Q. When I was a child I fell on my bike, cracked my front tooth (tooth #10), had a root canal done, then a composite attached to reshape the tooth from the crack. 9 years ago, the composite fell off and I went to the dentist to have a new one done and she said a crown would have to be done as soon as possible. She said the best one was a porcylain fused to gold crown and assured me that no black lines would show because it is not metal, it is gold. (I was young and uneducated in this department…) She immediately drilled down the tooth, took impressions, put a hidious bulky temporary crown on it and I left with a black and blue and extremely raised gum line. I returned 2 weeks later to have another hidious bulky permanent crown put on. The crown was longer than all the teeth in my mouth because she drilled my tooth so high up the gum line that my #10 tooth had a “new” gum line. The gum line is not only still much higher than all the other margins, but the “gold” from inside the hideous crown has darkened my gum line and the bulky crown does not slide under my gum line at all. The gum around the crown not only is dark at the margin, but almost appears to be dark farther up the gum than the actual margin, if that makes any sense. I don’t know why this is. I tried having this dentist resolve these issues, and it was an endless battle, so I decided to give up for now. I did not have the money at that time to persue the situation, or to have the problem fixed by another dentist. Now, 9 years later and financially fit, I have braces that are almost finished. I went to my local dentist to start preparing for the crown to be replaced (after braces come off) who said he could put a new crown on and it would look normal again. I asked him “what about the gum line, how are you planning on making the receeding gum look normal again and come down over the new crown and in line with all the other gums” and he then decided to add that I should see a perio before a new crown is done. I immediatly went to a local perio, he examined the area and told me that he would not be able to graft gum because the tooth was drilled as high as the gum line sits, so there would be nothing to graft to. I asked him if it would be wise for me to have my othodontist bring the #10 tooth down and hope that bone will come with it (and maybe even the gum) and if that would resolve my problem. A lightbulb lit over his head and he said that would be an excellent idea. I went to my ortho the next day, explained what the dentist and perio told me, and he said it is a 50/50 chance that the bone and gum would actually come with the tooth if he brought the tooth down. After all this controversy, I decided to go to a dentist out of the area and in a larger city that was referred to me by a friend. He is a cosmetic dentist (or so he says). He examined my tooth and felt with his instrument that there was a crack on the tooth just above the margin of the crown. He took a close up xray, and there in fact is a horizontal crack on my tooth between the crown margin and the gum line. He said he needs to cut the crown off soon so he can see what we are looking at. He also said a new post would need to be inserted to replace the existing post, as it is too short and not really supporting the tooth anymore. He said if the tooth can be saved (which he says is very very likely) he would put a temporary crown on, have my gum examined by his perio, have my ortho bring the tooth down with the temp crown in place, and return to have a Lava crown put on when all is ready. My questions are: All these professionals are giving me different advise on my gum line situation, I can’t be the only person out there with this problem. Will the gum most likely come down with my tooth and temp crown and avoid the need for perio work altogether? Is it normal for a gum to appear slightly discolored from a gold fused crown all the way up, and not just at the margin? Is a horizontal crack at my margin a cause for concern? (The last thing I want is an implant…) Is a Lava crown the best choice for a 100% natural look? I’m sorry this is so long, but after speaking to the dentist out of the area (that noticed the crack) he seemed to need to know everything from the beginning to be able to better help me. My lack of trust is explainable based on all these professionals telling me different things, and after my initial experience with a horrible crown. I would just like some other professional opinions, if possible. Thank you…

A. hi many thanks for your email, ok to try to explain everything i will use bullet form:

1: when a tooth is root canal treated the tooth can discolour all the way to the top which is the probably reason for the discolouration past the margin of the crown.

2:the horizontal crack is not a problem as long as its superficial and does not run through the whole crown, the crack can be caused by the post.

3:there is unfortunately more than one way to crack a nut and the same can be said to fix a tooth. there are always risks and benefits with all treatments.

4:the gum coming down is a possibility but unfortunately it is an unpredictable science, the orthodontic extrusion is the option i would try doing it very slowly.

5:make sure there is at least 3mm of tooth tissue above the gum line around the new post to ensure the crown will be sucessful.

6:if a new metal post is to be used to support the crown the best all porcelain crown is lava to replace the crown as it will not allow the metal post to shine through but does not contain metal so is aesthetic.

finally the option of an implant if done properely maybe better than the other alternatives.

Dr Kailesh Solanki

Dr Kailesh Solanki
Kissdental
www.kissdental.co.uk
Tel: 0161 748 5250
157 Woodsend Road
Flixton Manchester
M41 8GN
UK Practice of the Year 2007