Smile Repair Using Bonding and Emax Crown

Today's patient came to us with complaints of mismatched central incisors. The patient's right incisor had a large composite (tooth colored) filing that had become worn and stained over time. Their left incisor had a crown that was too light and opaque compared to the surrounding teeth. Both of these esthetic problems are very common, as teeth tend to age differently from the materials we use in dentistry. Composite fillings pick up stain and erode more quickly than enamel while crowns do not respond to color changes like surrounding teeth. The result is that restorations in the front of the mouth gradually become more obvious and less natural over time. 

Dr. Kari Ann Hong set out to repair this smile by placing a new filling on the left incisor and using an Emax Lithium Disilicate crown on the right. The new restorations add natural coloring, opacity and shape back to the patient's smile. In the before picture, the existing dental work is fairly obvious. The new crown and filling blend naturally and bring harmony back to this smile! If you would like to know more about crowns, fillings or other cosmetic procedures we perform at our office, please give us a call!

Case Presentation: Crown Delivery

Take a look at the amazing work we can accomplish with the help of our dental labs! This patient came to us needing a crown repaired in the front of their mouth. As always, our main concern was delivering a restoration that looked completely natural. After preparing the tooth and making impressions, we took a number of diagnostic photographs to capture the nature of the patient's smile. Using just the photos and impressions, our lab created an unbelievable new crown. The color, shaping and opacity are a perfect match to the existing teeth. If you would like to see more of the esthetic work we perform at our office, check out the "cosmetic dentistry" section on our blog index!

Specialist Spotlight-Synergy Dental Lab

At Thousand Oaks Family Dentistry, your appointment is much more than meets the eye. Behind the scenes, a network of dental specialists, labs and technicians help ensure that you receive outstanding esthetic results from our office. Today, we would like to highlight Synergy Dental Lab and its owner Andy Knapp, for their efforts in delivering our patients beautiful crowns and bridges.

Synergy Lab's owner, Andy Knapp.

At Andy’s lab, a team of technicians bring together over 70 years of design, ceramic and modeling expertise. They use a combination of proven techniques and the latest CAD/CAM technology to deliver products that fit and look wonderful. This ultimately means less time spent in our office, away from your friends, family or work. Even difficult cases can be handled with ease, through the use of digital photography and shade matching. The end result is a crown or bridge that looks, feels and fits like a natural tooth.

An example of the incredible work that comes out of Synergy Dental Lab. Through a combination of time, effort and technology, the quick impressions we take at our office become beautiful crowns and bridges. 

Synergy is a locally owned and operated business. Aside from being a part of the Thousand Oaks economy, this allows them to provide quick turnarounds and immediate support. Difficult time constraints, complicated cases and other concerns can be addressed in a matter of hours or days, instead of weeks.

We love working with Synergy dental lab because they offer a high quality product with excellent customer service. The speed, accuracy and support offered by this lab allows us to provide more convenient appointments at our office, ultimately saving you time and money. If you have any questions about Andy’s lab, or any of the other offices we work with, please give us a call. We are here to make your entire dental health experience as easy and confusion free as possible!

BruxZir Crowns

At our office, we want all of our dental work to be beautiful, functional and enduring. Many times, finding the intersection point of these three qualities requires us to turn to new technologies and developments in dental materials. In the case of dental crowns, we utilize BruxZir milled zirconia as a beautiful restorative solution that stands up to even the toughest conditions.

In the human mouth, the farther back a tooth is, the more relative force it will receive during a regular day. Teeth closest to the jaw joint are situated right next to the masseter, the muscle responsible for chewing, biting and closing the mouth. This muscle can generate incredible amounts of force, enough to crack or fracture your own teeth. Because of this, many types of crowns will chip, break or fail in the rear of the mouth.

A diagram highlighting the masseter muscle. 

In the past, porcelain fused to metal (PFM) crowns were the best tooth colored solution for posterior teeth, as their solid metal underpinnings are incredibly durable. However, the baked on porcelain can fracture and break during normal wear, requiring replacement or adjustment. Gold crowns were popular as well, so long as the patient was comfortable without a tooth colored restoration. Other materials, such as full porcelain crowns, are simply too fragile to be placed in such a functional position.

In contrast, Bruxzir crowns combine longevity, strength and natural beauty. They are milled out of a solid piece of engineered zirconia to match the color and shape of the original tooth. Since it is a single piece of material, it better matches the light characteristics of natural teeth. There is no metal backbone block out and less tooth structure has to be removed to accommodate the newly made crown.

