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: Mountain Dew Mouth Reconstruction

Today’s case is a typical example of a condition called “Mountain Dew mouth.” It shows how rampant decay develops and what we can do to repair and intervene. Before describing what we did, it is important to note that home care and diet are key in stopping the spread of cavities. All the dentistry in the world won’t help unless we can disrupt the decay causing bacteria!

We typically see Mountain Dew mouth in younger patients who haven’t seen a dentist in a few years. Sugary drinks (such as Mountain Dew) create the perfect storm for rampant dental decay. They can contain as much as 46 grams of sugar per 12 ounce serving, more than enough to feed the bacteria in your mouth and start the decay process. The liquid is both sticky and acidic, making it efficient at evenly coating and softening all enamel surfaces. Finally, these drinks usually consumed over a long period of time. Duration, not quantity, is the important factor in the tooth decay process. The same 46 grams of sugar wouldn’t be nearly as destructive if they were consumed quickly and not allowed to bathe the teeth.

This patient came to us with dark stained decay around the necks of their front teeth. These areas take the majority of liquid exposure when we drink, and thus tend to decay first. You can also spot dark shadows around the sides of the teeth, signifying more decay beneath the enamel surface. None of the cavities on the front teeth extended to the dental pulp, meaning root canals or extractions weren’t immediately necessary. Unfortunately, some of the molars did have extensive decay and will need to be removed at a future appointment.

We proceeded to remove all decayed and compromised enamel. This process is very delicate, as we want to be thorough while leaving as much sound tooth structure as possible.  Once the decay was gone, we filled the teeth using a combination of glass ionomer and composite tooth colored materials. Glass ionomer is great for repairing rampant decay, as it both bonds to the tooth structure and releases fluoride on to the remaining enamel. In contrast, composite allows us to recreate difficult contours and best match the cosmetics of natural teeth. The entire procedure took us a single appointment, and the patient left our office with a beautifully restored smile!

Again, it is important to note that all of our restorative work will come undone unless this patient can stop the intake of sugary drinks and keep up with their daily brushing and flossing. While fillings and crowns can remove active dental decay, only proper hygiene AND healthy diet choices can stop the bacteria’s progress. If you would like to know more about dental decay, what foods cause it or how to intervene, please contact our office.

Faith and her Daughter

Faith, our dental assistant, recently brought her daughter by the office for a checkup and quick filling. Dental work can be stressful, but blankets, headphones and your favorite TV show can sure help! If you would like to know more about what we can do to make you feel more comfortable during your dental treatment, please give us a call.

Dental Questions: Can a dentist diagnose decay in the mouth that is not evident on an x-ray?

Yes, it is absolutely possible to diagnose decay in the mouth from a visual exam with a mirror and explorer.  Decay on the biting surfaces of the teeth can often be hiding in a pit, groove or fissure of the outer enamel layer. On a visual exam, the area can look like a dark spot in the white of the enamel or an explorer can get stuck in the cavitation. The x-ray won’t show the decay in this area if is still primarily in the enamel layer. However, once decay spreads past this first layer of defense and lands in the internal dentin layer of the tooth, it will definitely show up on an xray.

Take a look at the following pictures, taken from the same patient in the same appointment:

In reviewing the radiographs, there is no apparent decay in this patient’s molars. There aren’t any suspicious shadows or defects in the enamel and the teeth generally look healthy. 

However, a visual examination reveals the beginnings of a cavity forming in the two maxillary molars. The geography of the tooth allows the decay to be hidden as the three dimensional object is translated into a 2D X-ray. Conversely, not all pit and fissure stains are cavities. Dentists can recognise unique shapes, patterns and texture changes in teeth that differentiate staining from active decay. This further highlights the importance of the entire dental exam to make a proper diagnosis. 

New Technology- The Isolite

Throughout the years, the practice of dentistry has certainly gone through many changes. New technologies have made the average appointment, quicker, more comfortable and more productive. At Thousand Oaks Family Dentistry, we stay at the forefront of the dental industry, always updating our equipment and techniques to the latest standards. One such instrument we are proud to utilize is the Isolite vacuum system.  

In the past, even simple dental work was clinically challenging to keep dry and clean.  An assistant would have to hold multiple suctions for the duration of your appointment, taking care to protect your tongue and cheeks. While effective, this process is cumbersome, difficult to use on certain teeth and ultimately less relaxing for the patient. The Isolite streamlines this entire process, while adding an extra dimension of comfort to your visit.

