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Periodontics/Crown Lengthening


Do you see crown lengthening in tooth # 28 ?
Do you see crown lengt  
QUESTION: This question is about tooth # 28, of which I attached 2 x-ray pictures. The upper picture shows tooth # 28 after treatment. The lower picture shows the tooth before treatment. Do you see a crown lengthening in tooth # 28 in the upper picture ?   

I look forward to your answer and thank you very much for your reply in advance. I will place my rating when I receive your reply.

ANSWER: The xrays are not angled the same and as such you cannot tell from the xray if there was crown lengthening. Also if there was crown lengthening on the direct buccal or lingual surfaces that would not show up on xray due to overlap of the image of the tooth.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your reply. The crown lengthening would not be on buccal or lingual surfaces, it would be in the bone under the gum, in the hard tissue. This would mean that the bone level would be lower in the x-ray after crown lengthening. This would be periodontal (functional) crown lengthening, to expose sound tooth structure above the gum line in order for the new crown to have retention. No bone reduction is visualized in the picture with the crown. When you consider this additional information, what is your impression ?

ANSWER: The xrays are taken at different angles.  There is no fixed reference point from which to measure the bone levels between the two xrays.
Best of luck
Dr. Scharf

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your answer. I see your point. The dentist who allegedly did the clinical crown lengthening with hard tissue used code D4249 for the billing, which means that he would have reduced the bone level(s). He stated in his records that he did this on the distal side of # 28. If that were true, the distal side's bone level should be lower in the AFTER (treatment) X-ray. It should be lower than the misial side. As you can see, both the distal and misial sides are the same level. The BEFORE x-ray shows both misial and distal bone levels as the same level. Same in the AFTER x-ray. Does this help with clarification ?

Looks like he must have removed some bone from the distal to get the  crown on beyond the existing decay and still be above the biologic width. Perhaps he removed some medial bone as well and didn't write it in the chart. Looks like a good job was done on the crowns.  Your lucky it was done well. Kudos to your dentist.  


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David Scharf


I am a board Certified periodontist which means that I am an expert in treating gum disease (periodontal disease) and placing dental implants. I can answer questions related to treating gum disease, bleeding gums, maintaining healthy gums, and structural issues with the gums such as recession, to gummy a smile, crown lengthening etc. I am also certified in Laser Periodontal therapy which allows me to treat gum disease with a laser rather than a scalpel. I can address those questions as well.


I have been practicing periodontics and placing dental implants since 1990. I have treated thousands of patients for both gum disease and dental implants. I currently an a Clinical Assistant Professor in the Department of Periodontics and Implant Dentistry at the nations largest dental school.

Journal of the American Dental Association, Journal of Periodontology, International Journal of Oral and Maxillofacial Surgery, International Journal of Oral and Maxilofacial Implants

BA/DMD Boston University Cum Laud. Certificate of Advanced Graduate Study in Periodontics fro New York University. Board Certification in Periodontics 1995

Awards and Honors
e was elected to Omicron Kappa Upsilon (the "Phi Beta Kappa" for dentists), and received the Boston University award for Excellence in Periodontology, the Boston University Predoctoral Prosthetic Award for Excellence in Prosthetics, and the Academy of General Dentistry Outstanding Senior Student Award, the Boston University Operative Dentistry Special Achievement Award, and the Quintessence Publishing Company Outstanding Senior Award for Excellence in Clinical Practice. Following dental school, Dr. Scharf completed a year long General Practice Residency at The Long Island College Hospital in Brooklyn, New York. As a resident at this top New York program, he gained extensive clinical experience in such fields as prothodontics, periodontics, endodontics, orthodontics, oral surgery, management of the medically compromised patient, and general dentistry. This experience was completed by clinical rotations in the departments of general medicine, anesthesia, and emergency medicine.

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