While some materials (such as Emax) offer better translucency and color properties, nothing can stand up to BruxZir’s durability. They are essential chip, grind and crack proof. Even with heavy grinders and clenchers, the single piece zirconia will not fail or erode. No other material can offer this level of endurance in an esthetic, tooth colored package.

Even taking a hammer to a BruxZir crown will not ruin it's structural integrity. 

We typically only place BruxZir crowns on molars and more rearward teeth. While these units are esthetically superior to PFMs, they are not as cosmetically versatile as Emax crowns. In essence, their incredible strength comes with the price of poorer relative translucency. For front teeth experiencing less average force and wear, we will typically place this more esthetic material. Of course, we still place PFM and gold crowns, but most patients are eligible and more willing to be fitted with these state-of-the-art units.

If you have any further questions about BruxZir crowns, or any other crown materials at our office, please give us a call. We would love to talk you through your crown options, and which material would work best for you personally!

Crowns and Bridges

Hands down, dental crowns and bridges are the most versatile restorative tools at our office. Whether going on previously decayed teeth, root-canaled teeth or a dental implant, they offer convenience, beauty and excellent flexibility. Please take a moment and read why we love crowns and bridges at Thousand Oaks Family Dentistry!

In it’s simplest form, a dental crown is a hard, solid object that replaces the natural “crown” of the tooth. It can add structural rigidity, biting function or esthetic value to any damaged or decayed teeth. Similarly, bridges are three (or more) crowns made in tandem, were the outermost two units are attached to your natural teeth (or implants). The goal is to “bridge” the gap created by a tooth that was previously removed. Both crowns and bridges are prepared using the same techniques.

Crowns and Bridges are placed for a number of reasons. Crowns can be used to fix teeth that have too much decay to be rebuilt with a dental filling. They can also restore structure after a tooth becomes cracked (depending on the nature of the crack). Bridges are used to replace once-missing teeth in almost any area of the mouth. All that is required is that the gap is “surrounded” by viable teeth for the bridge to be mounted to. Likewise, implant crowns are the final restorative step in implant surgery and give the implant its beauty and functional ability.

The basics of how a tooth is prepared for a crown. (Read top left to lower right)

To prepare a tooth for a crown or bridge, we essentially remove a ~1.5mm gap from around all surfaces of the tooth, in addition to any defects or decay. The walls of the teeth are slightly tapered, so that the crown can be placed easily and has ample tooth structure to hold on to. At the gumline, a distinct ridge (called the “margin”) is created to give an explicit surface for the crown to be cemented against. In the case of bridges, this step is done on two separate teeth, with special care given to making both teeth completely parallel. For implant crowns, these steps and designs are built into the shape of the abutment, which is essentially a manufactured “undertooth” made at an off site dental lab.

1) A natural tooth is broken/decayed and cannot be repaired with a filling 2) The tooth is prepared for a crown, giving it clearance for the new unit and proper structure. 3) The final crown is cemented and delivered. 

Preparing and delivering bridges is done with much the same technique. However, a missing tooth is replaced in the process. 

After your tooth is prepared, we have a number of material options for making your crown or bridge. In nearly every case, we will use tooth colored materials and restorations. We can match almost any esthetic concerns, from color to matching staining patterns and the shape of adjacent teeth. For front teeth, we often use eMAX lithium disilicate crowns for their excellent esthetic properties and strength. In molars and back teeth, we typically place a material called Bruxzir. Bruxzir is an engineered zirconia that surpasses all other crown materials in terms of hardness and durability. We also have a number of more traditional crown materials at our disposal, ranging from gold to zirconia and porcelain fused to metal (PFM). Picking a crown material is a discussion between you and Dr. Kari that considers your whole-mouth condition and your specific wants and needs.

An example of an eMAX bridge/crown. 

At a crown preparation appointment, we start by getting you numb and taking an initial impression for our temporary crown. We then prepare the teeth, taking care to provide ample clearance for the new unit. Once the tooth is fully prepared, we take a final impression and make notes for the lab. Finally, we use our first impression to make an acrylic temporary. While this will not be as strong as your final crown, it will allow you to leave with a fully shaped tooth. This is important for esthetics, chewing function and for maintaining the space between the prepared tooth and the opposing tooth. After two weeks, the lab will deliver your crown, which will be adjusted, seated and cemented in a quick follow up appointment. The process for implant crowns is slightly different, but still requires appointments for initial impressions followed by the actual crown delivery.

If you have any further questions concerning dental crowns, please give our office a call. We place and deliver crowns almost every day and can walk you through your unique needs. There should be no confusion, fear or apprehension surrounding your crown or bridge treatment!

