I have a gap after getting front tooth crowns!

I have have had traditional porcelain crowns on my front teeth for years, probably close to a decade now. The original work was done by a different dentist. The dentist I have been seeing for a couple years now told me that two of the crowns needed to be replaced. He told me that we should just go ahead and replace all four of them so they matched. He also said it was only a matter of time before the others would have issues too.

My dentist told me about same-day crowns and I was super excited since it could all be done in one visit. But, the new crowns look so different. There is a gap between them and a black, ugly looking area near the top of each crown. I hate this because I’m self conscious now when I smile, which I never dealt with before. When I asked my dentist about it, he basically said there was nothing that could be done to fix them. He said it was due to bone loss. But, how come I didn’t have these black areas before when I had the same amount of bone?

Do you think it was because of the same-day crowns process? Also, is it true that they cannot be fixed?

-Jeffery in Missouri

Jeffery,

The same-day crowns are not the issue with the discoloration you are referring to. The black areas you are referencing are known as black triangles among the dental community. Normally, a patient has bone and and tissue over the bone. Then there is a rounded area, known as the papillae, which fill in the gap. If that is lacking, a black triangle will appear.

There are many possible causes for black triangles, including:

• Shape of teeth – Some people’s teeth sit tighter near the bottom instead of the top.
• Gum recession – This occurs over time from varying factors, like brushing too hard, gum disease or simply getting older. Your gums move back away from the teeth revealing more of a gap near the top of your teeth.
• Bone loss – Gum disease is usually the biggest contributing factor to bone loss.
• Deep cleanings – When a patient has gum disease and hasn’t been in for regular cleanings, there is a great deal of build up and in some cases infections can occur. A deep cleaning can help with that. It is known as root scaling and helps increase the health of the gums. However, the downside of a deep cleaning is that patients notice the gaps near the top of the teeth that they haven’t noticed before, because their gums aren’t puffy any longer.
• Trauma to teeth – Another common factor that contributes to black triangles is when the papillae is damaged. This tissue is quite tender and sometimes a rough cleaning or treatment can mean that dental objects can bump into it, exposing more of the gap.

You mentioned that your dentist said the black triangles are from bone loss. But, it is odd that you didn’t have this issue with your previous crowns. The more likely reason could be that the papillae may have been damaged when the crowns were replaced. It is possible they will heal if you keep up with your hygiene.

You could monitor the area for a few months to see if the tissue begins to heal and the black triangles are less visible. Otherwise, you will need to have the crowns replaced. Your dentist sounds like his mind is made up that it cannot be fixed, which is not correct. So, you will need to find an experienced cosmetic dentist in your area.

It doesn’t sound like this dentist specializes in cosmetic dentistry or aesthetically-pleasing dentistry either, since he has determined they can’t be fixed. Also, an expert cosmetic dentist would be able to fix one or two crowns and blend them in perfectly to your exiting dental work. So, the fact that this dentist wanted to do all four at once also indicates his possible lack of cosmetic dentistry experience. Spend some time finding a dentist with cosmetic dentistry credentials, as well as experience treating patients with similar issues. An excellent cosmetic dentist will be able to fix your black triangles.

Hamburg Expressions, a cosmetic dentist in Lexington, KY, has a lot of experience in cosmetic dentistry, especially on front-tooth crowns. So, we know it can be addressed. Best of luck to you!