Serene, a dental patient from New York, asks:
My dentist, has recommended removing the root of my incisor because it’s casting a dark shadow through my porcelain crown (we have tried other methods of lightening the root, but they have not worked). He thinks a dental implant is the best solution because it will look completely natural in any light.
Another dentist advises against the dental implant in this situation. His worry is that that replacing the natural root with an implant may lead to gum recession, resulting in an unaesthetic gumline. On whether a gum graft might fix that problem, his opinion is that gum grafting in the front of the mouth might result in a “bumpy” gum.
Any thoughts? It would be great if I could get another opinion on this.
If your root is casting a shadow is probably due to a metal ceramic crown that wont allow light thru it and so it wont be illuminated as the others. A full ceramic crown with a fotoconductive post may do the trick.
If you have a full ceramic crown and have that problem, the situation is different, you may have a very thin buccal plate of bone and thin gum, if so an implant placed more to the palatal and some grafting may work but there are risks involved.
A gum grafting is a nice and probably simpler solution and normally wont seem bumpy or anything.
cheers
If your description, i.e. a dark root is causing a color discrepancy through some type of all ceramic crown, is correct, replacing the natural tooth root with an implant is not indicated. Any high quality dental lab can build opacity into a crown to mask darkness. Photographs including shade guides of the root should be included. Another option would be to have a high quality lab make a porcelain fused to metal crown which can also effectively mask a dark root. However, if your problem is a dark root that is casting a shadow through thin gingiva, that is a problem that might be addressed by an implant provided a ceramic implant abutment is used and the implant is properly placed. We are presuming also that internal bleaching has already been tried or that a long, cemented post precludes this approach to bleaching the root.
If you do consider an implant and you are worried about gum recession you may want to consider a Prevail implant from a company called 3i. They have an implant specifically designed to prevent bone resorption which in turn would prevent tissue recession. The bone remaining around the platform of the implant enables the tissue to remain and leave you with an aesthetic look. I have used this implant on dozens of aesthetic cases and the results have been phenomenal. Again, this issue only pertains to implants so if any of the above suggestions have not been approached or are more economical feel free to inquire about them. Good luck!
If color is your only problem then keep the tooth and place a captec crown with very high gold underneath or a zirconia based porc that is very opaque or even a pfm well down will work. The gum may also be very thin and that could be grafted.