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Question
I had RCT in #10 about 10 yrs. ago. Due to decay, I need a new crown. My dentist suggests crown lengthening but isn't optimistic because of implant in #9. Is crown lengthening worth a try? What do you think is my best option?

Answer
Hi Albert,

There are two main aspects to discuss: function and esthetics. To restore the function, implant will work fine - with or without bone grafting, depending on  the individual situation. However, the papilla (spear-shaped gum tissue between the teeth) between two implants (#9 and #10), most the time will recede and you may lose the symmetry with the papilla between #7 and #8. However, if you choose a dentist who is very good with implants in the esthetic zone and you express this concern, he may be able to avoid the problem with the right treatment strategy.

The other option is to keep the root. Crown lengthening and a new crown should also function well. However, you have another esthetic concern: crown lengthening will cause increased height of the future tooth as well as uneven gum margins, again losing the symmetry with #7 - the contralateral tooth. There is a solution to the esthetic issue, but it takes time and finances. With orthodontic device, the root can be extruded until the decay is exposed above the gum level. Then the decay can be cleaned easy without interfering with the gums, and you can have a new crown done without crown lengthening. If the gum follows the root during the extrusion, the extra tissue can be removed without compromising the esthetics.

To summarize, ideal results can be achieved only with the right implant system and protocol, or with combined orthodontic-prosthetic treatment. Everything else will easily restore the function and health, but the ideal esthetics is at risk.

You could schedule one more consultation with your dentist to discuss those questions and see what technique he is comfortable with.

Best regards,  

Dentistry

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Veselin Shumantov DDS

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