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Wednesday, April 23, 2014
How to cover gum loss?
I have a permanent bridge that covers four teeth on the bottom right side of my mouth. X-ray shows solid tooth with no periodontal disease. The last tooth in the bridge has some gum loss. One dentist suggestion was to cover the gum loss area with a composite another wanted to remove the bridge covering the last tooth and replace it with a bridge that would cover the gum loss area.
One should first question why gingival recession (gum loss) is occurring. X-rays are not enough to rule out periodontal disease and they only show a 2-dimensional view. Gingival recession on a crowned tooth may occur:
1- due to lack of oral hygiene (may be too hard for you to reach there and brush correctly).
2- due to trauma from brushing (although it should happen to adjacent teeth too if you are brushing too hard).
3- due to irritation from crown margins (sometimes margins are extended into the gingival sulcus to obtain a better esthetic outcome. This would irritate gingiva and cause inflammation. And inflamed tissue would leave tooth surface).
4- due to lack of attached and keratinized gingiva to start with (may be you did not have enough attached gingiva to protect underlying bone structure before you had the crown, and now you are loosing more due to an artificial material).
As a periodontist, I do not recommend composite restoration to cover the exposed root surface. This will probably irritate your gums more and will cause more soft tissue loss. We prefer to increase the amount of attached gingiva with a periodontal soft tissue graft procedure (getting some tissue from the roof of your mouth and grafting the exposed root surface). This will probably not be enough to cover right at crown margin. If the remaining exposed surface is hard to clean then I recommend you replacing the crown. But first, I recommend you seeing a periodontist to evaluate your gums before having any type of new restoration.
Binnaz Leblebicioglu, DDS, MS, PhD
Associate Professor of Periodontology
College of Dentistry
The Ohio State University