This patient had already completed ten upper porcelain veneers without tooth modification, and five lower porcelain veneers in the front of her mouth, as well as a molar on the lower right part of her mouth. This tooth was in-between her newer work and she wanted it to be replaced to complete her smile – a project that was accomplished in stages over many years. Recession can be caused by older crowns that either aren’t fitting well, for various reasons, or are in need of an adjustment that we call equilibration – excessive forces appear with porcelain crowns as they do not wear down at the normal rate of natural teeth. This will cause recession, which is bone-loss, accompanied by the gum line becoming altered or receded. Careful attention to the newly designed preparation for the new crown at the gum line can ensure years of stability without recession, especially if the occlusion or bite is adjusted for all types of jaw movement. What should be appreciated is that it is a good idea to have your dentist check the biting surface of older porcelain crowns to see if an equilibration is necessary. This can add years of service to older crowns without having to replace them.
Note Dr. Glassman has done ten veneers on this patients upper arch. Six veneers on her lower arch and she electively requested the replacement of an older crown seen on the lower left of the photo (yellowed with dark gum line)
Top is before treatment and below is after treatment of tooth #29. Note the healthy gingival response to a crown that fits well, and the dark at the gum line and the yellowing has been eliminated.
This is a pre-operative photo with the majority of dental work being completed, the patient elected to change a crown on her lower right and appearing on the lower left of the picture below to complete her smile.