Q: My upper canine tooth was removed and replaced by an implant and crown. When I smile big, an ugly gray metal line shows where the gum has receded. How can this be fixed?
A: If I answered this question just a couple of years ago, I would have responded: “I have no idea. Ok, where are we eating lunch.” Technology is constantly advancing in dentistry, solving problems we have been dealing with for years. Your problem is one of the classic nuisances in dentistry. That and asking patients questions when fourteen things are in their mouths.
The final position of where your gum will heal to is as unpredictable as Florida weather. (I still don’t know what a “30% chance of rain” means. Does that mean I will only get soaked from the head to mid-chest area?”)
Methods we use to cover the exposed metal:
Coronally positioned flaps: a small surgical procedure that drags the gum up and over the metal with tiny sutures. Sometimes we place a connective tissue graft to plump up the area to prevent further recession.
- Adding bone grafts and collagen membranes to cover exposed implant screw threads in severe cases.
- Remove the existing crown. Drill down the metal so it is flush to the gum line, or below it. Take a digital scan of the metal abutment post attached to the implant and make a brand new crown.
Methods we use to prevent this from happening:
- For teeth that really show your gum line, we surgically place the implant deep and even with the crest of the bone, or slightly below (Countersunk, for you hardware fans.)
- Place a plastic temporary crown to guide the healing of the gum.
- Use a tooth colored abutment post and crown in case the gum still recedes; you will see a tooth colored line; not a gray one.
- In some rare cases, opt for a permanent bridge vs. an implant altogether.
Dr. Mitchell Josephs practices Implant, Cosmetic and General Dentistry with an emphasis on implants, porcelain veneers, and complex crown and bridgetreatment. 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.