An unusual endodontic complication following crown lengthening surgery: A Case Report.

  • Tong Wah Lim Centre for Restorative Dentistry Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
  • Teng Kai Ong Department of Surgical Sciences, Division of Endodontics, Marquette University School of Dentistry, 1801 W Wisconsin Ave. Milwaukee, WI.


A gummy smile is a form of excessive gingival display when smiling. The excessive gingival display due to altered eruption is likely to benefit from crown lengthening surgery in order to restore the esthetic smile. Case Report: The potential complications of the crown lengthening surgery include possible esthetic deformities, dentine hypersensitivity, transient mobility, and root resorption. The present case report reveals a rare complication happened after an esthetic crown lengthening surgery which was performed to correct the gummy smile of a 37-year-old female. The patient experienced dull throbbing pain and mild tender to percussion on tooth 11, 3 weeks after the surgery, and the symptoms did not improve after the composite restorations were placed at the cervical regions. Instead, the tooth was tender to percussion and palpation with a sign of coronal discoloration. Pulp necrosis was confirmed with the clinical tests. A cone-beam computed tomography was taken after the root canal treatment, and apical fenestration on tooth 11 was noted. Therefore, this case report shows the possible correlation between crown lengthening surgery on a tooth with apical fenestration and pulp necrosis, if the apical vasculature is severed accidentally during the procedure. Conclusion: A cone-beam computed tomography should be considered prior to the surgery and extra precaution during the surgery may reduce the risk of severing the apical vasculature if apical fenestration is evidenced. 


1. Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontol 2000. 2018;77(1):65-83.
2. Silberberg N, Goldstein M, Smidt A. Excessive gingival display - Etiology, diagnosis, and treatment modalities. Quintessence Int. 2009;40(10):809-18.
3. Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontol 2000. 1996;11:18-28.
4. Chu SJ, Karabin S, Mistry S. Short tooth syndrome: diagnosis, etiology, and treatment management. J Calif Dent Assoc. 2004;32(2):143-52.
5. Periodontology AAP. Glossary of periodontal terms. Chicago (IL): The American Academy of Periodontology. 2001.
6. Canakci CF, Canakci V. Pain experienced by patients undergoing different periodontal therapies. J Am Dent Assoc. 2007;138(12):1563-73.
7. Xu BD, Yang PS. The effects of non-surgical periodontal treatment on the formation of root-dentin hypersensitivity. Shanghai Kou Qiang Yi Xue. 2004;13(3):238-40.
8. Cunliffe J, Grey N. Crown lengthening surgery–indications and techniques. Dent Update. 2008;35(1):29-35.
9. Simon H, Magne P. Clinically based diagnostic wax-up for optimal esthetics: the diagnostic mock-up. J Calif Dent Assoc. 2008;36(5):355-62.
10. Couve E, Osorio R, Schmachtenberg O. Reactionary dentinogenesis and neuroimmune response in dental caries. J Dent Res. 2014;93(8):788-93.
11. Whitworth JM, Walls AW, Wassell RW. Crowns and extra-coronal restorations: endodontic considerations: the pulp, the root-treated tooth and the crown. Br Dent J. 2002;192(6):315-27.
12. Bakland LK, Andreasen JO. Dental traumatology: essential diagnosis and treatment planning. Endodontic topics. 2004;7(1):14-34.
13. Raja Sunitha V, Emmadi P, Namasivayam A, Thyegarajan R, Rajaraman V. The periodontal–endodontic continuum: A review. J Conserv Dent. 2008;11(2):54-62.
14. Jacobsen I. Criteria for diagnosis of pulp necrosis in traumatized permanent incisors. Eur J Oral Sci. 1980;88(4):306-12.
15. Pan HY, Yang H, Zhang R, Yang YM, Wang H, Hu T, Dummer PM. Use of cone‐beam computed tomography to evaluate the prevalence of root fenestration in a Chinese subpopulation. Int Endod J. 2014;47(1):10-9.
16. Nimigean VR, Nimigean V. Combined mucosal and alveolar fenestration: a clinical report and literature review. Rom J Morphol Embryol. 2013;54(2):437-41.
17. Vernino AR, Gray JL, Hughes EA, editors. The Perio-dontic Syllabus. Lippincott Williams & Wilkins; 2007.
18. Marzadori M, Stefanini M, Sangiorgi M, Mounssif I, Monaco C, Zucchelli G. Crown lengthening and restorative procedures in the esthetic zone. Periodontol 2000. 2018;77(1):84-92.
How to Cite
LIM, Tong Wah; ONG, Teng Kai. An unusual endodontic complication following crown lengthening surgery: A Case Report.. Journal of Oral Research, [S.l.], v. 10, n. 2, p. 1-6, june 2021. ISSN 0719-2479. Available at: <>. Date accessed: 25 july 2021. doi: