Quick answer
Crown lengthening fixes a gummy smile only when the cause is excess gum or a high bone level covering the teeth. If the upper lip rises too high, the lip is short, or the upper jaw is vertically long, gum surgery will not change the smile. A periodontal exam should identify the cause first.
At a glance
- Best candidate
- Short teeth with excess gum and a high bone level
- Not a fix for
- A hypermobile lip or a long upper jaw
- Typical scope
- Four to six upper teeth
- Planning range
- $2,000–$5,000
A gummy smile is a description, not a diagnosis. Two people can show the same amount of gum when they smile for completely different reasons, and only one of them will benefit from crown lengthening.
The procedure changes the gum and bone level around the teeth. If the gum display comes from somewhere else — the lip, the jaw or the teeth themselves — the surgery will not deliver the result the patient expected.
The four common causes
1. Altered passive eruption (gum and bone)
During normal tooth eruption, the gum recedes to expose most of the crown. In altered passive eruption, it does not. The tooth is a normal length, but the clinical crown is short, the gum line sits low and the teeth look square.
This is the classic crown lengthening case. The gum is excess, and the bone is often high as well. Removing the gum and reducing the bone to the correct level exposes the tooth that was already there.
2. Excess gum with a normal bone level
Sometimes the bone is fine and only the gum is thick or low. A gingivectomy or laser contouring can be enough. The distinction is measured with a probe; it is not obvious from a photograph.
3. A hypermobile upper lip
The teeth and gum may be normal, but the upper lip rises unusually high when smiling, exposing the gum above them. Crown lengthening does not change how the lip moves. Treatment options include botulinum toxin to reduce the lip’s pull, lip repositioning surgery or, in some cases, orthodontic planning.
4. Vertical maxillary excess or a short lip
If the upper jaw is long, the whole middle face is long and the gum display is part of a skeletal pattern. A short upper lip has a similar effect. These cases need orthodontic or surgical assessment, not gum surgery alone.
The diagnostic exam
A periodontist should assess four things before recommending anything:
- Tooth proportions at rest. Are the teeth short and square, or normal length?
- The amount of gum shown in a full smile. How many millimetres above the gum line?
- The lip length and mobility. Does the lip rise high, or is it short at rest?
- The bone level. A probe and radiograph show how much tooth is covered by bone.
The answers point to one cause or a combination. Aesthetic crown lengthening is indicated when the first and fourth findings show short clinical crowns with excess gum and a high bone level.
What the surgery involves
For a typical gummy smile case, the periodontist treats four to six upper teeth, sometimes more. The plan is built around the smile line, the tooth proportions and the amount of gum shown.
- Gum-only cases: a gingivectomy or laser contouring removes the excess tissue. Healing is quick, but the result depends on the bone being at the right level.
- Gum and bone cases: a flap is raised, the bone is reduced to the planned level, and the gum is positioned and sutured. This is the version that produces a stable gum line when the bone is high.
The surgery takes one to three hours. Sutures come out at 7 to 14 days. The gum surface closes within two weeks, and the final contour settles over two to three months.
What it costs
Aesthetic crown lengthening across four to six upper teeth commonly runs $2,000 to $5,000 in the US. A gum-only gingivectomy is cheaper — often $350 to $900 per tooth — but it is appropriate only when the bone is already correct.
The fee usually excludes consultation, imaging, sedation and any veneers or bonding afterwards. Insurance normally treats the procedure as cosmetic and pays nothing, though a documented restorative reason for part of the surgery can change that. See the insurance guide.
When crown lengthening is the wrong answer
It is the wrong answer when:
- The teeth are already a normal length and the lip is the cause.
- The gum display is part of a long upper jaw.
- The teeth are worn short; the issue is tooth structure, not gum.
- The gums are inflamed and untreated; periodontal health comes first.
- The patient wants a guarantee of a perfect smile; no surgeon can give one.
A good consultation should tell you which category you are in, even when the answer is “this procedure is not for you.”
Alternatives, honestly compared
| Concern | Option | What it changes |
|---|---|---|
| Excess gum, normal bone | Gingivectomy or laser | Gum only |
| Excess gum and high bone | Crown lengthening | Gum and bone |
| Hypermobile lip | Botulinum toxin, lip repositioning | How far the lip rises |
| Long upper jaw | Orthodontics, orthognathic surgery | Skeletal position |
| Worn short teeth | Composite, veneers, crowns | Tooth structure |
These are not interchangeable. The right choice follows the diagnosis, and some patients need a combination — for example, crown lengthening to correct the gum line followed by veneers to restore worn edges.
What to ask at the consultation
- What is causing the gum display in my case?
- Are my teeth short because of the gum, the bone, wear or the lip?
- Is this gum-only or gum and bone?
- How many teeth will be treated?
- Can I see a mock-up of the planned proportions?
- What will the gum line look like at three months?
- What is the total cost, including any restoration?
The aesthetic crown lengthening guide covers the smile-design process, and the short teeth guide covers the wear case.
Causes of a gummy smile and the matching treatment
| Aspect | Gum / bone cause | Lip / jaw cause |
|---|---|---|
| What you see | Short, square teeth with a low gum line | Normal-length teeth; the lip rises high when smiling |
| Diagnosis | Altered passive eruption or excess gum | Hypermobile lip, short lip or vertical maxillary excess |
| Treatment | Gingivectomy or crown lengthening | Lip repositioning, botulinum toxin, orthodontics or orthognathic surgery |
| Crown lengthening result | Predictable if the bone is reduced correctly | Little or no change to the gum display |
Frequently asked questions
Can crown lengthening fix a gummy smile?
It can when the smile shows excess gum because the teeth are covered by gum and a high bone level. It cannot fix a smile where the teeth are already a normal length and the upper lip rises too high. The cause has to be diagnosed before surgery.
How do I know which cause I have?
Look at your teeth at rest. If they look short and square, the gum and bone are likely covering the crown. If they look normal but the lip rises high when you smile, the lip is the cause. A periodontist can measure the gum, bone and tooth proportions to confirm.
How much does gummy smile crown lengthening cost?
Aesthetic crown lengthening across four to six upper teeth commonly costs $2,000 to $5,000 in the US. A gum-only gingivectomy is cheaper but is appropriate only when the bone level is already correct. Consultation, imaging and sedation may be extra.
Is there a non-surgical option?
For a hypermobile lip, botulinum toxin can reduce how far the lip rises, and lip repositioning surgery is another option. For vertical excess of the upper jaw, orthodontics or orthognathic surgery may be needed. None of these change the gum level.
Will the gum grow back after surgery?
If the bone is correctly reduced, the new gum line is usually stable. If only gum is removed while the bone stays high, the gum often returns toward its original position. That is why the bone level decides which procedure is appropriate.
Can I combine crown lengthening with veneers?
Yes. The gum surgery is usually done first, the tissue is allowed to mature for two to three months, and the veneers are planned against the new gum line. Doing both at once makes it harder to predict the final tooth proportions.