Crown Height Reduction

Crown Height Reduction

In cases in which orthodontic repositioning and extraction are not feasible, crown height reduction and vital pulp therapy (VP) may be an option. A classic example is the young dog or cat with a severe overbite dentition, i.e. the upper jaw is excessively out in front of the lower jaw. In this condition the lower canines are often positioned to the inside (or the palate side) of the upper canines, resulting in traumatic contact ulcers.


Vital pulp therapy is endodontic treatment of the tooth pulp with the intention of keeping it alive (i.e. “vital”). This differs from root canal therapy in which the entire pulp, the living interior tissue of the tooth, is completely removed. Vital pulp therapy is performed in as close to a sterile fashion as possible (although the mouth is never a truly sterile environment).


Depending on the condition being addressed the selected tooth/teeth is amputated down to the preferred level. The inner pulp is now exposed and must be treated. Using sterile technique, a few millimeters of the exposed pulp is removed, and a clean “cavity” is created. Hemorrhage is controlled with gentle flushing with cold saline and light digital pressure with sterile paper points to wick up fluids. Next, a medication is placed directly on the newly exposed pulp to stimulate healing and provide anti-bacterial effect. Finally, a protective barrier of dental composite is placed – similar to what a dentist would fill a cavity with in people. The tip of the tooth is then smoothed so avoid self-injury in the future.


The advantages to this procedure are the relatively good success rates (about 85%) and the quickness with which the treatment may be provided. For comparison, orthodontic treatment usually requires at least two anesthetic procedures and multiple recheck visits. Extraction surgery often necessitates a brief period of chewing restriction. However, crown height reduction with vital therapy is completed in a single anesthesia event. The patient is allowed to return to normal activity almost immediately.


Besides cost, the biggest disadvantage to vital pulp therapy is the variability in success. Unlike root canal therapy which offers a successful outcome about 96% of the time (depending on the clinician and the tooth status), vital pulp therapy success can vary, even when performed properly. For this reason, it is imperative that follow-up dental x-rays are always obtained, usually within 6-9 months – to ensure treatment success.