This dental implant case was completed about 2 years ago in our office. Originally, the upper right canine tooth fractured and extraction was needed. After exploring different options, we decided dental implant would be the best option to replace the tooth after extraction. Now, two years later, the dental implant looks and feels as great as it was 2 years ago.  

Dental implant is the preferred choice to replacing missing teeth and is considered the standard of care by most dentists. However, dental implant is not suitable in every case. To determine whether dental implant is suitable for you, please call us for a consultation appointment. 

A veneer is a thin shell of porcelain that is bonded to a tooth to improve its color and shape. A veneer generally covers only the front and top of a tooth. Veneers can be used to close spaces between teeth, lengthen small or misshapen teeth, or whiten stained or dark teeth. Sometimes, veneers can be done without cutting down natural tooth structure. Sometimes, a small surface layer of tooth is reduced. 

In this case, #10 is a suitable case for veneer. Contact and shape of the tooth are both restored with a single unit veneer.  

Case is presented with multiple decays on the top and lower teeth with several teeth non-restorable. The main concern is aesthetics. After much consideration and communication with the patient, factoring into cost, time, durability, and comfort, we have decided that a bridge, using suitable remaining teeth to support the missing teeth, would be the best option. This bridge option allows correction of teeth alignment to a certain degree and covers undesirable discoloration of tooth structure. In addition, the bridge option is also a great opportunity to treat any issues of involved existing crowns.  

Trauma to the front teeth resulting in fracture of both. Fortunately, no pulpal exposure, and so, there is no need of root canal therapy at this moment. The best option for this would be crowns in the future, but for now, composite restoration will work fine. 

This was a relatively straight-forward case once the shade of the tooth is chosen with our Vita 3D Master shade guide. We were able to fabricate really nice temporary crowns for this patient. Our lab tech did a great job on matching the shade we chose and making sure that the restorations' margins fit.  We chose the e-Max crowns for this case because it has high flexural strength and has similar translucency to natural tooth structure. It is very satisfying to see how this can change a smile instantly. 

Is eMax a good choice for you? Come and consult with us to find out. 

Patient complains of a broken dental crown on tooth #28 that was made many years ago. Tooth #28 is not considered a front tooth, but it will be visible at the buccal corridor (corner of the smile). The most common tooth-color-only crowns are porcelain crowns, and this material has come a long way. There are many choices for different situations, especially eMax and LAVA with great aesthetics and Bruxzir with unparallel flexural strength. Our dental lab technician was able to fabricate a beautiful crown for us. Our patient and I are very pleased with the result. 

There was some abrasion on #30 (tooth with the gold crown), but the crown appears intact. We decided not to change the crown purely for aesthetic reason.  

Treatment of the month (combining both July and August) involved an anterior crown (more specifically upper right lateral incisor) with mismatched color and shade. Patient's chief concern was to change the crown so that it will look natural again. Upon inspection, the mismatched shade was quite obvious. One possible reason of this mismatch in color can be due to the darkening of the tooth itself; and this can be caused by trauma, root canal therapy, or other reasons. Another possible reason is that the rest of the teeth become brighter; and this can be achieved by teeth whitening. 

We have several shade guides to determine the appropriate shade of the tooth. The Vitapan classic is the previous standard of shade guide. It is still widely used but it has its limitation. For aesthetic zone, we decided to use the Vita3D master with the addition of bleached teeth shades. We were able to pick a shade that matches very well. The technology of all porcelain crowns nowadays is well-matured; but it is just as necessary to properly pick a matching shade for the tooth and the remaining tooth structure (stump shade) or else the lab technician would not be able to match the shade. 

Removal of the existing crown was achieved carefully to ensure minimal reduction of the remaining tooth structure. Additionally, we chose a subgingival margin to hide the border of the crown and tooth. In other words, you cannot see where the crown ends. 

For any crown, it is very important to make a provisional (temporary crown) that fits well and also aesthetically pleasing. For the fabrication of a provisional, we have multiple shades to choose from to ensure a good match. In addition to the color of the temporary, proper shape and polishing are essential to satisfy our dental patient while waiting for the actual crown to be fabricated.

The best indication of a well-made aesthetic provisional is that the provisional does not look much different than the final product, which was an eMax crown. 

This month, I'd like to share this case in which the original crown on an upper front tooth was fractured due to recurrent decay. The original crown cannot fit anymore. So, we decided to make a beautiful, temporary crown for the patient in the time being. 

This month, I decided to choose a relatively straightforward case. In this case, old fillings were starting to break, leading to leaky margin and recurrent decay. Again, prevention and regular dental visits are the best way to prevent more expensive and complicated dental treatments. If recurrent decay was not discovered in a timely matter, then the decay could spread further which could lead to root canal therapy or even extraction with dental implants. 

In this case, we decided to replace the fillings with resin. There are definitely other choices including inlay, onlay and crown, but the final decision was made after discussion with the patient. Unless there is some specific reason, we try to avoid using amalgam fillings in our clinic for various reasons. Amalgam fillings are aesthetically inferior, leak mercury over time, are hazardous to dispose of and are not environmental friendly. Amalgam fillings are actually outlawed in many developed countries already. However, in the rare case that amalgam is needed, we have it as a choice. 

The older system to perform fillings involve Tofflemire band, which worked well until the newer ring-type system came along. The ring-type system does take a little longer time and more skill to perform; however, it produces better contour and dental anatomy as a result. Ultimately, everything is dependent on the dentist's attention to detail and skill, cost, practicality, and patient's expectation. 

Patient complained of severe pain on lower right upon hot drinks and pain was relieved upon cold drinks. Symptom started a few days ago, pain worsened over time and pain lingered and often radiated to upper jaw. On the other hand, patient reported that cold water relieved pain. Cold test, percussion and palpation yield little diagnostic value. Cold test #30 and #27 no response. Although #28 looked suspicious, visual exam indicated all fillings were intact without any detectable open margin or recurrent decay. Heat test indicated #27 was definitely the source of pain, excluding #30 or #27. 

For the heat test, I still remembered that NYU taught us to use a torch to heat a gutta-percha. It works, but it's intimidating to see a torched gutta-percha immediately place into someone's mouth. Luckily, I decided that our office must have a water dispenser that can dispense hot drinking water, and the new water dispenser arrived less than a month ago. For that reason, I was able to perform the heat test by soaking a cotton pellet in hot water and then pressing it against the tooth #27. Worked like a charm. 

This is a typical case of necrotic pulp. The rationale is that dead issue creates gas pressure, and heat increases the inner pressure (causing pain) while cold decreases the inner pressure (relieves pain). 

So, really, the best option is Root Canal Therapy. I found that Dentsply's Protaper Gold and GuttaCore work well, cleanly and efficiently in simple endo cases such as this one. The x-ray indicated a well-done root canal therapy. 

After the root canal therapy, patient had soreness on chewing which resolved in several days but had no symptom on hot drinks anymore.