Q: Within a year, a gap formed, trapping food between the crown on my implant and the natural tooth next-door. It has become a big nuisance and my dentist says if he re-does the crown to close the gap, it still may happen again. What is up with that?!
A: Welcome to another edition of “Don’t shoot your dentist.” By the way, the high suicide rate among dentists is a myth. We were recently beaten by psychiatrists and, as I was told by one last Friday night, veterinarians. Did you know that the three most trust worthy professions, year after year, are dentists, pharmacists and clergy. Each year we swap places, but we always stay in the top three. I had a professor at McGill U. who was a dentist, a pharmacist and a Rabbi. As Adam Sandler would say: “Not too shabby!”
Unfortunately in the literature, 35 to 65% of all single implant crowns on the back molar next to your last molar in the arch, will cause the natural tooth to drift posteriorly. This open contact needs to be treated; otherwise every time you eat BBQ, the pulled meat will spend more nights between your teeth than your deadbeat brother in-law on your couch who “just needs some time to get on his feet.” This can cause bone loss, implant failure, decay on the natural tooth and breath like a Wookie.
The best fix is to re-crown the natural tooth, and leave the crown on the implant alone. This new crown will close the gap, but allow floss to still clean between the teeth. HOWEVER, to prevent the tooth from drifting allover again, and causing you to change dentists, here is my secret tip to prevent this. (No longer a secret, as you will surely share this one with your current dentist.)
- After removing the crown on the last molar in the arch, file the side of the implant crown so that it has a nice flat, wide vertical surface. This way the new crown next-door will have the same design and but up against the implant crown with a nice broad contact.
- And, this one is my own “low-tech” invention: Make the top edge of one crown over lap the other crown with a slant or a dove-tail joint like a quality kitchen drawer. This will still allow floss to clean in between, but will still maintain a closed gap even if some minute drifting occurs, if any.
I can better draw this on a white board to show you what I mean, so feel free to email me and I will send you a picture of my sketch.
Hold your fire. It’s not the doctor’s fault! Just life working in the pie hole.
Dr. Mitchell Josephs practices Implant, Cosmetic and General Dentistry with an emphasis on implants, porcelain veneers, and complex crown and bridge treatment. He is on staff at JFK Medical Center and is a Faculty Advisory Board member at McGill University’s Faculty of Dentistry. He completed his residency at Manhattan’s Beth Israel Medical Center and Mt. Sinai Hospital.