Consultation sheet · broken tooth decisions

Save the tooth or take it out? Questions to bring to the periodontist

When a tooth breaks at or below the gum, the choice is often crown lengthening plus a crown, or extraction followed by a replacement. Both cost real money. This sheet keeps the discussion on whether the tooth can be restored, which is the actual decision, before anyone compares prices.

§1What crown lengthening does

The American Academy of Periodontology describes dental crown lengthening as reshaping excess gum and bone tissue to expose more of the natural tooth, on one tooth or several. Periodontists, it notes, complete three years of specialised training after dental school. When a tooth has broken, the aim is to expose enough sound tooth for a new crown to seal.

§2Restorability questions

Question for the clinician	Answer
How far below the bone does the break or decay reach?
Will enough root remain once bone is reshaped?
Is the bone support around this tooth adequate?
Is the gum healthy, or does it need treatment first?
Is the tooth loose?
How important is this tooth for my bite or my smile?

These mirror the conditions in extraction versus crown lengthening: saving the tooth is the better path when the defect can be exposed without removing too much bone and the root and support are adequate; extraction with a graft is better when the fracture is below the bone, the root is short, the tooth is mobile or support is too compromised.

§3Insurance: three checks

Is the procedure being coded as restorative (to make a crown possible) or cosmetic? Plans that accept it as medically necessary commonly pay 50% to 80% of their allowed fee after the deductible; cosmetic contouring is usually excluded.
How much of my annual maximum is left? It is often $1,000 to $2,000 and has to cover the crown as well.
Request a written pre-treatment estimate, which is the only binding answer.

The figures above come from crown lengthening cost with insurance, which also explains the restorative-versus-cosmetic split in detail.

§4Comparing the two quotes

Line	Save the tooth	Extract and replace
Surgery	Crown lengthening $	Extraction (and graft) $
Healing wait	Before the final crown	Before the replacement
Final restoration	Crown $	Implant, bridge or other $
Insurance paid	$	$
Your total	$	$

§5Who should do it

Ask about training, the diagnostic exam that measured the bone, a written plan with CDT codes and who handles complications. How to choose a periodontist explains when the case calls for a specialist, for example when bone must be removed or the tooth is a molar with a furcation.

Sources used on this page

American Academy of Periodontology: Surgical Procedures — crown lengthening description, periodontist training
American Academy of Periodontology: Cosmetic Procedures — gummy smile and uneven gum line