Post-Braces Inflammation and Bone Reshaping in Dentistry

Q: Post-Braces Inflammation and Bone Reshaping in Dentistry

Hello： 1. Crown lengthening procedure. It can directly modify the alveolar bone, or an orthodontic approach can be attempted to extrude the tooth upwards. 2. The area being treated is quite small and localized, with minimal impact on adjacent teeth. 3. Typ

After getting braces, there was inflammation, and now I need to redo the braces, which may require addressing issues with the alveolar bone?

About a year ago, I had a root canal treatment on my first molar due to decay, followed by the placement of a ceramic crown.
A few months later, I started experiencing slight bleeding and mild discomfort in the gums on one side of that tooth (the same side where the decay was initially), while the other side remained normal.
I recently visited a dentist, who removed the crown and found no decay or significant cracks in the tooth.
However, the affected side showed clear signs of inflammation and redness, while the other side appeared normal.
The dentist speculated that the inflammation is likely due to the deeper decay on that side, which resulted in the crown being placed closer to the bone (the dentist mentioned that ideally there should be about 3mm of distance, but I measured only about 2mm on the inflamed side).
Therefore, it may be necessary to trim some of the alveolar bone to improve this condition.
A temporary crown has been placed for observation.

I would like to ask the following questions:
1.
Is it common for crowns to cause inflammation when they are too close to the bone? What is the name of this procedure? Can water laser be used for this?
2.
If the alveolar bone is trimmed, what negative effects could arise? (Especially concerning the adjacent healthy teeth; if treating the inflammation causes issues with the healthy neighboring teeth, it would be counterproductive.)
3.
If the same condition persists after the trimming, is dental implant the only option? However, regarding question 1, if inflammation occurs due to foreign objects being too close to the bone, wouldn’t the entire dental implant, being a foreign object, lead to similar issues with the gums?
4.
Since dental implants require healthy alveolar bone, if the bone is reduced, is there a way to restore it? Could this negatively impact future dental implant procedures?
Thank you for your guidance on these questions.

Xiāngwàng yá chǐ jiànkāng de rén, 30~39 year old female. Ask Date: 2023/02/24

Dr. Lin Jiayong reply Dentistry

Hello: 1.
Crown lengthening procedure.
It can directly modify the alveolar bone, or an orthodontic approach can be attempted to extrude the tooth upwards.
2.
The area being treated is quite small and localized, with minimal impact on adjacent teeth.
3.
Typically, there will be improvement after the procedure; at worst, it may remain as prone to inflammation as before.
Implants will integrate with the body's bone, and the materials used for implants are completely different from those used for dentures.
4.
Crown lengthening is a procedure that lowers the alveolar bone.
If you are particularly concerned and have always considered dental implants as the ultimate goal, it is advisable to postpone the crown lengthening procedure and accept the current state of localized inflammation.

Reply Date: 2023/02/24

More Info

Understanding post-braces inflammation and bone reshaping in dentistry is crucial for maintaining oral health, especially after procedures like root canal therapy and crown placement. Your concerns about inflammation, the proximity of the crown to the bone, and potential treatments are valid and warrant a detailed discussion.

1. Proximity of the Crown to the Bone and Inflammation: It is indeed possible for a crown to be positioned too close to the alveolar bone, which can lead to inflammation. This condition is often referred to as "periapical inflammation" or "periodontal inflammation," depending on the specific tissues involved. When a crown is placed too deeply, it can irritate the surrounding gum tissue and the underlying bone, leading to inflammation. The ideal distance between the crown margin and the alveolar bone is typically around 3 mm, as you mentioned. If the distance is reduced to 2 mm or less, it can create a conducive environment for inflammation and infection. Laser therapy, such as water laser (also known as Er:YAG laser), can be used to help manage inflammation and promote healing, but it is essential to consult with your dentist about the appropriateness of this method for your specific case.

2. Negative Impacts of Alveolar Bone Reshaping: Reshaping the alveolar bone to accommodate the crown can have potential negative effects. One concern is that altering the bone structure may affect adjacent healthy teeth. If the bone is excessively reduced, it could compromise the stability of neighboring teeth and lead to further periodontal issues. Additionally, if the bone is reshaped too aggressively, it may result in a loss of support for the crown, leading to future complications. Therefore, any surgical intervention should be carefully planned and executed with precision.

3. Considerations for Dental Implants: If reshaping the bone does not resolve the inflammation, and the situation persists, dental implants may be considered as an alternative. However, your concern about the implant being an "alien object" close to the bone is valid. Implants are designed to integrate with the bone through a process called osseointegration, but if there is ongoing inflammation, it can hinder this process. Therefore, it is crucial to ensure that the surrounding tissues are healthy before proceeding with an implant.

4. Bone Regeneration After Reshaping: If the alveolar bone is reduced, it is possible to regenerate bone through various techniques, such as bone grafting. This procedure involves placing bone material (either from the patient or a donor) in the area where the bone was removed. However, the success of bone regeneration depends on several factors, including the patient's overall health, the extent of bone loss, and the presence of any ongoing infections. If the bone is compromised, it may pose challenges for future implant placement, so careful monitoring and management are essential.

In conclusion, the inflammation you are experiencing may be related to the positioning of your crown and its proximity to the bone. It is essential to work closely with your dentist to monitor the situation and consider appropriate interventions, such as laser therapy or bone reshaping, while being mindful of the potential impacts on adjacent teeth and future implant options. Regular follow-ups and open communication with your dental care provider will be key to ensuring a successful outcome.

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