Irene Nosrati, DDS

I'm sorry to hear you're having such issues with your crowns. First of all, if you haven't yet, I would recommend getting an evaluation by a periodontist to determine the cause of your gum pain. However, the two most common reasons we see for gum pain around crowns are that the crowns were placed too deep under the gums, meaning they are too close to the bone. It is necessary to have 3mm of distance between the crown and your bone and if that is not present the gums become inflamed, painful and can bleed. If that is the case a procedure called crown lengthening can create the space necessary for your gums to be healthy. The other reason can sometimes be an allergic or irritation response to the metal that is under your porcelain. New crowns are now made metal free and could be more biocompatible. Allergy testing can sometimes be done to determine if that is the case. Lastly, with the double crowns the main reason to separate them is to make flossing easier, and possibly relief some papilla, but if you floss under and keep them very clean that is probably not the cause of the gum issues. Prior to doing anything I would recommend making sure the cause is understood so you can receive proper treatment.

Thank you for submitting the photos. There are most certainly signs of bone loss in some of your teeth. Bone loss has multiple categories - some can be improved with a bone graft (a vertical defect), others cannot (horizontal loss). You seem to have a few areas of the kind that can be improved so I would highly recommend seeing a periodontist as soon as possible. There are many other factors that would determine the recommended treatment (active periodontal infection, deep pockets, mobility, recession, etc.). All these need to be checked clinically by a qualified periodontist who would be able to recommend treatment as there are also various types of bone grafts. This problem could lead to tooth loss so I would not delay treatment and would hold off on any cosmetic treatment until the foundation is healthy and you know you can keep those teeth for a long time.

Pressure and some tingling are normal with a new Invisalign tray since each tray is applying additional pressure to various areas in your mouth which can be painful initially and typically gets better within 1-2 days. However, if the tingling you're experiencing seems excessive or doesn't improve when you take the tray out, I would recommend seeing your doctor to evaluate the tooth. Make sure you're seeing your doctor for regular Invisalign visits as well as dental check up visits to make sure no new cavities or bigger problems go unnoticed or assume tooth aches are necessarily due to Invisalign.

If decay is detected during clear aligner treatment, it is highly recommended to not delay treatment, especially since the extent of the decay under a crown cannot be truly evaluated until the crown is removed and could be worse than it appears. What we do in our office if a crown needs to be replaced during clear aligner treatment is keep you in the same aligner until the crown comes back and send the lab the next aligner. The lab can digitally scan the inside of the aligner and fabricate a crown in the exact same shape that fits perfectly in your aligner. Have never had any issues, and patients don't have to risk cavities getting out of control. Fillings can also be done since they can be adjusted chairside to fit the aligner and usually don't affect the shape of the tooth too much. Good luck!

This really depends on where your permanent canines are, and what is the plan to get them out if it is possible to do so. Have you seen an oral surgeon to evaluate the plan to expose those teeth once the baby teeth are removed? Often we like to place all the teeth in the right position and create the space necessary for your permanent canines prior to bringing them in, and then you may need to touch up on the position once they're in. However, without seeing an x-ray or knowing the surgical plan to get your permanent canines into your mouth it is difficult to say. Overall though, you would be a candidate for Invisalign treatment and it would close the gaps and correct your crowding. The overjet of your teeth (how far out the uppers are compared to the lowers), may or may not be fully corrected - hard to see from these photos. I would recommend that prior to starting any treatment you have both doctors (oral surgeon and orthodontist/dentist) discuss your treatment plan and work together in the order of events that they recommend.