Emax Lithium Disilicate Crowns

    When it comes to dental crown materials, there are many different options to suit a multitude of different scenarios. Some, like full porcelain crowns, provide excellent esthetic results. Others, such as full gold units, provide extreme durability along with desirable tooth-like physical properties. However, what options offer both beautiful cosmetic results along with enduring strength?

For many years, porcelain-fused-to-metal (or “PFM”) crowns were the cornerstone of “form meets function” in crown materials. These units are made by taking an alloy metal core and attaching a thin layer of porcelain over it, resulting in a durable tooth colored restoration. Unfortunately, this process is not without it’s downfalls. The porcelain has a tendency to crack and break between the opposing tooth and the hard metal sublayer. Additionally, the alloy substructure is extremely opaque, and prevents the overall crown from having the translucency of a natural tooth. This detracts from the overall esthetics of the final product.

While PFM crown still have a very useful place in dentistry (and are still regularly placed at our office for various reasons), modern technology has provided us with newer and more elegant solutions. Today, we can offer Emax as a means of creating a beautiful crown or bridge with long term durability.

An example of a finished Emax dental bridge (right) and crown (left)

Emax is a lithium disilicate material that combines the translucency of porcelain with incredible strength. On average, these restorations can withstand 360-400 megapascals of force before breaking. What does this mean? Essentially, you could hammer a crown made of Emax into a plywood board and pull it out without damaging the structure. This incredible resilience means that Emax can be placed in almost any location in the mouth with extreme confidence.

In terms of esthetics, Emax rivals porcelain in that it provides an incredibly toothlike translucency. One of the most obvious “tells” of a dental crown is poor transmittance of light. Crown that do not respond to ambient light like natural teeth are just as visually jarring as poor tooth shade matching. Emax offers this low opacity in conjunction with the ability to have natural artifacts “baked” into the crown’s surface. Surface lines, color gradients and staining can be added to the crown to blend it perfectly with the adjoining teeth. Overall, this step helps detract from the “chiclet gum” look that is imparted to certain crown.

Of course, Emax in only one of the excellent crown options offered at our office. While it has some great properties, it can be a poor choice of restoration depending on a number of factors. Your crown material should take into account mouth location, neighboring teeth and your personal expectations. We regularly work with a number of different materials because our patients regularly need a number of different materials. If you have any questions Emax, or any other materials we offer at our office, please let us know at your next appointment!

Invisalign Invisible Braces

One of our very satisfied Invisalign patients. Crowding was addressed on both the upper and lower arches, along with bleaching using the Invisalign trays. The total treatment took 17 aligners and 8.5 months. 

Your smile is one of your most noticeable and forthcoming facial features. Naturally, you take great care of your teeth, brush and floss daily and possibly use whitening products. Still, there is one feature of smile and facial esthetics that cannot be addressed by home care: Orthodontics. If you are interested in having a straighter smile with minimal dental appointments, excellent predictability and discreet treatment, you may be a good candidate for Invisalign.

Invisalign is a system that uses dental impressions, advanced computer programs and clear plastic trays to provide virtually invisible orthodontics. The process is very simple. On your first appointment, we will take a series of impressions and pictures and send them to Invisalign’s headquarters. After that, a representative will send Dr. Kari a digital mockup of your smile, including the movements each tooth is predicted to make. After she approves and adjusts Invisalign’s plan, a set of aligner trays are shipped to our office.

You then return for your second appointment, where we use composites (same kind used in tooth colored fillings) and a special template tray to construct a series of tiny “buttons” on your teeth. These buttons allow the trays to latch and move teeth with extra torque, when necessary. This appointment lasts about 45 minutes and you leave with your very first set of trays!

From left to right: We use the blue trays to take a quick impression of your teeth, followed by a "bite impression" using the purple material in the applicator gun (called Regisil). After invisalign receives and processes your impressions, we receive your custom trays (pictured far right). 

Most Invisalign treatment plans last around 9 months to 2 years, with about 15-30 included trays. You will be expected to periodically return to our office to ensure your treatment is going as planned. While this timeframe may seem lengthy, remember that the trays are invisible, comfortable in the mouth and removable. Any time you need to eat, brush or whiten your teeth, you can remove your appliance in a matter of seconds.

While Invisalign is an extremely predictable and effective process, not everyone is a good candidate. Those who cannot devote the majority of their day (awake and asleep) to wearing trays will encounter a delayed or entirely ineffective orthodontic treatment. For this reason, we do not recommend Invisalign for children, as “patient compliance” is especially difficult to obtain. Furthermore, certain tooth movements are impossible without traditional wire-and-bracket braces. Being a removable piece of plastic, there are limitations to the directions that Invisalign can precisely realign teeth. To determine if you are a good candidate, or address your questions and concerns, please schedule a consultation with our office.