An Isolite handpiece. The clear, flexible plastic forms a mouthpiece that keeps you safe and comfortable. 

The Isolite is a specialized suction system mated to custom sized mouthpieces. It connects to the central vacuum line at our office and is installed in every one of our operatories. The mouthpieces provide a comfortable place for you to rest your mouth along with continuous suction and lighting. They have two flexible “wings” that wrap around your tongue and cheek, creating a safe barrier between our instruments and your soft tissue. The end result is a quicker, safer and more comfortable appointment. Additionally, since the Isolite provides more thorough suction, it keeps our work area cleaner and drier. This translates to more precise preparations and stronger cement bonds with better longevity. 

An example of the Isolite in use. 

On top of coming in five different sizes, the Isolite mouthpieces can be further trimmed and shaped in a matter of seconds. Most patients find the fit to be quite comfortable, often forgetting we are using it. Overall, we have had excellent results with this system and use it for nearly every (non-cleaning) appointment. If you would like to learn more about the Isolite and why we use it, please give us a call. We are always happy to educate our patients on the instruments and techniques used at our office!

Kerr Sonicfill Filling System

If you have had a filling placed at our office recently, you likely noticed that the entire appointment was much shorter (and more comfortable) than when you were a child. This is due to a number of wonderful advancements in dental technologies and techniques, allowing us to move more smoothly and efficiently. A great example of this progress is the Kerr Sonicfill Composite Applicator.

The Sonicfill "handpiece" and composite filling material tubes. It plugs into our chairs much like the dental polisher and "drills." 

The Sonicfill is an incredible device that allow us to place certain fillings in the back of the mouth in a matter of seconds. Previously, properly filling a large cavity in the molars and premolars required two different types of materials, which had to be carefully packed, shaped, adjusted and finally cured. With Sonicfill, The entire process is completed in a single step, with outstanding results.

This incredible device works by utilizing the air supply built into our dental chairs to create a vibrating/pushing motion against a tube of tooth colored filling material. The vibrations cause the material to flow gently and thoroughly into the shape of the cavity, leaving no gaps or bubbles. Once the vibration is stopped, the material remains firm but pliable, allowing us to shape it perfectly before curing it completely solid. The end result is a beautiful tooth colored filling placed in practically no-time!

We love this technology for two reasons. First, it has provided us with excellent functional results. The vibrating motion truly does make a difference and has given hundreds of our patients strong, long lasting restorations. Secondly, its speed-of-use means a shorter appointment time. This translates to less time in our office, away from work and/or family.

As with all of our products, if you have any questions or concerns please call our front desk. We only use new technologies when we are absolutely sure they will provide a superior experience for our patients. Sonicfill has satisfied this requirement by making your appointment smooth, quick and comfortable!

Cosmetic Bonding

Often times, patients will be very satisfied with their oral esthetics aside from one feature. Thier teeth can be straight, white and well spaced, saving for a single tooth. In these cases, orthodontics may be impossible or unnecessary for purely esthetic results. Here, cosmetic bonding proves to be the most predictable and reliable treatment to a perfect smile.

In this case, bonding was added to compensate for a short lateral incisor (left of center).

Cosmetic bonding is one of the most underappreciated cosmetic procedures offered in dental offices. Using the same tooth colored material as fillings, we rebuild and recontour teeth to better fit and fill out your smile. This material is extremely durable, and can be used to lengthen, widen or "even out" the appearance of your front teeth. Our patients are always satisfied with the results, as the transition from natural tooth to filling material is virtually undetectable.

Here, bonding was used to close the gap between the patient's two front teeth.

Your appointment will begin with a short consultation on esthetics and a few photographs. We strive to match your expectations and desires before we start working in your mouth. Once a decision has been made on how and where to add bonding, we use high pressure air abrasion to temporarily roughen the tooth surface. This step is comparable to rubbing wood with coarse sandpaper before painting. After the tooth surface is prepared to accept composite, we add our bonding agents to the indicated area, followed by the tooth colored composite. Our composites come in a variety of shades and color, and can match practically any tooth shade. The material is added slowly, contoured to your tooth, and set solid via a high intensity curing light.

After we select an appropriate tooth color and light cure it, we begin shaping the material to resemble a completely natural tooth. The refinement process utilizes  sanding discs, polishing points and a number of sensitive techniques. The results look and feel completely natural in your mouth.

