When crown lengthening is performed before crown placement, structurally compromised teeth may be more likely to achieve long-term survival, according to a study recently published in the International Dental Journal.
However, further research may be needed to evaluate its cost-effectiveness and patient-reported outcomes, the authors wrote.
“Compromised teeth treated with crown restorations following crown lengthening showed a high long-term survival rate,” wrote the authors, led by Ahmad Alhabashi of the Mohammed Bin Rashid University of Medicine and Health Sciences in the United Arab Emirates (Int Dent J, May 30, 2026, Vol. 76:4, 109656).
The retrospective cohort study evaluated the survival and complications of teeth restored with single crowns after surgical crown lengthening. The study included 179 teeth from 81 adults who underwent crown lengthening and subsequent crown placement at Dubai Dental Hospital between January 2011 and January 2021, they wrote.
The surgical procedure involved flap reflection, osseous recontouring when necessary, and placement of provisional acrylic restorations during an eight- to 12-week healing period before final restoration. Restored teeth were assessed using clinical and radiographic examinations to identify complications and treatment failures. Also, patient- and tooth-related factors were collected and analyzed to determine long-term outcomes following crown lengthening and crown restoration.
Among the complications observed after crown lengthening and crown restoration, prosthodontic problems were the most common, including crown chipping in 21 crowns (12.4%), repeated crown dislodgement in 13 (7.4%), secondary caries in 10 teeth (5.8%), and open margins in nine crowns (5.3%). Periodontal complications included grade I and II furcation involvement in seven (4.1%) and eight teeth (4.7%), respectively, while mild and moderate bone loss were detected in 87 (50.9%) and 79 teeth (46.2%), with severe bone loss occurring in only one case (0.6%), they wrote.
Nine crowned teeth were missing at follow-up, resulting in estimated survival rates of 96.8% at five years and 95% at 10 years. A history of endodontic treatment was the only factor significantly associated with tooth survival (p < 0.001), with untreated teeth showing a higher failure rate (20%) than teeth that received root canal treatment (1.1%) or post placement (3.4%). Among surviving teeth, clinically significant complications were most frequently periodontal in origin (15.9%) followed by endodontic (11.2%) and prosthodontic (8.8%) while regular dental attendance emerged as the only independent protective factor protective against complications (odds ratio = 0.38; p = 0.013).
The study, however, had limitations, including teeth with diverse periodontal and restorative conditions that may have affected prognosis and survival outcomes, the authors added.
“The study’s limitations underscore the need for prospective research with long-term follow-up periods to more precisely identify predictors of failure and to strengthen the evidence base for clinical decision-making,” Alhabashi and colleagues concluded.
