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I have a front tooth crown where the gum line remains chronically inflamed and swollen.  The tooth was originally broken 30 years ago and a root canal performed. about 20 years ago the tooth became painfull and a procedure was performed above the tooth in the gum line to correct the problem (root resorption?). Shortly therafter the first permanent crown was placed and did well until 10 years ago when an infection developed causing pain and swelling. A new permanent crown was placed after a temporary for around 2 weeks. The tooth felt great with the temporary but the permanent crown has always felt to be inserted to high and has had variable inflammation of the gum particularly after alot of biting with some discomfort. As i said initially the gum line is now chronically inflamed and the tooth sensitive. Multiple x-rays of the tooth have been negative.  I realize its impossible to say what is wrong without examining the tooth,but what do you think the possibilities are and what are the treatment options?

Since your tooth has been root canal treated and clinical and radiographic examinations are negative for a tooth abscess, the source of irritation to your gums is likely the crown or possibly deposits surrounding the crown. Once your reverse root canal ('apical retrofill') was completed 20 years ago, and later a new crown placed, your gums faced a new environment to which to react. You are certainly correct that a proper diagnosis can not be made without a thorough examination, but a few possibilities are likely:
Teeth with a history of trauma such as yours are prone to having deeper pockets underneath the gums which need to be cleaned more thoroughly to prevent inflammation. Irritation with biting pressure may also indicate the presence of a fracture in the tooth. Teeth which have been root canal treated may become more susceptible to fractures, and these fractures often do not appear on x-rays. Also, if a crown is not contoured quite properly, or does not fit the tooth properly, the gums can become inflamed. If your crown has a metal foundation to it, the chance of a mild allergic reaction to the crown itself becomes more likely as well. Please remember that there are other possibilities as well, but these are some of the more common scenarios. Treatment for these conditions ranges anywhere from a simple cleaning and thorough oral hygiene, to replacing the crown, to possible tooth extraction (ie- if a fracture is too extensive). I hope this answers your question to your satisfaction and I wish you luck with your future dental health!


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