Remaking Front Crowns with Severe Gum Inflammation

Hello.

I am Park Jonguk, DDS, MS, director of Dream Dental Clinic, an Apgujeong-dong dental clinic.

There are 2 ways to change the shape of the front teeth, a process often called cosmetic dental reshaping:

laminate veneers and all-ceramic crowns.

As many people know, a laminate veneer

bonds a thin layer to the facial surface of a tooth to make its shape or shade

more attractive.

When possible, it is preferable to use laminate veneers because they cause less damage to the teeth.

However, when a tooth is fractured or has extensive decay,

treatment with a laminate veneer can be difficult.

In these cases, our Apgujeong-dong dental clinic may recommend an all-ceramic crown.

If a tooth is fractured or lost in an accident or for another reason,

all-ceramic crowns can be connected

to provide bridge treatment.

The patient had received a bridge many years earlier

after fractures and loss involving 4 front teeth.

The passage of time was likely one factor,

but when a tooth has fractured

and very little tooth structure remains,

gum inflammation can develop easily even when treatment is performed well.

The most significant concern was generalized inflammation of the gums.

Another concern was that the teeth looked very unnatural.

Because the central tooth was missing, the restoration was a bridge with connected teeth.

The teeth looked strongly fused together,

which made the result appear even more unnatural.

There were 2 issues that our Apgujeong-dong dental clinic needed to address in this situation.

We needed to improve the crown and bridge design so that inflammation would occur less readily,

and create a more natural appearance.

First, we removed the bridge.

Because the teeth had been fractured,

very little structure remained.

They appeared to have fractured down toward the roots,

and had barely been preserved by performing root canal treatment and laboriously building up posts.

As a result, the crowns had to extend deep below the gumline,

where they continually irritated the gums.

Because the teeth themselves were in such poor condition,

we planned to improve the inflammation as much as possible rather than expect it to disappear completely.

For retreatment in the presence of inflammation,

our Apgujeong-dong dental clinic places particular importance on provisional restorations.

Precisely fitting provisional restorations are essential for confirming whether the gum inflammation resolves.

The provisional restorations are worn for at least 2 weeks and sometimes for as long as 2-3 months.

Because they are made of a resin material, wearing them for a long time

leads to discoloration.

Although the provisional restorations had become fairly discolored,

we could see that the gum inflammation had almost completely resolved.

We then placed the ceramic bridge.

The gum inflammation had resolved cleanly.

The shade, shape, and even the translucency of the teeth were all reproduced naturally.

As mentioned earlier,

the condition of the teeth was very poor,

so we expected it would take a considerable amount of time to determine whether the inflammation had fully resolved.

Root canal treatment can cause tooth discoloration.

In this case, the portions of the teeth visible above the gums

had all fractured and were made of resin, so they did not show discoloration.

The root portions, however, had darkened after root canal treatment.

Because this darkness showed through the gums,

a dark area was visible near the gumline, as shown in the photograph above.

When inflammation was present, the area appeared dark red.

As the inflammation resolved, it took on a slightly bluish appearance.

Compared with the previous restorations,

the result looked much more natural.

In particular, the visual separation between the teeth improved markedly.

The gum inflammation had, of course, also almost completely resolved.

In cases where inflammation repeatedly recurs,

it is extremely important to use provisional restorations to control the inflammation

before completing treatment.

Since 2006, Dream Dental Clinic