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Periodontics/Rear Molar too short. Crown keeps coming off.

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Question
My lower L. molar at the back (#7) was badly damaged, had root canal treatment and filling and was then fitted with a crown in 2009. In 2012 this crown started to come off very often. My dentist said that my molar (height above gum line) was very short. Each time this crown came off it was recemented, but the last time on 24/12/2014 it disappeared while I was eating (I must have swallowed it by mistake). There is no LL tooth #8, and LL tooth #6 has a crown and has had no problem. Now, I am not using this molar (#7), and am using the teeth on the right side (LR tooth #6 missing) for eating.  

What options do I have ? Is crown lengthening on this LL molar (#7) viable ? What are the risks ? Will crown lengthening loosen this molar and make it unable to perform its chewing function ? Will the exposed roots be difficult to clean and cause problems ? Will adjacent teeth be affected ? In case crown lengthening fails, is it not possible to insert an implant later ? Is forced extrusion viable and what are the risks ?

Answer
Wow 8 questions.  They are all good questions and best answered by the dentist who examined you and recommended crown lengthening as the answers are not general but related you your tooth specifically.

In general terms
What options do I have ?  Crown lengthen, extract tooth, make new crown without crown lengthening, leave as is without crown.
Is crown lengthening on this LL molar (#7) viable?  Depends on the anatomy of the area, usually yes
What are the risks ?  Discuss with examining dentist
Will crown lengthening loosen this molar and make it unable to perform its chewing function ? Usually not
Will the exposed roots be difficult to clean and cause problems ? usually not, the roots will not remain exposed, they will be covered by the new crown.
Will adjacent teeth be affected ?  Some bone us usually removed from the teeth next to the one being lengthened.  The procedure is usualy not done if removing the bone will compromise the adjacent teeth.
In case crown lengthening fails, is it not possible to insert an implant later ?   Usually but it depends on the anatomy of the area.
Is forced extrusion viable and what are the risks ?  Probably not a viable option, surgical crown lengthening still needed after forced eruption.

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David Scharf

Expertise

I am a board Certified periodontist which means that I am an expert in treating gum disease (periodontal disease) and placing dental implants. I can answer questions related to treating gum disease, bleeding gums, maintaining healthy gums, and structural issues with the gums such as recession, to gummy a smile, crown lengthening etc. I am also certified in Laser Periodontal therapy which allows me to treat gum disease with a laser rather than a scalpel. I can address those questions as well.

Experience

I have been practicing periodontics and placing dental implants since 1990. I have treated thousands of patients for both gum disease and dental implants. I currently an a Clinical Assistant Professor in the Department of Periodontics and Implant Dentistry at the nations largest dental school.

Publications
Journal of the American Dental Association, Journal of Periodontology, International Journal of Oral and Maxillofacial Surgery, International Journal of Oral and Maxilofacial Implants

Education/Credentials
BA/DMD Boston University Cum Laud. Certificate of Advanced Graduate Study in Periodontics fro New York University. Board Certification in Periodontics 1995

Awards and Honors
e was elected to Omicron Kappa Upsilon (the "Phi Beta Kappa" for dentists), and received the Boston University award for Excellence in Periodontology, the Boston University Predoctoral Prosthetic Award for Excellence in Prosthetics, and the Academy of General Dentistry Outstanding Senior Student Award, the Boston University Operative Dentistry Special Achievement Award, and the Quintessence Publishing Company Outstanding Senior Award for Excellence in Clinical Practice. Following dental school, Dr. Scharf completed a year long General Practice Residency at The Long Island College Hospital in Brooklyn, New York. As a resident at this top New York program, he gained extensive clinical experience in such fields as prothodontics, periodontics, endodontics, orthodontics, oral surgery, management of the medically compromised patient, and general dentistry. This experience was completed by clinical rotations in the departments of general medicine, anesthesia, and emergency medicine.

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