Case Presentation: Premolar Crown

Premolars can be very difficult teeth to repair. They are both functional (absorbing about half the chewing force of molars) and cosmetic (adding to the "corridors" of the smile). Often times, fillings cannot satisfy all these needs when restoring tooth decay or a fracture. A full coverage crown is usually recommended to provide a solution that will both look great and help protect the underlying tooth. For today's patient, an Emax lithium disilicate crown was used to restore their right first premolar. Notice how the shade and opacity blends in with the enamel of the adjacent teeth. The result is a virtually undetectable dental treatment- good as new!

If you would like to know more about fillings, crowns, implants or veneers please give our office a call. We specialize in providing cosmetic treatments that stand the test of time and would love to discuss your options!

Gold Crowns and Fillings

Before the age of modern dental materials, metal played an important role in almost all types of restorations. Many dentists opted to use gold for fillings and crowns for it's durability and ease of use. If you have gold dental work, you may be concerned if it's utility has been surpassed by modern technology. On the contrary, gold still stands as one of the best materials available for dentistry today. Read on to learn how and why gold was (and continues to be) a popular dental material. 

Gold is a very malleable metal with a relatively low melting point and high polishability. These properties make it an ideal material for replacing lost tooth structure. Molten gold readily flows into complicated molds, allowing it to be cast into a variety of shapes- including tooth crowns. Once a crown is cast, it easily polishes to a high shine surface that deflects plaque and has great adaptation to tooth structure. Gold is also highly inert, meaning it will not rust or corrode over time. In dentistry, pure gold is mixed with a variety of other metals to better control the durability, color and resilience of the final product. 

Today, gold is used much less frequently than previous decades. However, it still has its place in restorative dental treatment. Gold can be an ideal material for creating a crown on a tooth when only a minimal amount of tooth structure needs to be removed. However, many modern tooth colored materials have met or surpassed the qualities of gold while providing better esthetics. 

In short, there is absolutely nothing wrong with gold as a dental material. Still, there are many newer materials available that mimic the benefits of gold, but with better cosmetic results. If you would like to know more about gold crowns, porcelain crowns or dental materials, please give our office a call!

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!

Case Presentation: Cosmetic Veneer Transformation!

Check out this awesome veneer transformation! This patient came to us with anterior teeth that were cosmetically compromised but structurally sound. The patient's left lateral incisor had an aging composite filling, the two central incisors were chipped and all the teeth had uneven staining and decalcification. In cases like this, we like to use zirconia veneers to enhance aesthetics while altering the original tooth as little as possible. 

Teeth are prepared for veneers by removing a small amount of enamel to compensate for the new dimension of zirconia. Once the teeth are prepared, impressions are taken and sent to our lab. You will spend two weeks in temporary veneers while the technicians hone in the ideal dimensions and shade to match your other teeth. The result, as seen above, is a beautiful transformation that looks entirely natural. Modern veneers can make you look younger and create a more vibrant smile with minimal changes to your existing teeth. If you would like to know more about veneers, how we place them and why we use them, please give our office a call!

Dental Questions: What is a root canal?

Before and after X-rays of a completed root canal (rightmost tooth). Notice how the roots have whiter centers once the procedure was finished. 

In today's article, we are going to shed some light on a common (and commonly misunderstood) dental procedure: the root canal. Many patients fear and dread these treatments when in actuality they are painless and routine. We hope you find this information helpful!

Root canals fall under the dental field of endodontics. These procedures may be carried out by a general dentist or at a specialist's office. Then end goal of any root canal treatment is to remove the nerve tissue from the inner tooth, desensitize it and eliminate any bacteria or infection. This process allows us to save and treat many teeth that would otherwise need to be extracted. 

The first step in root canal treatment is to get the tooth in question completely numb. These procedures can be time consuming, so complete anesthesia is absolutely crucial. Contrary to popular belief, modern root canal therapy is virtually painless, with the many patient leaving the office with much less pain than they were in before!

Once the patient is numb and comfortable, a small opening is made in the top of the tooth to access the innermost layer called the pulp chamber. Here, the nerve endings that cause symptoms such as pain and cold sensitivity are cleaned out from the tooth.  This step is continued down the roots of the teeth, where a series of small files are used to clean and shape the root system. Once the pulp chamber and roots are completely cleaned, the tooth is filled with a thick, rubbery material called gutta percha. This step is crucial as it creates a plug against bacteria and recurrent infection.

After the treatment is complete, the top of the tooth is filled and restored, typically with a tooth-colored material. In many instances, teeth that receive root canals will need crowns for optimal strength. This is something the treating dentist will discuss with you and plan ahead of time. 

As with many dental treatments, this article is a general guideline and doesn't cover all aspects of endodontic therapy. If you have been told you need a root canal or want to know more about this type of procedure, please give our office a call. We will be more than happy to ease your mind and point you in the right direction!

Dental Questions: Help- I Broke My Temporary Crown!

Anyone who has had a temporary crown break knows that they tend to come off at the least convenience times. After the initial shock and confusion wears off, you may be wondering what your next step is. Even if the crown falls out in one whole piece, do not try to put it back on the tooth and continue using it.  Although the crown seems small, it poses a serious choking risk particularly when sleeping or chewing. Additionally, don't try to glue the crown back together or recement it. This can result in damaging the underlying tooth structure in a way that ruins the fit of the permanent crown. 

