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Monday, March 10, 2014
Filling extending below gum line.
About two years ago, I had a cavity filled on the side of one of my molars. The filling extends a little below the gumline. I recently began going to a new dental office. At my first appointment, the dentist noticed this filling and took an x ray. He says that the filling is preventing the gum from bonding to the tooth. Although this is a relatively small filling, he says that the jawbone is receding, in order to allow the gumline to recede, and join to the tooth, closer to the root. He tells me that to correct this problem, I must choose either a crown or getting an artificial tooth. He told me that getting a crown would cause a higher risk of tooth decay in the tooth next to the crown, and that crowns do not last forever, and would have to be replaced, after 10 or 20 years. However, he says that a titanium tooth would last forever and solve the problem. He told me that, while getting a titanium tooth to replace a mostly healthy molar would not be advised by most dentists, he feels that it`s a good choice. He tells me that although the gum cannot bond to my filling, it would be able to bond to the titanium tooth, preventing futher bone loss. Frankly, I`m a little nervous. My previous dentist didn`t mention any of this when he put in the filling. My current dentist referred me to a periodontist that he knows, for a second opinion, but he wants to replace the tooth himself. I`m just a little nervous because my current dentist mentioned that this is an "unconventional approach." This filling doesn`t extend very far under the gum line and has caused no noticeable problems. Is is really necessary to have a crown or to take out the entire tooth? If so, wouldn`t my previous dentist have mentioned that this filling would lead to all these problems? Is there a name for this condition, so that I can do further research, before having my molar replaced? I suppose I`m just a little nervous that this may not be a necessary procedure. Thanks.
Root decays are not easy to deal with. Previously we did not have different restorative materials to fix the problem. If you restore root decay with an amalgam restoration, soft tissue will not like it and will try to stay away from it. Thus, based on the location, you will have a soft tissue pocket (retentive to everything you eat) or gingival recession and exposure of further root surface. There are other more tissue friendly restorative materials. However, soft tissue will not adhere on them.
Building a crown on that tooth (depending on where the root decay was) may irritate your gums, too. Thus, you may need a surgical procedure to open up space for the crown margins so that it would not "pinch" your gums. This may be indicated based on severity of root decay, and it may also be contraindicated if we need to remove too much of supporting bone tissue to open up space for crown margins.
Saying all that does not mean that dental implant is the best alternative. You need to have bone in the right place to be able to place a dental implant and have a nice restoration on it. With severe root decay and trauma from extraction, we may need to do a bone graft procedure first to increase the amount of bone, wait for approximately 4 months and place implant, and wait again for a couple of months before restoring it.
And again, implants are not forever. They may have inflammation around them, etc., if you do not clean and maintain them. Thus, the answer to your question is it all depends on the severity of the root decay and its location compared to bone level. A periodontist should be able to examine all this and give you your alternatives. Also, if you have a periodontist, he/she should do the surgical part of the treatment (including implant placement).
Binnaz Leblebicioglu, DDS, MS, PhD
Associate Professor of Periodontology
College of Dentistry
The Ohio State University