How does crown lengthening differ from anatomic crown exposure?

Anatomic crown exposure (D4230/D4231) is similar to crown lengthening in that it involves the removal of soft tissue and bone, and it is performed in a periodontally healthy area. However, the purpose of anatomic crown exposure is to expose the anatomic crown when it is encroached upon by enlarged gingival tissue. According to the American Academy of Periodontology, a typical scenario might involve a teenager referred by the orthodontist because the gingival tissues have become firm and fibrotic during treatment. Probing depths are in the 2-3 mm range, the alveolar bone is at the CEJ, and the enlarged tissue must be removed in order for orthodontic treatment to be completed.

Anatomic crown exposure involves the excision of excess soft tissue and removal of supporting bone at the cementoenamel junction in order to force the gingival attachment to move apically. If only soft tissue is removed, the gingival attachment will not move apically. Osseous surgery (D4260) cannot be reported because periodontal disease is not present, and crown lengthening (D4249) is not appropriate because the procedure is not performed to allow for restoration of the teeth.

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