I can chew... continued...

About a year ago we told the tale of a woman who had to lose all her lower teeth..
we replaced them with implants and here is how the implants looked about a year ago, right after they were placed and before the tissue had healed...

Now fast forward to the present and here is a picture of those implants with the gum tissues healed up nicely and the final teeth in place...in this first photo, you are looking at the gold custom posts upon which the porcelain teeth will be cemented...


Still to come..we are doing the same to the upper teeth!!

It helps to have connections...

This patient has braces as an adult and to prevent the lower teeth from drifting back to the original crooked positions we try to connect the teeth by bonding them together.
This patient had it done about a year ago and now the plastic that was used was starting to loosen...

The treatment is to drill out the old plastic and create a fresh channel to place a new connection..here is the new channel prepped...

A twisted steel wire is fitted to the space and will be bonded into place to help hold the plastic and teeth together..here i am fitting the wire to get the right size...

Once the wire is sized I then take the soft plastic and embed the wire as you see here...I then continue to fully cover the wire and polish it so that the patient has no feeling whatsoever that anything is even there...


Unfortunately the mouth is a tough place to survive and this procedure will have to be repeated every so often..but the patient does not mind..her teeth are straight!

Cracked!

Most of the time, no matter what you do to your tooth/teeth we can figure out someway to save them...whether a filling or crown or root canal or something else.
But occasionally a patient presents with a situation where no way no how can I fix the the problem...and here is one of those situations. A cracked tooth, where the crack runs the entire width of the tooth and the two pieces are now separated.
Usually this can be a rather tricky diagnosis...because the tooth pieces that are cracked are not separated..but in this case it is rather obvious...
In this photo..rather gruesome, you can see an up close picture of a molar where the crack has developed and the tooth is now in two pieces! Amazingly the patient has no pain whatsoever and was not even aware of the seriousness of this situation.
The patient has been referred to a surgeon for removal of the tooth and hopefully we will be able to place an implant to restore him back to full function.

Which camera do you use...

That is probably the question I get asked most..
Most of the dental pics that you see are taken with a simple point and shoot camera..
in the old days before digital we had fancy set ups with single lens reflex cameras and ring lites and macro lenses..Wow..things have changed..now I use a simple little camera with a built in flash on the macro setting..and I am very pleased with my results..


For pictures that require me to get deep into the mouth I will use an intra oral camera...it is a small camera placed on the end of a wand which has a lens and two lights to to illuminate the dark workspace.
The intra oral camera has been especially useful in educating my patients as to dental situations in the mouth that they would normally not see!
This is a good example of new technology which I use daily.


and this is what it looks like with the lights turned on...

More implants

This gentleman came to me twenty years ago and was missing a front tooth right up front..he is clarinet and oboe player and I made him a removeable tooth that held up well while he played...now he wants more!! He wants to get rid of the removable tooth...so I had my surgeon place an implant..and here it is...the implant that is..
We will start working on the replacement tooth as soon as the gums heal up around the implant...

Before and After

So lets return to an old posting and see how a patient is doing..you may recall seeing these pics when i posted them telling you how i fixed the upper teeth and now the lower teeth looked lousy..so she came back to do the upper teeth..
well see the following three pics for the before middle and after!
here is the photo with the upper teeth fixed but not the lower teeth...

and here is the picture of the lower teeth prepped for new crowns...

and finally here is a picture with the lower teeth finished...she loves it!!

Freshen Up..

Here is a simple one..Patient is a middle aged woman..has receding gums but the gums are healthy..
she wants a cleaning to get rid of the grime..especially on the lower teeth.
Well the cleaning certainly gets rid of the grime but I cannot make them whiter unless she wants to do some dental bleaching.
As usual click on the picture to get a nice big one for detailed viewing!

Identical twins...Identical teeth??...not!

Identical twins came in today..13.5 years old..girls..
So the question is..are the teeth identical also..well you be the judge..
they both need braces but the teeth are certainly not identical!

The top three are one twin...the bottom three are the second twin.
Click on the picture to get a larger version for comparison purposes.

Sunset atop Mauna Kea on the Big Island of Hawaii...awesome!

Tough Choices...Photoshop it!!

