Gum-line complications sometimes associated with crown and veneer placement.

This digital smile makeover demonstrates how the placement of dental crowns can be used to improve the apparent alignment of teeth. It also illustrates an aspect of crown placement that patients sometimes don't expect, and can ultimately lead to sub par results.

While crown placement can substantially alter the shape of a tooth, placing one must conform to the tooth-gum relationship that already exists. In some cases, like this one, that may present a problem.

There are solutions for this type of dilemma (see below). But failing to anticipate this obstacle beforehand, can lead to an inferior outcome. (This same complication also applies to the placement of veneers.)

Case issues and concerns.

As seen in the "before" picture.

  • The upper front teeth have a slightly irregular appearance. The central incisors have a crooked alignment. The lateral incisors are a little shorter and more pointed than is ideal.
  • The biting edges of the lower teeth have a ragged look.
  • Beyond that, from what can be determined from this picture, this person's gums and teeth appear healthy.

(In almost all cases, and especially in those situations where the patient's teeth require no other type of dental work, alignment issues are best resolved via the use of orthodontic treatment. This makeover simply demonstrates what approach might be taken if that one is rejected by the patient.)

As seen in the "after" picture.

  • This image shows the type of improvement placing crowns could make.
  • Notice that the gum line discrepancy still exists on the center two teeth. That's not something that crown placement can remedy. It takes an additional procedure (gum sculpting) to resolve that issue.
  • The center two teeth display a gum-line discrepancy.
    The center two teeth display a gum-line discrepancy. The center two teeth display a gum-line discrepancy.
  • Crown placement alone can't fully address the gum issue, gum sculpting is needed.
    Crown placement alone can't fully address the gum issue, gum sculpting is needed. Crown placement alone can't fully address the gum issue, gum sculpting is needed.
 

Photo submitted by website visitor.

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Treatment solutions:

1) "Straightening" teeth without braces.

Our "after" picture shows how the apparent alignment of teeth can be improved by placing dental restorations.

We've illustrated the placement of dental crowns on the center four upper teeth. The modest changes we've illustrated for the upper eyeteeth could probably be made just by placing dental bonding.

a) Gum-line challenges.

The awkwardness of this treatment approach lies in the fact that the placement of the crowns will not significantly change the contours of this person's gum line. That means that the restored front teeth will vary in length (as we've illustrated in the "after" picture). This may or may not pose much of a problem, depending on how much of this person's teeth show when they smile.

b) Gum Sculpting.

The gum line discrepancy could be remedied by a minor surgical procedure called gum sculpting. (The gum tissue on the patient's upper right tooth would be positioned higher, so more of it shows.) This procedure would need to be performed before the dental crowns are made.

2) An alternative treatment approach.

As an alternative, a great way to treat this case would be with orthodontic treatment (braces). After all, this person has nice-looking teeth, so why junk them up by placing dental restorations on them?

Assuming that they would be committed to wearing a retainer after their braces had been taken off (so the alignment of their teeth would not relapse), this approach would probably provide the nicest, most lasting and trouble-free result.

Gum-line considerations.

As a side benefit of an orthodontic approach, during treatment the gum-line discrepancy we discuss above would be expected to resolve on its own. No gum sculpting would be needed.

3) The lower teeth.

Our "after" picture illustrates how just minor tooth trimming could be used to improve the appearance of the lower front teeth.

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Input from site visitors.

Front Veneer

I had a front tooth veneer on after root canal treatment 11yrs ago now my veneer needs replaced.. When first applied it was slightly shorter but my dentist said he couldn't make it bigger as my gum line has changed and darker. Can it be corrected to make both teeth look same length and get rid of gum darkness at one side. Will a new veneer bond as good or better with a crown thanks

Nicola,

We're assuming that the gum line/tooth shortness issue you mention is somewhat similar to that illustrated with the case above.

If so, it's most likely that "gum sculpting" could be performed, so to show more of the shorter tooth. Afterward a new veener could be placed so both teeth look the same length.

We're unclear exactly what type of gum discoloration you have. Periodontist (gum specialists) are expert at performing gum sculpting. They would also know if the gum discoloration problem you mention could be resolved too.

Every time a veneer is replaced a little bit more of tooth enamel gets trimmed away (enamel creates the strongest possible bond with a veneer). If you finally reach a point where little enamel remains, a crown likely makes the better choice. You'll simply need to rely on your dentist's judgment on this matter.


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