Can the embrasure between a crown and first molar be widened, AFTER cementation?

[ToothPatient]

The second pic is after using disclosing tablets so there's a little red there, and that pic is shot from the buccal side.

The first is from the palatal side.

I can sort of get a 0.4 mm dental brush in from the buccal side, but it stops about 30% of the way in.

I still have gum irritation and gingivitis RIGHT in the middle of the interdental space, so doesn't show up on the external gum views really, as in these pics.

But it throbs and bleeds and is irritated.

Question being, can a dentist actually open up that embrasure using a very narrow burr?

And do so without damaging the healthy tooth in front of it? (accidentally catching it with the burr)

This is a shot from the 3D scan, prior to the crown being placed.

I understand Concavities can harbour plaque that cannot be reached by floss, where interdental brushes that fit, will address that.

Does it look like such a concavity exists in the interdental space there, on the distal surface of the first molar?

When gum irritation is quite intense, flossing reduces it, but doesn't eliminate it. Which makes me think there's residual plaque being left in there after flossing, probably in said concavity?

If I could get an interdental brush in there, perhaps that would alleviate it entirely.

 

[ToothPatient]

Distal surface of ULM1, is that decay or calculus?

I've found when flossing between the crown and molar tooth in front of it using thick woven black floss, lots of plaque or that white biofilm, is reliably coming off of the molar tooth in front of the treated and crowned tooth.

The mesial surface of the 2nd molar was where the initial heavy decay was that cause that tooth needing a RCT.

So it would make sense that some of the distal surface of the 1st molar would have a little decay, perhaps?

That intraoral pic taken from the buccal side, showing the space between ULM1 and ULM2, does that look like decay on the distal surface of ULM1?

Or just plaque and calculus?

What would explain why I'm getting so much plaque on the floss when I clean that area?

 

[MattKW]

It's difficult to say whether this could be improved. The Xray from the 3D scan is not helpful at all; I'd prefer a standard bitewing to better see the contours. Anyway, once a crown is cemented, you can't refine it in any way. The only option is to replace the crown.

 

[ToothPatient]

Recent intra oral x-ray.

Problem is, that area is a food trap but only floss fits in.

The interdental brushes don't so there's a part of the gum tissue in there that's still inflammed.

I found a way to access the interdental area from the inside of the mouth with the smallest interproximal brush, but it's been bleeding so far.

However, using the proxy brush there so far provides insane relief, like being able to scratch an itch I just couldn't otherwise reach until now.

Which is exactly what I've been putting up with this last year plus, keeping me up night on occasion. Only way to sometimes get relief is to drill the gum with a water flosser until it settles down.

With that being said, I can only access the interdental space from the inside, so it doesn't actually reach all the way through, there's still a part of the gum and interdental space I can't reach.

Would a dentist entertain replacing the crown for this reason, being unable to clean that space properly cause this crown was over-contoured?

He's already replaced it once already due to height issues, perforation occurring during adjustment.

The distal face of the molar in front of it was also not cleaned or polished, so there's filling residue there (maybe visible in the pics above?), which may be additionally trapping more food?

 

[Dr M]

Can you get in there with normal floss at all or not?

 

[ToothPatient]

Can you get in there with normal floss at all or not?

Yes I can, I can get in there with thick woven floss as well.

But it reliably pulls out a thick wad of white biofilm, morning and evening, and to be honest, flossing does not really provide relief, maybe slight relief when the inflammation is really bothersome.

Since yesterday I figured out how to get a proxy brush in, from the inside aspect of the teeth, which is tricky and doesn't go all the way in or through, plus it causes the gums to bleed.

But it felt like such a relief I spent about 10 minutes last night just using the proxy brush, causes it was hitting an area I just couldn't reach until now, an area that based on how it feels, the floss simply misses.

I've read this can be due to the 3D contouring of the tooth surfaces?

 

[Dr M]

When a crown is designed, they tend to design it in such a way, that it minimizes food entrapment. You should however still be able to clean adequately. A waterflosser should also get into the spaces better than normal floss or an interdental brush. It does sound like you can clean however, so I think the dentist would not be open to re-do the crown, especially free of charge.