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I am a 30 year old female. Two months ago, I had a new crown fitted on my front tooth. I broke this as a child and due to an abcess had to have root canal treatment which also left me with a very dark gum.

My last porcelain crown had developed an unsightly black line below the gum over the years and therefore I decided to have it replaced.

I am an NHS patient but paid £500 for my dentist to replace the crown privately. Unfortunately, the new crown, although an improvement on the previous one, still has a black line which I immediately pointed out. My dentist referred me to see her collegue who is more experienced for a second opinion and I saw him today.

He said that I have been fitted with a ceramic crown with a metal base. He feels the problem could be either the metal base of the crown is visible or the dark root is showing through. Apparently, I have thin gums.

I have been told I can either have a new porcelain crown fitted, have my gum and root bleached or have a skin graft which is very invasive.

I feel the problem is the metal base as the temporary crown I had whilst I was waiting for this to be made, looked very good at the gum line and had no black line. I’m not so concerned with the dark gum as this is not as visible.

I have already paid a significant amount of money and feel unhappy to pay for another crown. Should my dentist have used a crown with such a visible metal base to begin with?

Many thanks

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Asked on 11/08/2008 12:00 am
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Private answer

Hi there !


Modern all ceramic crowns can be far more aesthetic and lifelike than the traditional metal bonded crown that you have described as just being fitted. I would therefore think it is a good idea to discuss the matter again with your dentist or his colleague to decide if it is a good plan to change it yet again[occasionally there can be a reason for choosing the metal based one].


 Ideally you would have had a chance to see the crown in situ before it was cemented on and to have discussed your options for different crown types in advance of the procedure. I would hope that your dentist wants to do his best for you so I suggest you meet again to chat over cost issues and what can be done to get a result that you will be happy with.


Best wishes- Michael Lowdell


 

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 19/08/2008 12:00 am
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Hi,


 


I would also just like to add that there are always reasons why gum can move up or down when prepping for a new crown (eg, high in occlusion or trauma of prepping, both reversible with careful treatment). This is sometimes out of a dentist immediate control.


Generally speaking if the crown root join is in the same place as before you started your treatment, you have not had your requirements for a new crown achieved. If your root was not grey in the temporary stage,this is then being caused by the type of crown used, not the root. If the root was filled and restored to take the new crown or has subsequently died, then this can also cause the problem.(when having a crown made there is always this biological risk)


When choosing a metal supported ceramic crown it can look good with proper tooth preperation to maximise the aesthetic result . This should be planned before the crown is sent to the laboratory for making by the dentist.


 


Good Luck.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 19/08/2008 12:00 am
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This is a common problem and a difficult one to solve if one wants to achieve a perfect result.


It looks like there has been a lack of planning and /or discussion prior to providing the new crown and unless you upper lip hides this region of the tooth when you smile then something will have to be done. The person you saw for your second opinion is correct that those are the options available and you will need to return to your dentist to ask why he/she chose not to use an all porcelain crown.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 18/08/2008 12:00 am
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Whether you pay for the new crown or not is a discussion that you must have with your dentist. However there are now all porcelain crowns that do not require a metal sub structure and these are now just as strong as porcelain fused to metal  Zirconium crowns . The materials used should probably have been discussed in advance, but even with porcelain fused to metal crown, if the margin is tucked beneath the gum then the line can be hidden. However all porcelain crowns do reflect light in a more natural way and so decrease the amount of root darkness


 



David Bloom


President BACD



 

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 18/08/2008 12:00 am