Crown lengthening consent form 2026

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The document is an informed consent form for clinical crown lengthening surgery, authorizing Dr. George H. Maxfield to perform the procedure. It outlines the purpose of the surgery, which is to allow access to healthy tooth structure for dental restoration while ensuring periodontal health. The document details the surgical process, potential complications, and confirms that all patient questions have been addressed.

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Click ‘Get Form’ to open the crown lengthening consent form in the editor.
In the first field, enter your name where indicated. This identifies you as the patient authorizing the procedure.
Review the purpose of the procedure outlined in the document. Ensure you understand that it aims to provide access to sound natural tooth structure for restoration.
Read through the details regarding potential surgical complications. It’s important to be fully informed before proceeding.
Once you feel comfortable and all your questions have been answered, proceed to sign in the designated area labeled 'Patient Signature'.
Finally, enter today’s date next to your signature to complete the form.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the code for crown lengthening?

Dental Code D4249 represents the clinical crown lengthening procedure, focusing on the hard tissue aspect.

What is the diagnosis for crown lengthening?

Indications for crown lengthening include caries or tooth fracture at or below the gingival margin, teeth with excessive occlusal loss, teeth with insufficient interocclusal space for a required restorative procedure, and APE. The treatment plan is predicated on the diagnosis and goals of definitive therapy.

How to get crown lengthening covered by insurance?

In some cases, when the procedure is deemed medically necessary by a dentist, insurance companies will cover a portion of the cost. Get in touch with your insurance provider ahead of the procedure to find out what forms and documents they require.

Can anyone get crown lengthening?

If you have a gummy smile, where your gums cover too much of your teeth, crown lengthening can be done to even out the gum line. This procedure can also be done if you need a dental crown but there isnt enough tooth exposed to provide a proper foundation.

Is crown lengthening considered surgery?

Crown lengthening is a simple surgical procedure where the position of the gum around a tooth is adjusted to expose more of the tooth structure.

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