The American Dental Association’s Current Dental Terminology (CDT) notes that crown lengthening (D4249) “is employed to allow a restorative procedure on a tooth with little or no tooth structure exposed to the oral cavity. Crown lengthening requires reflection of a full thickness flap and removal of bone, altering the crown to root ratio. It is performed in a healthy periodontal environment, as opposed to osseous surgery, which is performed in the presence of periodontal disease.”
Why crown lengthening?
Crown lengthening exposes sound tooth structure by removing bone before a restorative or prosthodontic procedure. Crown lengthening can ensure an adequate tooth to restoration margin and prevent a compromise of the periodontal attachment to the tooth. It is not generally provided in the presence of periodontal disease. This procedure is a benefit only when bone is removed and sufficient time is allowed for healing.
This means:
- Without crown lengthening, the margin of a proposed restoration cannot be established or it would violate the periodontal attachment;
- Subgingival caries, or fracture, requires removal of soft and hard tissues to enable restoration of the tooth.
Consistent with the ADA definition, removal of soft tissue alone does not constitute crown lengthening. Additionally, to allow sufficient healing time, a restoration cannot be placed on the same tooth on the same date of service. Finally, crown lengthening would be considered integral to other periodontal treatment, such as osseous surgery, performed on the same tooth.
Submitting claims
Denials for crown lengthening can be a source of frustration, so it’s important to be aware of the criteria before submitting a claim. When submitting a claim for crown lengthening, include a diagnostic radiograph that documents less than three millimeters of sound tooth structure between the restorative margin and the alveolar crest.
If indications for this procedure are not evident on a radiograph, additional documentation, such as a detailed narrative documenting the need for treatment and a follow-up restorative treatment plan, should be provided. If your claim is denied and you wish to appeal the decision, provide additional detail in the form of radiographs, photos and/or a narrative.
Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
