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

4 little teeth/caps

Well when you are in dental school they sort of scare you away from doing crowns/caps on the lower front teeth..why...well they are very small and hard to prepare properly..the angle to work on them is tough even though they are right up front...and the teeth are small and any mis-prep and you hit the nerve...
but sometimes we have no choice..this gentleman had radiation and chemotherapy about two years ago and since that time his lower front teeth were continuously getting new areas of decay...
finally we decided to cap them all and hopefully prevent future decay...I had to make sure to get the crown margins below the gum level to prevent gum level decay and that made it even harder..but here he is and here are the crowns at the cementing visit..
the gums are a little puffy from irritation from the temp but i am optimistic that they will tighten up around these little caps!!
It helps when they come out looking this good..the patient loved them!

sometimes you get lucky...

A long time patient came in about two months ago...reported that she took a fall and may have injured her front teeth...clinical and xray exam showed nothing unusual.
About a week later the tooth took a turn for the worse..it was still asymptomatice but it had turned a dark grey...I explained this was due to the traumatic injury and would need to be treated ASAP with a root canal treatment to remove the damaged puly tissues.

Root canal treatment was successful but she still had a greyish tooth..and being that this is right up front and center it was no good!!!

A crown or laminate was ruled out as the whole tooth was basically intact and I felt that due to the unusual prominence of the tooth any artificial restoration, no matter how good, would be obvious...

So we decided to do an internal bleaching, often called a walking bleach...although this can sometimes have some unintended side effects...we decided to go ahead with it.

It basically involves placing a bleaching material in the tooth and letting the bleach penetrate the internal discolored aspect of the tooth...well the patient came in ten days after the first treatment and we had a huge success.

The patient and doctor were thrilled!
Please click on the photo to get a larger version!

Ouch..that's got to hurt...

Unfortunately when you have a practice with a lot of elderly patients you occassionally get the phone call telling you that one of your patient's took a fall and stopped that fall with their face...
In any case this wonderful woman was just in last week for a routine procedure and yesterday she called to say she took a fall yesterday and needed to see me right away...
I told her to come on down and here she is..fresh out of the emergency room...

Clinical exam shows that although none of the teeth are unusually loose there are some chips evident on the two central incisors...take a look...


Now we have a machine to tell us the vitality of the nerves that are in the teeth and the test revealed that all of the teeth except for these two respond normally..
these two teeth show no response to an electrical stimulus...
so stay tuned...she is returning next week and we will re-examine her and see if
she will need to have work done on these teeth....

Did you say white???? Yes Dr. - I said WHITE!

As dental students one of the first things you learn about cosmetic dentistry is that you don't want to give someone really white white teeth...it just looks too fake.
Well in today's world it seems that patients will occasionally want that overly too white to be true look and here is one of those cases.
This gentleman has seen his share of dentists over the years and he wants to have a certain look at all costs...
He had his upper teeth capped with really white porcelain and now he is in my office to have his lower teeth "fixed"....He says he wants them to be whiter, and bolder, and stronger ...and bigger and so on and so on.
So take a look at these two pictures and you can see how the lower front six teeth are looking pretty poor next to what was done on the upper...
As usual for this blog..click on any picture to get a larger version then hit the back button to return to the blog!

Now the upper six teeth, were like I said, done elsewhere....and I made the 2 back teeth that you see on each side on his lower jaw...

And to tell you the truth in this particular case I see his need to have his lower teeth whitened, since they are so off shade from the uppers...so here goes...
I determined that in order to make them a bit taller and stronger I would have to
open his bite slightly...which he was able to easily tolerate with the temporary caps I made for him...
After about three try in visits in which our patient had numerous requests for changes we finally settled on this result....
He loves it and is very happy...and he is especially pleased with the slight overlapping of the teeth to give them a more natural appearance instead of the straight line across look.
Would I do it from the outset...probably not..but he claims he is in show business and he needs it...
so there you go....white as white can be...maybe he should say he is in snow business with this level of white! Here are a few different views.


Of course, now the upper teeth don't look as white as he would like them to look..
I would not be surprised if he wanted his upper teeth redone to look this white...
and by the way these crowns are pressed porcelain and are very easy for the labs to work with and modify!