Quick answer
Crown lengthening saves a tooth when enough sound root and bone remain to support a restoration. Extraction and a bone graft is better when the fracture is below the bone, the root is short, the tooth is mobile or the support is too compromised. The decision is a restorability assessment, not a price comparison.
At a glance
- Save the tooth
- Crown lengthening, $700–$1,800 per tooth
- Remove and graft
- Extraction + graft, $900–$2,600
- Replacement
- Implant, bridge or denture, separately priced
- Decision driver
- Remaining tooth structure and bone support
When a tooth breaks below the gum, the conversation often comes down to two options: spend money to save it, or spend money to replace it. Both are expensive. They are not equivalent, and the cheaper option is not always the one that lasts.
The decision is a restorability assessment. It is not a price comparison, although price matters.
The case for crown lengthening
Crown lengthening is the better path when:
- The fracture or decay can be exposed without removing too much bone.
- The root is long enough to support the tooth after the bone is reduced.
- The bone support around the tooth is adequate.
- The gum is healthy or can be treated.
- The tooth is important for the bite or the smile.
- The patient can maintain the site.
The advantage is that the natural tooth is kept. A natural tooth has a periodontal ligament, proprioception and a seal that no implant fully reproduces. When it is restorable, saving it is usually the conservative choice.
The disadvantage is that the tooth has already failed once. A fracture, a deep cavity or a failed crown means the tooth is compromised, and the restoration may still fail later.
The case for extraction and a graft
Extraction is the better path when:
- The fracture extends below the bone and cannot be exposed safely.
- The root is short or the crown-to-root ratio is already poor.
- The tooth is mobile from periodontal disease that has destroyed support.
- The decay or fracture involves the furcation and cannot be sealed.
- The tooth is not restorable with a reasonable restoration.
- The patient cannot tolerate the surgery or the healing period.
A bone graft after extraction preserves the ridge for a future implant or bridge. Without grafting, the bone can shrink, especially in the first months, and the replacement becomes harder or more expensive.
The disadvantage is that the tooth is gone. An implant, bridge or denture is a replacement, not a restoration, and each has its own maintenance and failure modes.
Cost comparison
| Path | Planning range | What it includes |
|---|---|---|
| Crown lengthening, one tooth | $700 – $1,800 | Surgical fee only |
| Final crown | $1,000 – $2,000+ | Restorative fee |
| Extraction + bone graft | $900 – $2,600 | Extraction and graft |
| Implant + abutment + crown | Several thousand dollars | Replacement, separate |
The numbers are not directly comparable because the paths include different stages. A fair comparison lists every stage for each path:
Save: consultation, imaging, crown lengthening, temporary crown, final crown, follow-up.
Replace: consultation, imaging, extraction, bone graft, implant surgery, healing abutment, final crown, follow-up.
When the full lists are side by side, the gap often narrows. The implant path can be more expensive, but it may be more predictable in a tooth that has already failed.
Timeline comparison
Crown lengthening: surgery, 6 to 12 weeks of healing, crown preparation, crown delivery. Often two to four months in total.
Extraction and graft: extraction, 3 to 6 months of graft healing, implant placement, 3 to 6 months of implant healing, crown. Often four to twelve months, sometimes longer.
A bridge can be faster than an implant but requires preparing the neighbouring teeth. A removable partial denture is the least expensive replacement and the least like a natural tooth.
The questions that decide it
Ask the dentist and periodontist:
- How much sound tooth remains above the bone?
- What is the root length and crown-to-root ratio?
- Is the fracture or decay accessible without removing too much support?
- Is the tooth mobile, and why?
- What is the long-term prognosis of the tooth versus an implant?
- What is the total cost of each path, including every stage?
- What is the maintenance for each?
If the answers are vague, get a second opinion. The decision is consequential and irreversible in one direction.
What not to do
Do not choose crown lengthening because it is cheaper today if the tooth is not restorable. The surgery will fail, and the extraction will still be needed.
Do not choose an implant because it sounds more modern. An implant in a site with poor bone, uncontrolled gum disease or a heavy clenching habit can fail too.
Do not let a quote decide alone. The cheapest path is the one that lasts.
The role of the periodontist
A periodontist is trained to assess both the periodontal support and the restorability of the tooth. That is why the consultation matters more than the fee schedule. The surgeon should be able to explain why the tooth can or cannot be saved, and what the alternatives are.
If the answer is extraction, ask about the graft, the timing of the replacement and the cost of the whole plan. The periodontist directory lists practices by state and city, and the cost hub explains the surgical fee.
Saving the tooth vs replacing it
| Aspect | Crown lengthening | Extraction + graft |
|---|---|---|
| Best when | Enough root and bone remain; the defect is accessible | Fracture below bone, short root, mobility, poor support |
| Visits | Surgery, healing, crown preparation, crown | Extraction, graft healing, implant or bridge, crown |
| Timeline | Often 2–4 months to the final crown | Often 4–12 months to the final replacement |
| Main risk | Gum rebound, sensitivity, restoration failure | Graft loss, bone loss, implant failure |
| Reversibility | The tooth is kept | The tooth is gone; replacement is elective |
Frequently asked questions
Is it better to save the tooth or extract it?
A restorable natural tooth is usually preferable when the support is adequate and the patient can maintain it. An implant is not automatically better. The decision depends on the fracture depth, root length, bone support, gum health and the cost of each path.
How much does extraction and a bone graft cost?
A planning range is $900 to $2,600 for the extraction and graft together, depending on the tooth, the graft material and the city. That does not include the replacement — an implant, bridge or denture is a separate cost.
Can I have crown lengthening after an extraction?
No. Crown lengthening needs a tooth to lengthen. After an extraction, the site may need a bone graft to preserve the ridge for an implant or bridge. The procedures solve different problems.
How long does each option take?
Crown lengthening followed by a crown often takes two to four months, including healing and the restoration. Extraction and a graft followed by an implant and crown commonly takes four to twelve months, depending on the graft and the implant healing.
Will insurance pay for one but not the other?
It depends on the plan. Crown lengthening may be covered when documented as necessary for a restoration. Extraction is usually covered as a surgical benefit. Implants are excluded by many plans or covered at a lower percentage. Ask for a pre-treatment estimate for both paths.
What if the tooth is already loose?
A mobile tooth from untreated periodontal disease is not a crown lengthening candidate until the disease is treated and the support is assessed. If the support is too reduced, extraction may be the more predictable option.