Q: Dr. Crapo: In my late twenties, I began to experience decay, I mean real decay. It was hard to pay for fillings but with help I kept my teeth. I’m now in a position to fix my teeth and make them beautiful again. I’m going to need crowns but I show a lot of gum above my upper front teeth (gummy smile). I know I have to do something but I’m afraid of the dark line I see around crowns. I hate that look. I’m told that new crowns don’t have that dark line but I’m not sure. I have a friend who got the new crowns and it looked great for several years but now I’m seeing darkness appear that’s not black but still looks bad. It’s crazy, I look at everybody’s teeth wondering if I’ll be able to get something that won’t turn out unpleasant looking and then feel it wasn’t worth the expense. What do you do when crowns get dark right at the gum line – get new crowns? That’s a great expense and is discouraging, at least to me. I’m immobilized by the possibilities that the obvious decision – getting crowns – may lead to unsightly teeth like I’m experiencing now. The other thing I’m thinking is with the new crowns – even though there’s not black at the crown edges the gums around my friend’s crowns seems to have receded – what’s she to do – you can see the tooth under the edges of her crowns, will that happen to me and if it does, then what?
A: There are many points of interest and many challenges to sort out before crowns – especially for upper anterior teeth. The first is – what is the state of health of the teeth and the surrounding gum and bone structures. There must be healthy and stable gum and bone around your existing teeth. Second is the genetic strength of those gums and boney structures. Some individuals have very fine and delicate supporting bone and gum and they must be treated by the dentist with great care. Individualized care means that what may work for one doesn’t for another. Third is the bite alignment in the mouth and the forces on each tooth. Teeth that are carrying loads beyond their biologic limits will often show bone and gum loss that can expose crown edges. Fourth – what are the habits of one’s home care – flossing, brushing, nutrition, substance abuse etc. the list could go on but these must be evaluated.
If these elements are considered and addressed, a favorable treatment plan and result can be expected with long lasting gum stability so the edges don’t show.
For those who are experiencing your friend’s problem, there are wonderful corrective gum alterations that can restore gums to their original shape and often make them more robust and resistant to shrinkage.