Dentaltown June 2021 - 28

message board
Invasion of Biologic Width?
An aging PFM crown and infl amed, purplish gums have this Townie asking the community for advice
afcdds
Member Since: 03/01/02
Post: 1 of 70
Dear Townies, I have a patient with a PFM crown tooth #8 who's complaining of her gums
being darkened and the color is moving mesially (purplish). It has been in her mouth for 10 years.
It's always had some infl ammation but it's getting worse. The root is darkened over time due to
tooth having had endo. I am recommending a new crown (porcelain fused to zirconia [Lava])
but wonder if it's being caused by a nickel allergy or invasion of biologic width or both. Any
suggestions with similar cases? ■
8/3/2017
mouthjanitor
Member Since: 03/11/15
Post: 2 of 70
kmarzouk
Member Since: 01/20/14
Post: 3 of 70
I'd personally refer that to a prosthodontist. Or someone really good at handling sky-high
expectations, and who will charge enough without losing money on a redo. ■
Gingiva looks like it is of the thick biotype, which usually react to violation of biologic width
8/3/2017
by infl ammation more than recession. There could be also some amount of recession as ~90% of
buccal bone is 1mm width on the facial surfaces of upper anteriors, making it within the radius
of infl uence of dental plaque.
We always want the maximum retention for crowns, which is not possible (especially with
PFM) without going subgingivally, a practice that is associated with violation of biologic width.
Nickel allergy is not excluded but in either case, crown needs to be removed and replaced
with a highly polished provisional that is thin enough around the cervical area to allow resolution
of infl ammation and possible soft-tissue creeping.
If this doesn't happen, then a graft or crown lengthening (considering the zenith) on adja19th
Century
Doc DT Kardashian
Member Since: 05/22/05
Post: 5 of 70
Amc1111
Member Since: 07/28/15
Post: 10 of 70
I also agree that most of this can be handled prosthetically; however, I will also add that
these teeth appear somewhat short and you could enhance everything with some aesthetic crown
lengthening as well if the patient is willing.
As far as prosthetics go, I wouldn't just replicate the crown as it is now. Likely it was underreduced,
so the lab bulked it up to get material thickness. I would make a diagnostic cast and cut
it back to ideal contours, then make a matrix for your provisional off that. ■
8/3/2017
28 JUNE 2021 // dentaltown.com
cent tooth #9. I hope this is helpful and thanks for sharing. ■
This might not be that complicated. Remove the old crown, do an excellent provisional with
8/3/2017
the margin a bit more incisal ... and see how it heals. You gotta charge for a provisional phase,
though. No need to rush off for surgery. Not yet anyway. ■
8/3/2017
https://www.dentaltown.com/messageboard/thread.aspx?s=2&f=137&t=296808&g=1 http://www.dentaltown.com

Dentaltown June 2021

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