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Dark Shadow near Crown Margin
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Questions in the Dental Health forum are answered by Dr. Jerome Tsang. Topics covered include bridges, cavities, crowns, and x-rays.

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Dark Shadow near Crown Margin

Several months ago I got a new crown. While looking at one of the x-rays (Photo No.1 in my album) taken right after the procedure, I noticed a darker than usual area near the margin of the crown. On another x-ray that was taken during the same visit (Photo No. 2 in my album) and a third x-ray taken three months later (Photo No. 3 in my album), the dark area is not as obvious, though.

My question is: Is the dark shadow in the first photo indicating an open margin? If yes, why is it not as obvious in the other two photos? Many thanks.
540545_tn?1377626518
It looks to me that the first photo does indeed have an open margin at the time.  Did the doctor adjust the crown after the initial x-ray?  It may have fit better after it was cemented in.

Also, its not as obvious on the other photos either because of the adjustments that were made or because of the angulation of the x-ray.  
6 Comments
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Avatar_n_tn
Thank you. I just realized that I was not precise in using "right after." I got the crown in late August last year. Photo No.1 and No. 2 were actually taken in early September, about one week after the crown had been cemented in and adjusted twice as I kept feeling it was too high.

A few days later I went back for the third time and then the doctor further shortened the crown. I no longer feel it is high afterwards (as it is actually shorter than other teeth now).

However, I feel moderate but constant pain near the crown or the neighboring tooth (the further inside one), but I could not locate exactly where. The distance between the two teeth is normal (meaning not too tight). As the pain is bearable and I am tired of going back, I having been forcing myself to get used to it ever since.

I only noticed the dark shadow in Phono No. 1 recently and brought it to the attention of my dentist during my semi-annual oral exam. Photo No. 3 was taken during that visit. The dentist said as the dark shadow was only obvious in one X-ray, she tends to think the shadow was caused by angulation of the X-ray. This is basically why I am asking the above question.

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540545_tn?1377626518
Well, its hard to give a precise answer but my guess is that there may have been a gap initially and it was adjusted and fixed prior to cementing?  Sometimes the cement will also seal the gap although that gap on the first photo is a bit large to seal with cement ideally.

The pain is constant?  As in it hurts thorough the day and at night?  There was a root canal done on the tooth so there shouldn't be any "pain" from the tooth.  It could be from the gums or there could be an issue with the root canal.  You may want to have a specialist (endodontist) check it out.  You shouldn't be in constant pain.

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Avatar_n_tn
Thank you. No adjustment was made prior to cementing. Photo No. 1 that shows the gap was taken after the crown had been cemented in for a week. So I guess the gap is still there. What harm will an open margin bring? Should I replace the crown?

As for the pain, I think it is from the gum. It lasts for the whole day but in the morning the feeling of pain is comparatively stronger. (But overall the pain is moderate and bearable.) The feeling is like I just had a teeth cleaning, but instead of the pain going away in a while, it persists.

Thank you.
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540545_tn?1377626518
There may be an irritation from some cement in that area?  I'm not sure.  The crown may need to be replaced. Based upon what you say, there probably is still an open margin.  It can be an area where food can get trapped and bacteria can grow.  Basically a cavity can form underneath that area in the future potentially.
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Avatar_n_tn
Thank you for your time and patience.
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Jerome Tsang, DDSBlank
Irvine Modern Dentistry
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