However, there are limitations to cosmetic bonding. It can generally compensate for deficiencies in tooth structure, but cannot address size issues such as overcrowding. Additionally, once structure has to be built out over 3-4mm, bonding becomes a less reliable long term cosmetic solution. For these in-depth cases, we typically recommend more involved esthetic procedures. Finally, bonding can interfere with teeth whitening or whitening results. Since bonding material does not respond to hydrogen peroxide, it does not change shade proportional to your natural teeth. Hence, we recommend you complete a bleach treatment prior to performing esthetic bonding.

Many consider veneers, orthodontics and whitening  as the standard of dental esthetics. However, we urge you to consider bonding to address your mild to moderate cosmetic dental concerns. The minimally invasive nature of these procedures makes them convenient and accessible to many patients. Feel free to call our office with any questions or concerns you have about the process, materials or results behind cosmetic bonding.

Removal of Amalgam Fillings

One of the hundreds of beautiful amalgam swaps we have performed at our office. 

Amalgam fillings are a tested and proven dental material and have been in effective use for over 100 years. There are many aspects of these metal fillings that make them excellent candidates for tooth restoration; they are durable, easy to place and have many of the same physical properties as natural tooth structure. However, they are not perfect (there are no perfect materials in dentistry). Over time, amalgams can crack, “leak” or become surrounded with decay. Furthermore, they are not as esthetically pleasing as tooth colored materials and can tarnish from silver to black very quickly.

These are some of the compelling reasons that we remove amalgam fillings at Thousand Oaks Family Dentistry. While we recommend replacement for ALL compromised fillings (both metal and tooth colored), we only replace amalgams for esthetics upon patient request. Additionally, we do not recommend removing metal fillings over concerns of mercury exposure. The long term safety of amalgam fillings and their associated mercury content is well understood and documented. Additional information can be found at http://www.ada.org/en/member-center/oral-health-topics/amalgam or by calling our office.

The result of an amalgam replacement procedure. While amalgam fillings are easy to spot, composite fillings blend very well with natural tooth structure. However, this difference in esthetics does not necessarily make one type of filling functionally superior. 

The removal process is a simple procedure that parallels how we place fillings on decayed teeth. We start by removing the existing amalgam from the tooth by carefully cutting it with a high-speed handpiece (“drill”). While amalgam fillings are very safe, there is a slightly elevated risk of mercury exposure upon their removal, as the material becomes loosened and aerosolized. To counteract this, we rely on two forms of suction and isolation to prevent any of the metal from being swallowed. Typically, we pair an Isolite suction/bite block with our high speed suction to gather any stray metal.

Once the amalgam is removed, we eliminate any decay under or around the filling and reshape the tooth to better accept the new composite. Once the tooth is “prepared,” we proceed by bonding and curing in tooth colored material. After it is set, we recontour the filling to the natural shape of your teeth and adjust so it feels natural in your mouth. The entire process takes under an hour, and can be considerably shorter depending on the size and shape of the existing amalgam.

If you have any questions, or would like more information on how and why we remove amalgam fillings, please call our office. We regularly remove amalgam fillings under a number of different scenarios, and would be more than happy to walk you through the process.

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. 

New Technology- The Wand

For many patients, the dreaded “ Novacaine* shot” is a source of anxiety, fear and apprehension. The process almost seems backwards; you have to sit through a painful injection just so you can avoid being in pain later. However, this does not have to be the case.

At Thousand Oaks Family Dentistry, all of our operatories are equipped with a device called The Wand. This device uses modern technology to provide pain-minimized and often undetectable dental anesthetic delivery.

While this system still utilizes a needle, this is the end of its similarities with traditional syringes. It uses air power and electric servos to target the primary source of anesthetic discomfort: delivery speed. In almost all dental shots, pain isn’t sourced from the actual needle, but rather from the medicine entering the tissue. The Wand counteracts this by giving the dentist complete control over speed of delivery.

By adding the anesthetic at a slower and more consistent speed, the tissue has time to numb at an appropriate pace to delivery. This minimizes pain and gives the doctor absolute control over location and amount of medicine delivered. Many of our patients are unaware that they have even received a shot by the time we are done!

*Note: Novacaine is no longer a commonly used anesthetic in dental offices. Our office uses a variety of optimized Novacaine variants for different applications and conditions.