Interproximal space closure between teeth
Interproximal space closure between teeth can be accomplished with several methods, including a restorative option or the walking it forward technique.
When do we see an interproximal space open between teeth?
If you have done dentistry for awhile you have both seen this and had this happen to you. Typically it occurs on upper distal molars, especially after a new crown. Usually the patient is a cleancher or grinder and is thus putting a lot of force on the teeth. The tooth that moves will have a contact on a distal incline that is pushing the tooth distal without a balancing contact on the mesial incline or vice versa. The tooth could also have a lateral interference pushing it distal as Lane shows on DT.
The other time you see this is when the patient has a dental implant next to a natural tooth. As the body continues to grow and change, an interproximal space will often open on the mesial of the implant crown. More information on the causes for interproximal spaces in regards to dental implants can be found on our implant problems page.
What are the options for interproximal space closure?
Options to close an interproximal space depend are:
- Replacing a crown next to the space.
- Adjusting the bite to “walk” the tooth back into contact.
- Short term aligner therapy.
- Restorative procedure to close the space.
Replacing the crown is a last resort. Walking forward is a nice technique for a upper posterior molar that just got a new crown. Aligner therapy is overkill unless doing for another reason. A restorative procedure like a composite filling is a really nice option if there is an existing composite on one of the teeth adjacent to the interproximal space. If not, then adding composite can be technique sensitive.
What is walking forward?
Walking forward is a technique that involves altering the occlusal surface of the tooth so that the bite is driving the tooth froward. Often this reverses what has recently happened. Walking forward is a little technique sensitive and you risk losing the patients confidence if it doesn’t work. The steps can be found in this article.
Restorative procedure to close an interproximal space
This is fairly straight forward and easy as long as one of the teeth next to the gap as a filling or enamel. It gets more challenging if there is a crown, especially if there is a zirconia crown. Over the years we have successfully been able to add composite to PFM crowns. This is a great money saving procedure that can be done in a very similar manner to a regular filling. If there is a failure it is typically becauase our slot prep is too much of a round cup shape instead of an undercut box shape.
Steps to close a space when there are PFM or emax crowns.
Start by picking which tooth you plan to restore. Any tooth with a filling of virgin surface is going to be your first choice. Gold crowns can have an amalgam slot prep. Zirconia crowns are tricky. PFM crowns or emax are very doable with porcelain etch by choosing the tooth with the thicker porcelain interproximally.
- We do not numb for these procedures but we do place topical anesthetic through the space and into the sulcus.
- The prep is an inverted slot prep ensuring there is some undercut for mechanical retention. We use small diamonds for this cutting.
- Place your sectional matrix.
- Porcelain etch for 30-60 seconds.
- Phosphoric acid etch for few seconds to clean the surface.
- Silane, air dry then bond. Use a bonding agent without HEMA if possible. Air dry your bonding agent but do not cure yet.
- Burnish the matrix
- Place your choice of composite into the box and cure it
Charge or cost to close an interproximal space.
The majority of these occur next to recent dentistry. To some extent it is the dentists “fault”, although it is not totally predictable. We do not charge to fix this issue if we have recently done something in that area. However, if there is an existing interproximal gap, then we charge for either a 2 surface filling. The cost of an interproximal space closure that is around $300-400 and can be found for any zip code on fair health consumer by using dental code D2392.