Q: I just had a new crown placed and when I got home I noticed that the edges are nowhere near my gum line, yet the temporary that I wore for three weeks looked great. What gives!?
A: My old dental prof, Dr. Woolhouse of Montreal used to say: “don’t make the temporaries too nice; the patients won’t come back to pay for the final crown!”
Well, you can’t just go on forever with a plastic temporary crown. The tooth will eventually disintegrate underneath leading to its removal and significant costs for its replacement.
Very often impression techniques that use the goopy molds, result in shrinkage and recession of the gingiva while you are waiting for the permanent porcelain crown. Often the culprit is the placement of thick threads soaked in medications, called retraction cords, which are designed to push the gums out of the way to allow for the goop to flow around the tooth like a mote around a castle.
These cords are soaked in epinephrine which is adrenaline and can make your heart race and interfere with heart medications. They also can cut off too much blood supply to the gum causing shrinkage, similar to when a hemorrhoid is removed by tying a string around them, killing the blood supply to allow them to slough off. (There’s a visual for ya!). This exposes the root surface causing a pesky gray or yellow discoloration where the porcelain is supposed to meet the gum line.
Solution? Dump the retraction cords, use a diode laser to create the “mote” and take digital impressions called iTero vs. the trays of goop. These are digital scanners that take a 3D video of the teeth. The images are emailed to a special lab where robotic milling machines mill out an exact replica of your mouth. No plaster models from rubber molds from days of yore.
The gum has a much better chance of meeting the edge of your crown.