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About Joel S. Teig, DMD, FABOMS
Expertise
I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience
Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA
DMD

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

You are here: Experts > Health/Fitness > Dentistry > Dentistry > open embrasure

Dentistry - open embrasure

Expert: Joel S. Teig, DMD, FABOMS - 11/6/2009

Question

tooth #7

Went to a dentist for a porcelain fused to metal crown (high-noble)on #7. The fit wasn't good; the dentist said there was a black hole in the triangular area between tooth #7 and #8. He said this gap or space is known as an open embrasure. The dentist said it can be corrected by having the crown sent back to the lab where the technician can add more porcelain to it.
Yesterday, I went to the dentist for the crown with the newly added porcelain. The fit seems better than the first time. The dentist used temporary cement, and said to see how it is for a few days. But, when I look in a mirror I still see a pocket of empty space in that triangular region (though smaller gap than first time.) What amount of space is normal? And what amount of space makes it an open embrasure?
To help you better answer my questions, here ia a little more info: Adjacent tooth #8 was loss to trauma more than 20 years ago. Had bridges but now have an implant on #8 (porcelain fused to metal.) Implant restoration crown on #8 was completed about 4 months ago. Only reason needed crown on #7 was esthetic; natural tooth crown was small in length and the dentist thought it would be a good idea to get a crown so that this tooth can look good next to the implant crown.
I've attached a digital photo of crown #7; please tell me in your opinion if there is an open abrasure? Also please note if the slight swelling and redness in gums above #7 is an indication that this crown is not the righ fit?
Thanks a lot, Bob

Answer
Bob - It is obvious that whoever did the implant did not restore the normal anatomy in the area. You have evidence of a severe bone recession from normal height, as seen on tooth #8, where you had the implant placed. That is the cause of the large triangular space. What would have been correct, is that before the implant was placed at #8, the bone height should have been correctly reestablished. That empty space should not be corrected with larger teeth, but a proper resolution of the space is with a bone graft to the area. This is not something that general dentists frequently attempt. I wish I could tell you a simple solution, but proper bone contouring is the best approach to close that space. Once the bone height is corrected, then new crowns should be made in the area to restore a proper anatomy.

I wish this was a very simple solution, but it is obvious that your dentist is not equiped to handle it. He should refer you out to an oral and maxillofacial surgeon or periodontist to restore a normal anatomy.

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