AboutMark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Expert: Mark Bornfeld DDS Date: 7/22/2008 Subject: Crown fit / food impaction
Question Two weeks ago I had the completion of the final step in an implant replacement for two teeth in my lower right jaw. The two crowns look great and the lower/upper fit is fine. BUT food impaction is occurring between the two crowns and with the adjacent teeth both front and rear. The impaction is dramatic, in my opinion, I've even had to pry a small currant out of the rear interface. This is not my experience from when the natural teeth were in place and it is unlike any other location in my mouth. The dentist responsible for this work says essentially "live with it" and states the shape of the crowns is "normal". I was astonished at this result after the lengthy implant procedure. I have no objection to the amount of the cost IF the result is mostly like when the original teeth were in place. So, I'm wondering (1) what variability there may be in, as it were, crown geometries that might be available to me? and (2) how can I get a second opinion without experiencing the professionals closing ranks to protect one of their colleagues?
Answer Dear Paul,
Dentists generally distinguish between two types of food impaction: horizontal and vertical. Horizontal impaction is an almost unavoidable passive accumulation of food debris at the gum line; this problem is accentuated by gum recession because the lowered gum level exposes the tapering contours of the roots and the triangular spaces between the teeth that were previously filled with gum tissue. Although some dentists will bulk up the gum line areas of crowns to minimize these spaces, this is considered a poor strategy, because it almost invariably provokes gum disease. If this is the kind of food impaction you are experiencing, your dentist's guidance is appropriate, because modification of crown margins to ameliorate the problem can adversely affect the health of the tissues supporting the implant cylinders.
On the other hand, VERTICAL food impaction is a serious problem that can endanger your comfort and the future of your implants. Vertical food impaction is what happens when food is forcefully intruded between two adjacent teeth right through the area that these two teeth contact. This vertical food impaction can be the result of insufficient pressure between the two adjacent teeth, or if the adjacent teeth are not of equal height, or if there is a prominent "plunger cusp" on the tooth opposing the space between the two teeth.
So, if you do have vertical food impaction, your dentist should verify that:
1. the two adjacent teeth have what is termed "adequate contact"-- i.e., it should take some effort to work a piece of floss between the two teeth, and
2. the height of the two teeth where they contact each other-- at the so-called "marginal ridges"-- should be of equal height, and
3. any sharp plunger cusps opposing the food impaction area should be rounded off.
As for obtaining a second opinion-- it is my perception that there is no dental equivalent to the police force's "blue wall of silence". I have no reluctance to call dental incompetence as I see it, as you will find if you have read my other posts here. Dentistry is becoming an increasingly competitive field, and the level of honesty vis a vis second opinions, fortunately or not depending on your perspective, has gained ground at the expense of comradery among dentists. If you want a second opinion, you should just get it-- I don't think you need to feel that another dentist will pull his punches out of some sense of loyalty to his colleague.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
