Case Presentation: Esthetic Veneers Part 1

For many patients, cosmetic veneers are a great way to transform their smile with a short turnaround time. This patient is a grandmother who always wanted to close the gaps in her front teeth. Using veneers, we will both close the gaps and create a beautiful and natural looking smile. We just finished the first part of her treatment, where we prepared her four front teeth, took impressions and made the temporary veneers. She will return in about two weeks to cement the final product!

Before

Before veneers, this patient's teeth had large spacings and were not completely symmetrical. 

After

Here is the same patient with her temporary veneers on. You can really see how this procedure will create a more esthetic smile!

The "after" photo shows our patient in acrylic temporary veneers. They are created immediately following the preparation to hold space for the permanent restoration. Right now, our dental lab is working on the permanent veneers, making sure they have the right color, shape and opacity to match the rest of her teeth. We are eagerly awaiting the final product and will post as soon as we deliver it!

Case Presentation: Premolar Implant

Every day, our office sees patients with a wide variety of restorative needs, each of which we try to match on an individual basis. Today's patient came to us with decay in their second premolar that structurally compromised the tooth. Radiographs revealed that there was not enough healthy enamel/dentin left to do a traditional filling or crown, so we had to consider other treatment possibilities. After reviewing options with the patient, it was decided that the tooth should be extracted and replaced with an implant by one of our specialists. 

Take a look at how the decayed (darker appearing) tooth was removed and replaced with a titanium implant. 

After the implant was placed and healed, we took impressions to make a custom mounting for the final crown (called an abutment). Since the second premolar is far back in the mouth, we had our lab create a gold abutment matched to a porcelain and metal crown. This combination of materials allowed us to create a crown that was both durable and beautiful without risking damage to the opposing teeth. The patient gets all the structural benefits of a metal crown, but with no metal showing. Careful planning provided us with great results; both our office and the patient were ecstatic with the outcome!

The final product! Notice how natural the implant crown looks in the patient's mouth. 

Overall, dental implant cases typically take about 8 months from start to finish. The vast majority of this time is spent making sure the implant is healed correctly and properly integrated into bone. In the meantime, there are numerous other considerations and adjustments needed: the appearance of the surrounding gum tissue, the color/shade of the crown and even the shape/material of the underlying abutment. If you are interested in an having a dental implant placed or are just curious about what goes into making an implant, please feel free to call our office! We are always happy to walk you through any of our procedures!

Anterior Veneer Case

Take a look at one of our recent smile transformations! This patient came to our office with concerns about the esthetics of their anterior incisors. Wear to the incisal edges (biting surfaces) had created a "flat and sharp" appearance that takes away from the naturally contoured look teeth typically have. By using zirconia veneers, our office restored dimension and shape to the incisal edges and facial profiles of the lateral and central incisors. This allowed us to give the teeth a more youthful look and create a universally lighter shade. If you would like to know more about this process or other esthetic services we offer, please contact our office!

Dentures

One of the greatest aspects of modern dentistry is our ability to replace missing or extracted teeth. Today, patients typically seek out implant crowns and bridges as quick and safe methods of restoring their smiles. But what about dentures? The name alone might conjure up pictures of older relatives and seltzer tabs, but they are still an excellent way to fix a gap in your dentition. At Thousand Oaks Family Dentistry, we offer a number of denture options for patients needing everything from temporary single tooth replacement to permanent appliances for entire arches. No matter what your needs, there is likely a denture solution to fit it!

Patients who still have some existing teeth are typically eligible for partial dentures. These appliances bridge one or more empty spaces between teeth to recreate a natural smile. They usually require healthy molars or premolars to snap on to and give them rigidity. Some partial dentures are made entirely out of acrylic. These are commonly referred to as “flippers” and typically serve as temporary solutions until an implant can be placed or a permanent denture can be made. Because they are plastic, they need to be made thick for rigidity. Likewise, flippers can feel bulky and uncomfortable and are prone to becoming brittle. Still, they are an excellent interim esthetic solution for patients missing teeth.

a full acrylic partial denture or "flipper"

Partial dentures can also be made using a combination of acrylic and cast metal. These devices are stronger, thinner and typically more comfortable than flippers. When you smile or open your mouth, pink and enamel colored acrylic hide the metal framework beneath and the appliance looks like natural tissues. Rigid metal partial dentures are appropriate for long term use and are often the most comfortable option. If you have enough teeth to anchor the device, they can fit snugly and comfortably in your mouth.

A partial denture with metal framework

If you are missing all teeth on an entire arch, you are likely eligible for full dentures. Full dentures are made out of acrylic and stay in your mouth using the suction created between your gums and the denture base. Since they rest on your gum tissue, full dentures can take some time to get used to. Many patients will feel sore spots or an uneven “rocking” sensation until they become accustomed to the feeling of the appliance. Our office can make small adjustments to dentures to better accommodate your mouth, but they will never feel as natural as something anchored to your teeth. Still, they are a great alternative to smiling, chewing and speaking with no teeth.

a full upper and lower full denture

A final subset of dentures are implant supported dentures. Here, an acrylic appliance is mounted to 2 or more implants (depending on the number of teeth replaced) through rubber snaps. These are typically the most comfortable denture style for replacing whole arches of teeth. However, this treatment option is both costly and time consuming; Implant placement can take up to six months to become healed and sturdy enough to support a denture. Still, many patients are extremely satisfied with the resulting product, as the implants keep the appliance rigid and out of contact with gum tissue.

A diagram of how implant supported dentures are mounted

No matter what type of denture we are making, our office needs three types of impressions: one impression of the teeth (or gums) on which the dentures will be made, one of the opposing teeth and one of how the teeth come together when you bite down. Once we take these impressions, we send them off to a lab along with instructions on tooth color, transparency and brightness. From there, the lab will either fashion your permanent denture, make a wax try-in (a soft, denture lookalike used by our office to ensure fit and esthetics), or send us custom trays. Custom trays are impression trays that precisely fit the dimensions of your mouth. These instruments insure a perfect impression (and a better fit) for the final denture. Once we are ready to deliver your appliance, you will return to our office for a short fitting appointment where we can make minor adjustments.

The true scope of dentures extends into many different devices, materials and mounting styles. We like to have a lengthy discussion with every patient prior to taking impressions, to make sure they will satisfied with the final product. Only a consultation between you and Dr. Hong can show us what kind of denture is appropriate for your specific needs. If you would like to know more about dentures or any other type of appliance offered at our office, please give us a call. We are always happy to walk you through any and every procedure!

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.