where did all the enamel go? ...erosion

Now that I am back it is time to start posting again..so lets go..
Here we have a patient who has no cavities..but...he has many areas on several teeth where the enamel has worn away and the underlying tooth structure..the dentin..is exposed.

The problem with this is that the dentin is softer than enamel and is much more susceptible to dental caries(cavities)...so theoretically this patient could get bunches of cavities in these areas. Luckily for him...and me...so far he really has not been getting cavities here but slowly we are restoring the bonded areas..

Here is a photo of some areas that we had bonded about a year ago..they are holding up well and they are preventing further erosion from occurring on the teeth!

...and we're back!!!!

Well it has been a long time but I am now back in my original office and it has been completely renovated..the layout is the same but we have new floors, walls, ceilings and equipment. There is still more to do but I can certainly work very comfortably here and we are all glad to be back...Thanks to all our patients for sticking with us thru this hard time.!!
Here is a picture of my treatment room complete with a computer monitor/TV for the patients viewing..
Everything you see in this room is brand new and I am thrilled to have all my patients coming to treatment room like this and getting state of the art treatment!!
See you all soon!!
Dr. Stan

Grand Central Station

Was playing around with my photo gear...managed to take this shot of the big hall at grand central station...make sure to click on the image to get a larger view...

Top to bottom

So what happens when I make a patient's upper teeth look so good that now the lower teeth which seemed to be good... look lousy??
Well you got it....we do the lower teeth!
Here is the case where the patient had upper caps done and wanted them nice and white and now the lower teeth look like ...well you know...

So we prep all the lower teeth...and if you are looking you will see that one is already an implant....

We are going for the gold here...that is we want the most esthetic result possible so I am making crowns with a gold metal underlay for support...and the gold tone gives a very nice esthetic look to the porcelain which will be baked on...here are the gold substructures(copings)first on the lab model and then on the prepped teeth....


All the copings fit very well...a new bite relationship is recorded and the case is sent back to the lab for the porcelain...so come back next time to see how it all looks!!

Mobility Factor

So what do we do when you are getting on in years and your teeth are getting loose...
sometimes we have to resort to capping the teeth and then connecting the caps in order to stabilize the teeth...but that is a big project...and very costly$$.
So an alternate method is to do an intracoronal splint...and here is a good example...

There is one solid tooth and a few loose teeth...so let's connect or splint them to stabilize the loose ones...
First I drill a channel and fit a metal rod into that channel...

Then we bond the metal rod into the channel with good old bonding material...
I then do the same thing for the tooth next to it...

I will do the same thing for all the front teeth in this area...but this was enough for today..next time we will carry this stabilization to the other side...

Guardian Angels!

So here is something I don't do every day...a night guard. Many patients, sometimes even unknowingly, grind or clench their teeth, mostly at night, but sometimes even during the day. Although it usually does not produce symptoms, it definitely has a negative impact on the teeth. This is sometimes called bruxism.

Teeth are not meant to grind against each other(or open bottles and crack ice)...they are meant to chew food. So when you start to grind teeth against each other, they start to wear out and loosen. Some people will get muscular pain as well...
So what do we do...we fabricate a guard to watch your teeth. It is made out of a clear plastic and it can me made to fit either the upper or the lower teeth. Patients are instructed to wear them when they sleep and even during the day when the grinding is severe...

The first photo shows you what they look like sitting on my lab table...a view from the outside and inside...

They are made on models of your teeth as you can see here...

When the patient comes in we try them in and make sure they fit comfortably and snug and we instruct you in putting them on and taking them off and how to care for them.
And when they are in the mouth they really don't look too bad and some patients do wear them during the day....


So why don't I do this more often...because most of the time when I recommend it to a patient these guards end up in a night table drawer more than in a patient's mouth!
The patients who do best with these are those who realize they have a problem and are actively interested in guarding their teeth!

Drill-etch-glue-fill-polish

I have been away lately due to a death in the family...and have been very busy setting up a blog for the family....
But now I am back and here we have one of my usual cases of bonding an eroded tooth.
In our first figure you can see that this was bonded many years ago but both the bonding and the tooth have eroded even more..

the first step is to drill away the old bonding and prep the tooth to accept a new bonded filling...so i drill away until I am down to clean fresh tooth structure...but that is not all...to get the filling to stick I have to first use a conditioner to etch the surface of the tooth..and that is what this next photo shows...if you look carefully you can see that the arrows are pointing to a frosty surface...that is etched enamel which has micro-porosities...

At this point I take the bonding agent...which is just a fancy term for glue and lightly apply it to our tooth surface....

Once this layer is hardened with my bonding light I then apply the filling material until it blends in with the rest of the tooth...
The filling can now be polished and we have a nice smooth surface ...