A young woman came in today and although we have discussed doing some aesthetic dentistry on her front teeth she has always declined. Well today she tells me that now when she smiles and is photographed the photos clearly show something wrong with the front teeth. This has prompted her to finally get these fixed.
I gave her some choices..none too easy...
1. bond them with tooth colored acrylic..not a bad choice but has a limited lifespan and will probably need rebonding rather often...and the color will be close but not perfect.
2. porcelain veneers or laminates...i can probably get a great color match and this would last a long time without any maintenance needs..but this is much more expensive..
She will think about it and let me know which solution she wants..
Of course being who I am..I gave her a third option which is probably the easiest..Just photoshop the pictures after they are taken!!
Click on the picture below for a close up view of the problem!!

And of course here is the photoshopped version...
while I was at it I could have done all the teeth but the front two incisors are all for today.

Implants

So what do you do when you lose teeth and you dont want to make a conventional fixed bridge because you don't want to grind down perfectly healthy teeth?
Implants...perfect solution.
This patient lost the lower front four teeth and we did not want to have to make a bridge involving the adjacent canine teeth which were healthy..so the implant surgeon placed two implants in the toothless space...and this is what the implant fixtures look like before teeth are built on them...

Onto these implants we now build a metal framework that gets screwed into the implants and eventually we will bake porcelain onto the metal to make this patient beautiful..
here are two photos of the framework and you can clearly see the screw holes which will be used to secure the implant into place.

Pinned down

So what happens when you break a tooth and half is gone and you need a quick fix because you've got a big dinner date later tonite?
Well that is what i was up against today.
A long time patient broke a tooth and needed a quick fix...here is the broken tooth

Now you just can't put a filling into this tooth and even with modern dentistry's miracle bonding agents we still need some old fashioned help...and for that we turn to small pins...so i drilled two pin holes into the teeth in the area where the tooth broke as you can see here...

Into those pinholes I can now place/screw two titanium pins around which I can rebuild the tooth.

Decay... decay... where art thou?

So the patient says what do you mean I need a filling..everything feels great...no way!!
Well I say you do need a filling..and here is the proof..
Bicuspid tooth...young woman...20 years old...tooth looks OK and on the X ray there is no evidence of a problem...but the central groove looks suspicious..on both of these teeth..but I am only doing one today...take a look...

So after a little novocaine I take my small drill and carefully open into the groove and sure enough there is more than just a little decay...this is rather significant for a tooth this size...

So with a careful excavation I am able to clean out all the affected tooth structure until it looks nice and clean...

and in just a few minutes I can bond a tooth colored filling into place and it
is like it never happened...everybody is happy and the patient now sees these photos and says ..Wow doc..how did you know! Next visit we do the tooth next door!

To drill or not to drill..that is the question.

This morning I am encountering a very frequent quandary...tooth colored fillings that have small defects. The question is do I remove the fillings and replace them with nice new ones or are these fillings still functioning and perhaps I should leave them alone? In this case, X rays do not offer any help.
Although it may seem like a simple situation in which I should just re-do the filling..the problem is that anytime you drill into a tooth to replace a filling you might end up with a sensitive tooth afterwards and then I have a patient telling me that everything was just fine until I suggested this!!
Well in this case I decided that I should replace the fillings to prevent this from becoming a larger problem down the road....will report back on this next week.

...and we're back, again! one year later, blogging resumed!

It has been well over a year since I returned to my rebuilt office after the steam pipe explosion near our building. A lot has happened since then and I am pleased to say I am busier than ever and had forsaken the blogging. But due to popular demand I am resuming the daily blog so that my patients and future patients can search this site to satisfy their dental curiosities..if such a thing exists?
In any case, this can also be a useful tool for someone contemplating becoming a dentist. So with a full schedule of patients I still hope to find some time to amuse and inform you all.
So with that here is my general setup...you should first notice that my treatment room is a large spacious room and affords plenty of room for all patients including those needing wheelchair access...secondly the room is outfitted with the newest technology to give my patients the best possible care...3 large windows in my treatment room give some of the best views of the grand central area including a stunning view of the Chrysler building...

so now...first patient in the morning here for a routine cleaning and exam. A very delicate woman who does not want to experience anything even resembling pain..so we roll out the Nitrous Oxide(laughing gas)and she has a very pleasant experience..take a look at the setup. Click on the photo to get a larger view and then click your back button to return here!