Subject: Clinical Crown Lengthening
Reviewed: April 9, 2012
Important NoteThis Clinical Policy Bulletin expresses our determination of whether certain services or supplies are medically necessary. We have reached these conclusions based on a review of currently available clinical information including:
Clinical crown lengthening is generally categorized as a dental procedure used to facilitate placement of a restoration on a tooth with little or no tooth structure exposed to the oral cavity. Radiographic evidence of fracture or decay that extends below or near the alveolar crest is the usual clinical indication for necessity of the procedure. Aetna considers clinical crown lengthening in conjunction with osseous surgery for periodontal disease inclusive to the osseous surgery.
Clinical crown lengthening is a periodontal procedure in which gingival and osseous tissue is removed in order to expose more clinical tooth structure to the oral cavity. Crown lengthening requires reflection of a flap and osseous recontouring. It is performed in a healthy periodontal environment, as opposed to osseous surgery, which is performed in the presence of periodontal disease. If there are adjacent teeth, the flap design may involve a larger surgical area.
There is limited documentation/information that this procedure can be accomplished with a laser.
In the absence of periodontal disease, a clinical crown lengthening procedure performed on one tooth requires extension of the osseous recontouring to partially include teeth that may be present (contiguous) on either side.
D4249 -- Clinical crown lengthening -- hard tissue
Original policy: September 13, 2004
Updated: September 5, 2007; December 29, 2008; December 21, 2009; February 28, 2011; April 9, 2012
Revised: December 5, 2005
1 American Dental Association. Current Dental Terminology, CDT-2011-2012: 27.*
2 American Academy of Periodontology. AAP Policy Statement; Surgical Clinical Crown Lengthening, 2003
Property of Aetna. All rights reserved. Dental Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical/dental advice. This Dental Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical/dental advice and treatment of members. This Clinical Policy Bulletin may be updated and, therefore, is subject to change.
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