Porcelain Power

Like everything else around us...dentistry evolves.

For years, when a patient needed a full crown (cap) to restore a tooth, the state of the art, was a crown that had a metal understructure and then porcelain baked on top of the metal..and they were beautiful, strong and long lasting...

Over the last several years the standard of care has changed...and I can now offer crowns that are even more esthetic..as they are now made of porcelain only...no metal understructure.

The technology now exists where we can have porcelain strong enough to resist breaking and without the metal understructure... the translucency of the porcelain leaves it even more esthetically pleasing..

In addition..with our old style porcelain/metal crowns...no matter how well we did it, the metal could leave a slight grey tone at the gum line...not really noticeable to most people...and not objectionable...but there was a greyish tone if you really inspected.....

Now with the power of porcelain...gum line areas are no longer getting that grey tone..

These photos will tell the story...

here is the preparation of the tooth ready for 

crown try in...

Do you speak dental??

So there I was...working hard on a new crown for a patient..when suddenly I decide to talk to her...
and of course she tried to respond...but how could she...both of my hands, two instruments, saliva ejector, a multitude of cotton rolls all seemed to render her attempted answer into a new language..
I looked up and said to her..what did you say...??
that is when i realized I could not possibly understand what she was saying...

After all these years I am still expecting patients to answer my queries..that btw, had nothing to do with anything concerning the procedure I was doing!

I still don't speak dental! Even after all these years!

Decided to start a website for the office..here is the intro video.

Ok..it's time to resume posting some real life dentistry.

Let's start with this 74 year old woman...she has had dental work her entire life covering almost all her teeth...when she came to me her chief complaint was that her lower teeth looked awful
And, she was correct...as one gets older the upper teeth show less and the lower teeth show more due to muscle sagging...and now she always noticed her dark and non uniform lower front teeth...

In order to correct the crookedness and restore a full lustre look to these teeth, porcelain type crowns are the treatment of choice.. We could have opted for a laminate/crown combination plan but I felt that I would be more in control of the final look if I had full coverage of the teeth.

I would do 6 crowns in front...at today's visit we prepared 3 teeth for crowns...she could not sit through a long enough visit for me to prep all six teeth, so we decided on three preparations and temporaries today..and three next visit.

I fabricated the three temps with an alginate technique.  The patient left the office after a 90 minute visit and was very comfortable and satisfied with the fit and look of the temps.  At this point the temporaried are modeled off her original teeth but the final porcelain crowns will be straightened out as much as possible without having to do root canal or minor tooth movement.

Patient will be returning next week and I should have the next three teeth prepared and hopefully will take an impression for the permanent crowns as well.

Hope you enjoyed this real life dentistry.

Dr Stan

One tooth smile makeover...

Sometimes one tooth can disrupt the entire smile line...with this patient, a middle aged woman...she had what is called a peg lateral where the lateral incisor is in the shape of a peg. This is not an umcommon finding and there are a number of ways to treat it. In this case I decided to place an all porcelain jacket on the tooth to get the most esthetic result possible...take a look at these two images of the tooth before any treatment.


The first step is to file or prepare the tooth so that a jacket can be placed over it...in this picture you can see the finished preparation...

And one week later the patient returned and we tried in and cemented a beautiful porcelain jacket that matched the adjacent teeth and immediately changed her smile...she still has an unesthetic tooth on the other side but that tooth does not bother her and we are leaving it alone for now.


Now...if she would only let me do the tooth on the other side of the smile!!

everybody needs implants

Implants are now the first choice for restoring missing teeth.
We don't have to involve other adjacent healthy teeth to make a bridge..with implants we are only dealing with the patient's missing tooth/teeth situation.
Here is a case where a patient lost three teeth in the lower front jaw. Years gone by we would have made a bridge where we grind down the adjacent healthy teeth..but no more.
As you can see here, in the photo above, the patient had two implants placed into the area of missing teeth..these two implants will now hold three porcelain teeth.
First the lab makes a metal framework for me that I try into place...in this photo you can see the framework that was tried in..

the framework then goes back to the lab and porcelain is then baked onto the metal framework and as you can see it is made to appear as three distinct teeth.

and in the next photo you can see that this is not cemented into place but rather we are making this as an implant case which is screwed into place.

The screw holes will be filled with a tooth colored acrylic and will not be visible and the patient will not feel anything unusual in that area.
of course now the problem is that the remaining teeth that the patient has really look old compared to the new teeth..but that will be changing as the two teeth remaining are scheduled for some cosmetic work...we were not going to make the new teeth look like the old teeth!

porcelain and gold ..a winning combination.

Gold..still the best metal that dental scientists have to offer us..but you would be hard pressed to find a patient willing to accept any gold showing when you make them teeth, no one wants any gold showing.

So here is a case where i used gold for the posts underneath and then porcelain crowns on top.
The implant surgeon placed 5 implants and I made 5 gold abutments/posts...on top of those posts we place a 10 unite porcelain splint..done in two sections...
in the photo above you can count 5 posts and one natural tooth upon which the porcelain bridgework will be made.

I decided to make this case in two sections...lower left and then lower front...



First I cemented the lower left for the patient and then lower front...
the patient feels great and loves the fact that by giving a slightly different size and angle to the teeth they look like they are his teeth and not just another set of straight caps with an artificial look.

Combo Case

Implants are everywhere in people's mouths today...
here is a case where there are two implants in the back section of the mouth and I connect those two implants with a natural tooth that had a root canal and a post.
The natural tooth is somewhat questionable as to its longevity so i am hoping that by stabilizing it with the impants I will get extra years from it...
If in the future the natural tooth needs extraction then I will have a single tooth implant placed there...we shall see