A receding gumline happens to us naturally, as a result of ageing. However, the severity depends on many factors. Someone with advanced periodontal gum disease, is likely to have very large gaps as a result of bone loss. There could also be gumline recession due to the improper and too vigorous use of a toothbrush, pushing the gums away and exposing cementum -- the layer of tooth just under the gumline. There are two specific cosmetic treatments to make the recession look better, but these must be done by a dentist who has access to a dental laboratory.
Schedule an appointment with your family dentist. When arriving for the appointment, the dentist may require full mouth X-rays or FMX to check the level of the bone. A tooth that has very little bone due to peridontal or gum disease is not a good candidate for crowns.
Discuss the treatment plan with the dentist. In many cases of periodontal disease, the first step will be called a gingivectomy. This is basically removing gum that no longer has bone supporting it. Schedule a second appointment for the crowns, if nothing needs to be done in preparation for them.
Return for the dental visit to prepare the teeth for crowns that were discussed at the previous appointment. A dental assistant will take an impression of the opposing arch, to establish a bite for the dental lab. Because the preparation will go further down the tooth to the more sensitive cementum, additional anesthetic may be necessary.
Relax as much as possible, while the dentist prepares the teeth for crowns. This is done with a diamond burr on the high speed hand piece and is quite involved. Once the preparations are done, the dentist will pack what is called retraction cord, a thread coated with epinephrine,between the gum and the tooth. It will relax the gum and allow the dentist a good impression of the margin where the crown and tooth will come together.
Allow the dentist to take a final impression, usually using material called hydrocolloid, that starts out hot and is cooled once in the patient's mouth. the dentist may also use an impression material called vinylpoly siloxane. This is a putty type material. Both are accurate materials for crown impressions.
Sit back and cooperate, while the dentist or the dental assistant make acrylic temporary crowns that look much like real teeth. These will stay in the mouth the duration of time between crown prep and cementation of the new crowns. The doctor and the patient will work together to choose an appropriate shade that matches the other dentition.
Return for the crown cementation appointment. Anesthetic will probably be given, due to the depth of the preps into the more sensitive portion of tooth under the gumline.The dental assistant will remove all temporary crowns, and one at a time, the dentist will try-on and adjust the crowns. Once the crowns look the way the dentist and patient want them to, the dental assistant will mix the cement and the crowns will be cemented one by one. Once the cement has set, the excess will be removed from outside of each crown.
Take the mirror that is offered to you, and take a good look at the new crowns. They have been built up in between the teeth a bit to take up space formerly taken up by recession, showing the less attractive portion of tooth underneath. These crowns extend further down the tooth, creating a more aesthetically pleasing smile.
Allow the dentist or his assistant to take X-rays of the teeth to check the recession and bone. Recession that exposes the cementum of the tooth can be painful, but does not always warrant crown therapy. In many cases of recession due to toothbrush attrition, the areas look like hatchet marks in a tree. The dentist will likely suggest composite resin fillings for these areas, because they are less conducive of hot an cold, lessening discomfort.
Allow the anesthetic to be given for the teeth involved. It will make the treatment much less difficult and minimise the pain reaction to cold. A high-speed hand piece with numerous burs or drill bits will be used to prepare the erosion marks. An acid etching agent will be used to open up the pores and roughen up the area to receive the bonding. After the acid etch is rinsed, the tooth is ready.
Stay open, while the dentist coats the teeth being worked on with a bonding agent that will help hold the composite fillings. The bonding agent is cured or hardened with an ultraviolet light lamp. The patient must not stare at it, as it can cause damage to the eyes. Once the bonding is completed, the dentist will use a series of burs to shape and polish the new composite fillings that should blend in with the natural teeth.
Listen to the dentist when he instructs you on how to maintain these new restorations, so that the teeth do not end up back in the condition that they were. They will require special care to ensure long life. With either of these treatments, the areas of recession will return if new habits are not formed.