Case Presentation: Repairing Periodontal Damage

According to a recent study put out by the CDC, about half of American adults are affected by periodontal disease. As this condition progresses, the gums and bones recede away from the teeth, eventually leading to their loss. While deep cleanings and medications can stop the spread of the disease, nothing short of extensive surgery can replace lost bone and gums. 

In today's patient, periodontal disease had left them with three lost mandibular incisors and deficient gum levels. Due to the thin nature of bone at the front of the mandible and damage from disease, there was only enough structure to place one implant. Fortunately, by working with the experts at Opus One Dental Labs we were able to create a beautiful three tooth bridge complete with mock gums. Restorations like this have to be designed very carefully to protect the implant and prevent rotation/unscrewing. The end result looks phenomenal and functions just like natural teeth! If you would like to know more about what we can do with implants, please give our office a call!

Different Types of Dental Crowns

As technology progresses, the field of dentistry gains new materials, techniques and services. However, we rarely stumble upon a magic "one size fits all" approach. This is particularly true of the advancements in dental crowns. There are nearly hundreds of different crown materials and manufacturers, each with their own specific use. In this article, we will discuss four general types of dental crowns and why we use them. Enjoy!

Porcelain fused to metal- These crowns combine the esthetic properties of porcelain with the adaptability of metal. A metal framework is cast to a stone model of the prepared tooth. Afterwords, layers of porcelain are baked on, creating the look of a natural enamel. These crowns are typically used in the back of the mouth, as they are durable and resist wear to the opposing teeth. However, the metal substructure can make these crowns too opaque to be used in cosmetic applications.  

Gold- Gold crowns are less frequently used in modern dentistry due to the availability of newer, more esthetic materials. However, gold is one of the most adaptable materials available, allowing for a near seamless junction between tooth and crown. It also requires the least amount of tooth structure to be removed, but this becomes irrelevant in instances of severe decay, chips and fractures. 

Lithium Disilicate "Emax": Emax is an extremely durable and esthetic material. It can be used in nearly all areas of the mouth, although we tend to use it in cosmetic areas. Since these crowns are made from a single type of material, they transmit light very well and perfectly match natural enamel. Emax can even be stained or painted to match imperfections in the surrounding teeth!

Zirconia "BruxZir": Like Emax, BruxZir crowns are made from a single type of material (engineered zirconia). However, they trade cosmetic advantages for extreme fracture resistance and durability. BruxZir crowns are best used in patients with strong jaws or grinding problems, where other materials will not last. In fact, these crowns are hard enough to wear enamel, meaning that they need to be used judiciously and only when necessary. 

An important note is that Thousand Oaks Family Dentistry charges the same crown fee regardless of material used. We want our patients to know that we are focused on the best long term outcomes for their dental care- be it from the newest technology or tried and true methods!

Case Presentation: Midline Correction

Here's a great example of one of the more dramatic changes we can achieve using ceramic crowns. This patient came to our office with white and appropriately shaped front teeth, including a crown on the front-left incisor. However, their midline had a noticeable leftward tilt.

In dentistry, midlines have a huge impact on how we perceive teeth and cosmetics. If the line between the two central incisors isn't perfectly horizontal and centered on the face, we perceive the overall smile as crooked or uneven. To correct this patient's midline, we removed the existing crown on the left central incisor and changed the underlying tooth to face more horizontal. We then corrected the right central and lateral incisors to match. Even in temporaries, this patient's smile is instantly more esthetically pleasing. In two weeks, our lab will deliver a set of ceramic crowns that will complete the transformation If you want to know more about midlines, crowns or cosmetic dentistry, please give our office 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!

Cosmetic Reconstruction With Emax Crowns and Veneers

Today's case is a great example of the importance of color and translucency when designing a crown or veneer in the anterior region. This patient came to our office dissatisfied with their current dental restorations and overall smile esthetics. The crowned teeth appeared unnaturally opaque and presented with a sharp change in color where the teeth met the gum tissue. These crowns were created using porcelain fused to metal (PFM), a classic technique for fabricating tooth colored crowns. While they make very functional restorations, PFMs take away from the natural translucency of teeth due to their solid metal underpinnings. This patient's condition was exacerbated by gingival recession, which revealed contrasting natural tooth structure underneath the crown.

