Q: I need a bunch of crowns, but my doctor is telling me I need what he called “crown lengthening” gum surgery before he starts the crowns. I was told this involves more expense, cutting the gum, stitches and delays the treatment. Can I skip this?
A: There are two types of “quality, skilled dentists”: The ones that perform dentistry as if to impress their old dental school professors and to make the centerfold in Dentistry Today; the Playboy equivalent of dental magazines. They mean well, but sometimes the patient receives more procedures and fees which may be a bit overkill.
Example: If the patient is 95 years old, must they pay for four extra procedures in addition to the crown fee in order to make that tooth last for twenty years? No. This is what I call: “herodontics”. A patient with Parkinson’s may benefit from a temporary fix or a less aggressive fix to accomplish the same goal as a crown on a twenty-year old weightlifter. Does the 100 year old diabetic go for a double knee replacement or the meds for arthritis? (At that point I would for the Chianti and a box of cannolis.)
The second type of “quality, skilled dentists” are the ones that perform dentistry to please the patient. Is it affordable for the patient? Is it practical? Are the goals achieved with as few appointments as possible and with as little discomfort as possible?
Most ethical and skilled dentist fall somewhere in between the above two classes.
Often when massive decay under an old filling or old crown is removed, insufficient tooth structure is left above the gum line to cap with a crown. Crown lengthening surgery cuts away bone and gum tissue to expose more of the stump to support a cap (crown). If no bone needs to be removed, often the gum can be easily trimmed with a Diode Laser, or a new type of drill called the CeraTip which spins rapidly along the gum line, causing coagulation and retraction of the gum, allowing us to take an accurate digital impression for a properly fitting crown. This is an ideal alternative to a scalpel or an electrosurgery unit.
Dr. Mitchell Josephs practices Implant, Cosmetic and General Dentistry with an emphasis on implants, porcelain veneers, and complex crown and bridge treatment. He is on staff at JFK Medical Center and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry. He completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.