Your best bet for fixing a broken or missing temporary crown is calling our office. If the crown can't be recemented, we will make a new one on the spot. We keep copies of all the temporary impressions we make until the final crown is delivered. This allows us to recreate temporaries on-demand and in short notice. Our office always tries to work these type of appointments in same-day or early the next day! If you have any further questions on the dental crown process, please give us a call or email. 

Dental Quesitons; Why aren't temporary crowns permanent solutions?

A typical temporary crown.

If you've ever had a crown placed in your mouth, you know the typical steps: one appointment to prepare the tooth and another to fit and deliver the final crown. In between, you were given a temporary crown as a placeholder to protect the tooth. Many patients love the look and feel of their temporary crowns and are curious as to why they can't be used as a permanent solution.

There are a few important reasons why we don't use temporary crowns as final restorations. First, they are made of a weaker material. The composites used to make temporary crowns are designed to be easy to cast and manipulate while remaining durable enough for short term use. They are not designed to stand up to years of biting, chewing and grinding. Only a permanent crown made from high strength metal, zirconia or composite can handle this task. Secondly, there is no was to adapt a temporary crown to a tooth as exacting as a lab made permanent restoration. The crown margin (where the crown meets the tooth) needs to be adapted to the tooth on the micron scale to seal out bacteria and prevent tooth decay. This level of precision can only be reached with the tools and techniques of an experienced dental lab.

You may have heard of "same day" crowns that skip the temporary crown step. While this option may sound attractive, our office feels that this technology still needs further improvement before it matches the quality of work we get from our dental labs. We only offer new procedures if we are absolutely sure they are the best options for our patients! If you would like to know more about crown procedures, temporary crowns or any other dental topics, please give our office a call.

Dental Questions: What is a “Same Day” Crown? How Does It Work?

Same day crowns are typically made by scanning the patient's tooth, designing a crown and milling it out of a ceramic/zirconia block.

    You may have seen advertisements for dental offices offering “same day” or “same visit” crowns. These services rely on a common engineering technology called CAD/CAM (computer automated design/ computer automated milling). During this procedure, your impression is taken digitally with a 3D scanner and uploaded to a special software that designs crowns. The dentist then finalizes the crown and sends it to a milling machine. After about an hour, the completed permanent restoration is ready to be finished and delivered to the patient. 

    On paper, this treatment sounds great and you may be wondering why we don’t offer it at our office. The reality is that these same-day crown systems have some serious drawbacks that we do not want to extend to our patients. For starters, an in-office milled crown is only as good as the time invested in it. Theoretically, we could scan your tooth, use a “generic” design, mill and deliver your crown in about 45 minutes. However, for these restorations to look and function properly, they need to be digitally adjusted, glazed and sintered in an oven. When done correctly, this process can take up to 2 hours; time you may not have to wait around! We much prefer utilizing the expertise of our local dental labs. Think of it this way: can a product produced in 45 minutes by a dental office really rival something that takes a master ceramist days to complete? 

    Furthermore, the typical two week turnaround for a dental crown may seem like an inconvenience, but it actually serves a functional purpose. The unfortunate truth is that any time a dentist works on a tooth there is a (typically small) chance the nerve will become irritated and need a root canal. In the two weeks between preparing a tooth and cementing the crown, patients can usually tell if something is wrong with the nerve. Hence, we can provide a root canal before putting on the permanent crown. This can save a lot of headache in the future, particularly with the new, extremely hard zirconia crowns available. 

    Finally, using a CAD/CAM system severely limits the crown material choices available. There are no “one size fits all” dental materials (and anyone who tries to convince you otherwise is pulling your leg!). At our office, we treat each patient holistically and try to provide the best restorations for every tooth in its unique situation. There are a number of materials that these machines can’t use or can’t use well. With these milling units costing upwards of $100,000, many offices feel obligated or “locked-in” to providing CAD/CAM crowns, even when they are not the best option available. 

    As the technology currently stands, we are not comfortable offering in-office milled crowns to our patients. Our office feels that we get better results using a traditional dental lab to make our restorations. If you have any further questions or concerns on our crowns, how they are made or the materials we use, please give us a call!

Specialist Spotlight- Opus One Dental Lab

When having a crown or bridge placed, your ultimate goal is to have it look, feel and function like the natural tooth that was there before it. While this process is never “easy,” it becomes even more difficult when dealing with anterior (front of the mouth) teeth. For these complicated lab cases, we are proud to work with Opus One Dental Lab and it’s owner, Uri Yarovesky.

Uri standing with his many awards and honors. 

Uri has over 40 years of experience in the dental field as a technician, lab owner and world recognized lecturer. He has made crowns and bridges for celebrities, heads of states and even as prosthetics for blockbuster movies. His credentials include countless awards from the most prestigious dental publications and institutions. Opus One Lab was designed as an extension of his years of experience- cutting edge techniques with a personal touch. In addition to the typical technologies and instruments you would find in most labs,this office houses a research facility used to develop and manufacture new ceramic technologies. For some of the services the lab offers, they are the only location in the entire world with this technology available.

Crowns on anterior teeth need to be a near identical match to the surrounding teeth. Small deviations in coloration, shape, size or translucency can translate to a product that looks “fake” or out of place. It takes careful examination and years of experience to deliver a perfect prosthesis that feels great. Opus One delivers this by offering customs shade matching appointments, where you meet with Uri one on one to design and perfect your dental crown. He and his team have a deep appreciation for dental restorations and can meet your desires on shade, feel and even age appropriateness.

We love working with Opus One because they are both a local business and a global leader in dental technology. Uri’s lab understands the importance of both esthetics and function in delivering a quality product. Their crowns and bridges fit and look great, which results in happier and more satisfied patients.