To create a completely natural smile, we utilized Emax lithium disilicate crowns and veneers across the maxillary and mandibular teeth. These crowns are made of a single type of translucent material, and thus transmit light like natural enamel. Similarly, the single piece construction makes these crown very strong, allowing us to replace the PFMs in the posterior region as well. By working closely with our dental lab, we created a set of crowns and veneers that are uniform in shape, color and shade. The final product is a natural and youthful smile designed to stand the test of time! If you would like to know more about crowns, veneers or any other esthetic service offered by our office, please give us a call. 

Dental Questions: What are my options in improving the esthetics of a single tooth?

This new tooth was restored using only bonding and disking. What a change!

Teeth can become cosmetically damaged through a number of different means; from chipping to fractures, staining, decay or even as a result of problems in development. Likewise, our office offers a variety of ways to restore your teeth and make them appear natural in your mouth once again.

As with any procedure, we start the process by making sure the tooth in question is sill alive and healthy. There is no sense in restoring a tooth with serious underlying problems. Secondly, we assess the extent of the damage. For minor chips and blemishes, a combination of bonding and “disking” may be the perfect fix. This process is virtually drill-less and conserves as much tooth structure as possible. You may be surprised to see what we can achieve without a crown or veneer!

For teeth with larger blemishes, or those missing a substantial amount of structure, we will often elect to utilize a crown or veneer. Cosmetic veneers are usually placed on anterior (front) teeth to modify their appearance. Since they are cemented to only one surface, they do not add any additional structural integrity. In other words, the underlying tooth must be in good condition to receive a veneer. In contrast, crowns can be used to improve the cosmetics of a tooth that has lost a significant amount of structure.  Since crowns wrap around the tooth, they can restore shape in every dimension while adding strength and rigidity to the underlying enamel and dentin.

In any instance, the result of your treatment will be a beautiful and natural looking tooth. We pride ourselves in offering high quality cosmetic solutions, no matter what the problem. If you would like to know more about bonding, veneers or crowns, please give us a call!

Pankey Institute

As you likely already knew, one of the cornerstones of modern medical education is the idea of being a “lifelong learner.” Dentists, physicians, hygienists and nurses all have to meet yearly  “continuing education” requirements to hold a valid license and continue providing care. At Thousand Oaks Family Dentistry, we pride ourselves in treating our patients with the most up to date and complete dental knowledge. With this principle in mind, we are proud to announce that Dr. Kari Ann Hong recently completed training at the prestigious Pankey Institute in Miami, Florida.

The Pankey Institute offers world class teaching facilities and laboratories (pankey.org)

The Pankey Institute is a nonprofit organization that prides itself in offering unbiased and research proven dental courses. Their current curriculum spans the entire scope of practice, including esthetics, night guards, and functional shaping of dental restorations. The culmination of their educational program is the Core Diagnosis principle. Here, a series of facial measurements and proportions are used to make better decisions for cosmetic procedures such as orthodontics, crowns/veneers and periodontics. Tooth shape, gum height, and smile size all have a dramatic effect on how we perceive facial esthetics. This system collects all this data to define the safest and most efficient way to develop a beautiful and natural looking smile!

The Core Diagnosis system takes a unique and comprehensive look at facial esthetics. 

Dr. Kari started her coursework with the Pankey Institute in 2007 and completed their most up-to-date coursework in October of 2014. She has been proud to utilize their unique and patient focused perspectives for effective dentistry. Beyond many continuing education courses, the Pankey program brings together cosmetics, prevention and patient safety- Ideals we strive for with everyone who visits our office.

If you have any further questions on why we chose the Pankey Institute or any other educational programs we use, please let us know. Our office is here to provide the absolute best service we can. We always strive to use techniques, ideas and products that keep our patients at their healthiest!

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!

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!