jan 06
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Romano, the periodontist

Right after Tony tells Jackie that being a doctor is a β€œvery powerful position,” we see one screaming at and threatening the ref at a high school game.

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πŸ“°︎ r/thesopranos
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πŸ‘€︎ u/ThaCaptinNow
πŸ“…︎ Nov 01 2021
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Recommend good gum graft periodontist around CNY area

Hey everybody, trying to find good gum periodontist (I think that's who I'm looking for) in CNY area......

Thank You

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πŸ“°︎ r/Syracuse
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πŸ‘€︎ u/blueballCR
πŸ“…︎ Dec 22 2021
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Periodontist (gum specialist) recommendations?

Hi guys, does anyone have a recommendation for a good periodontist in Dubai?

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πŸ“°︎ r/dubai
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πŸ‘€︎ u/ifza
πŸ“…︎ Nov 27 2021
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Good dental studio with both a dentist and periodontist in St. Louis City/Clayton/Central WE areas

Hi all,

Do you have any recommendations for a good dental clinic where I can find both a dentist and periodontist? I would like to go to a clinic that can offer routine dental treatments but also implants, complex oral surgery etc.

Areas: St. Louis City/Forest park, Clayton; Central West End

I have Anthem Blue Cross Blue Shield as dental insurance however I can go to out of network clinics as I would still have some discount.

Thank you!

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πŸ“°︎ r/StLouis
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πŸ‘€︎ u/MaruDramaMon
πŸ“…︎ Dec 05 2021
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Um how would I ensure a dentist or periodontist addresses this amount of recession on my upper left molars? reddit.com/gallery/q0qpgy
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πŸ‘€︎ u/ACSpectator
πŸ“…︎ Oct 03 2021
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His mom is a periodontist
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πŸ“°︎ r/toofers
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πŸ‘€︎ u/saxamaphon3
πŸ“…︎ Nov 24 2021
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RCT last Friday, 3 days of antibiotics left, due for resorption surgery Tuesday. Will periodontist still be able to do it or will I need to treat this longer?
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πŸ“°︎ r/askdentists
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πŸ“…︎ Oct 30 2021
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Periodontist Referral?

Hi Reddit Friends!

Relatively new to town, still trying to find local health care providers.

I was referred to a periodontist for possible gum surgery, but it turns outs my referral is out with a major back injury. I saw his partner for a consultation, but wasn’t impressed.

Can anyone recommend a periodontist that you like?

Bonus points if they are closer to the Largo/Clearwater area.

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πŸ“°︎ r/StPetersburgFL
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πŸ‘€︎ u/AirbagOff
πŸ“…︎ Sep 29 2021
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What is the best insurance for periodontist treatment?

I'm researching insurance plans specifically for coverage of periodontal disease treatment. I'm an unemployed college student at the moment and want to see if anyone has any recommendations for a personal plan that would be the best use of the money.

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/MrBond90
πŸ“…︎ Nov 04 2021
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LPT: If your gums occasionally bleed during brushing or you occasionally taste blood in your mouth while eating, see a periodontist (gum specialist)!

Don’t suffer the same fate as I did! Gum disease is a silent killer that is too light to be concerned about until it is too late to be reversed.

A common early warning sign is gum bleeding but to most people (and even many dentists), gum bleeding is a tiny issue or nonconcern. Wrong!

See... for a decade (or longer), my gums would occasionally bleed during brushing. My family dentist had never flagged this as a major concern. During routine visits, he would occasionally comment β€œOh your gums are a little weak.. just take note to floss that area.”

It was only recently that I visited a periodontist for an issue (a shifting tooth) that required specialist attention. I was diagnosed of a late stage gum disease (periodontitis) resulting in the shifting tooth due to bone loss (because left untreated, the disease eats away at the bones little by little...).

I did a deep scaling and cleaning treatment and bone graft treatment which halted the progress of the disease.

Unfortunately, the effects of the disease (a shifted tooth resulting from bone loss) was unreversible. Regrettably, this could have been avoided had I not ignored the bleeding gum warning and went to a periodontist for a second opinion.

In the words of my periodontist, β€œThere is no such thing as weak gums... you either have healthy (non-bleeding) gums or a diseased (bleedy) gums.”

After the periodontic treatment, my gums no longer bleed even under the hardest of brushing so I strongly urge you to consult a peridontist if you experience that occasional gum bleeding. Don’t wait till it’s too late!

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πŸ“°︎ r/LifeProTips
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πŸ‘€︎ u/Keithsg
πŸ“…︎ Jul 14 2021
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Periodontist says I need $20,000 in gum grafts!

My dentist has been monitoring gum recession for years and finally decided to call in a periodontist for a consultation. The periodontist says many of my teeth need gum grafts and I need a series for four surgeries that cost about $5000 each (after insurance)! Should I get a second opinion? I do OK but there's no way I can afford that. This feels like an impossible choice.

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/wwdvd
πŸ“…︎ Sep 23 2021
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So the dentists had me try seeing a periodontist to address my gum recessions and bone loss, but the periodontist had me schedule an appointment 2 months later cause he’s β€œbusy” atm. Is that fine?

I hope gum recessions are slow and gradual whenever they progress, but would it have been more ideal if the appointment were to take much sooner?

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/ACSpectator
πŸ“…︎ Oct 29 2021
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Receding gum in one tooth - Ortho wants me to see periodontist before starting Invisalign

What can I expect? Having me worried as I don't want to get a graft done. Other 4 orthodontists I consulted with wanted to keep an eye on it but never asked me to see a specialist.

Should I go with a different Ortho?

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πŸ“°︎ r/Invisalign
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πŸ‘€︎ u/indyanguy
πŸ“…︎ Sep 09 2021
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What is the least offensive or most polite way to tell my periodontist that her hands reek of her prior patients diseased mouth? ...and could she be spreading disease from that mouth to mine?

I had a very unpleasant experience with a periodontist that my dentist referred me to. They both work at the same HMO dental office.

She was nice and friendly so no complaint there, but I think she didn't change her gloves and wash her hands between her last patient and me because her gloves/hands smelled really really bad -- exactly like halitosis or gingivitis or some kind of mouth disease.

Aside from the very unpleasant oder every time her gloved hands got within 2 feet of my nose, I'm worried that she could be spreading the germs from her prior patient to me.

I suppose it might be possible that she did change her gloves but the oder was on her hands and it was so strong that it permeated through her gloves.

I do remember from biology class that a person might not even be aware of an oder after a while if their nose has become used to it -- could this be the case with this periodontist?

What should I do next time if this happens again?

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/W0lfBird
πŸ“…︎ Aug 03 2021
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Need some advice from a periodontist

So I have a receding area right below my front tooth it looks exactly like this https://ibb.co/6HCRM52 ( not my mouth but same position and looks 100% the same) my teeth are over crowding and my general dentist has said this is the reason for it receding. I have a appointment in February for a consultation with a periodontist for a gum graft but I’m also looking into getting braces to fix my problem with the teeth being crowded in one area. Would you advise that I still get the gum graft then proceed with the braces? Or would the gum graft be pointless if I don’t get my overcrowding fixed first? Thanks

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πŸ“°︎ r/askdentists
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πŸ‘€︎ u/LEGIT-X-Bacon
πŸ“…︎ Nov 23 2021
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Hygienists, at what point/what conditions do you refer your patient to a periodontist?
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πŸ“°︎ r/DentalHygiene
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πŸ‘€︎ u/yoyoscrape
πŸ“…︎ Nov 14 2021
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