In this case, the patient presented with unsightly old dental restorations and gum recession, leading to dark gaps between teeth and between teeth and gums (more technically called black triangles). The patient came in to see Dr. Mazhari for a general check-up. The patient initially had porcelain fused to metal full coverage bridges for his dental restoration design performed years ago, and as a result of the metal used, X-rays couldn’t be used as a diagnostic tool to detect the health of underlying tooth structure.
However, Dr. Mazhari was able to perform an exam where she discovered that the patient’s original restoration had a detrimental effect on his gums and teeth. Although this issue couldn’t be easily detected on x-rays, Dr. Mazhari determined that if the patient had waited a few more years to receive an exam, he would have lost the opportunity to save his original healthy underlying front teeth.
When porcelain fused to metal restorations is used as an option, cement is used to bond the restoration to the natural teeth. In some cases—such as in this one—the cement can wear away over a long period of time. These small gaps can lead to decay formation in the retainer (holds bridge or crown in place) tooth structure underneath the dental work. It is essential to use a bonding mechanism to bond the restoration to the underlying healthy tooth structure rather than cement, which can easily create gaps over time and could be the start of decay.
The patient was also missing a tooth in the upper left arch and wasn’t aware of dental implants as a replacement option for missing teeth. Dr. Mazhari was able to replace the missing tooth with a healthy and secure dental implant to prevent teeth from shifting and bite changes, which could lead to more serious issues such as malocclusion and TMJ pain and compression over a long period of time.
Dr. Mazhari was also able to replace the porcelain fused to metal restorations (bridges) with the all-ceramic ones. Dr. Mazhari uses ceramic restorations in order to ensure X-rays can be used to detect any dental problems, including decay on patient's yearly maintenance visits. Utilizing bonded all-ceramic options prevents gaps since the restoration and underlying tooth structure are interlinked to the tooth structure. Coupled with enormous esthetic enhancement compared to the porcelain fused to the metal option, which leads to a gray line appearance at the gum line over time.
Improving and upgrading patients’ old restorations (bridges), helped in improving gum health and gum appearance, as is evident in the after photos. The patient was extremely pleased with the results.