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!

Dental Questions: What is the difference between a Crown and a Veneer?

Dental crowns and veneers are two of the most commonly used techniques for restoring teeth in the front of the mouth. They are both typically made from thin layers of zirconia or lithium disilicate and are chemically bonded to the teeth. However, the applications in which they are used can be quite different. In general, crowns have certain structural advantages, while veneers allow us to make cosmetic changes while removing a minimal amount of tooth structure. 

Crowns work by encasing all surfaces of a prepared tooth (hence the nickname "cap"). They can be used on any tooth in the mouth for either esthetic or functional purposes. To place a crown, we need to reduce every side of the tooth to make room for the incoming restoration. The complete coverage allows crowns to repair extensive decay, replace fractures and even add some structural integrity to a compromised tooth. Crowns also have incredible retentive properties, as the cement and mechanical design truly lock it to the tooth. 

In contrast, veneers are typically used in cosmetic applications on the anterior teeth. They are bonded to the front surface of the tooth (as opposed to the complete coverage of a crown), and derive their retention entirely from the bonding cement. Veneers are either placed directly over an unaltered tooth or used after reducing the front surface to accommodate the extra width of material. They can repair smaller chips, close gaps between teeth or correct cosmetic concerns. 

Depending on your personal needs, a crown or veneer may be the most appropriate treatment option. If you have any further questions about crowns, veneers or other dental restorations, please give our office 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.

Pediatric and Orthodontic Offices We Work With

Providing care for children is one of the most challenging and sensitive aspect of dentistry. Kids react to the office setting within an entire spectrum of behavior; from eager and inquisitive to scared and frustrated. We have designed our office to be as welcoming as possible for your young ones with toys, cable TV (Nick, Nick Jr., Disney, etc.) and even a dedicated kid's room (seen in the background of the title photo). Still, there are times that we need to rely on our network of specialists to best meet the needs of your individual child. 

We are proud to work with Dr. Ahsan Raza of 1000 Oaks Children's Dental Group. On top of specialized behavioral management techniques, Dr. Raza prides himself in being an extremely communicative and personal pediatric dentist. He uses a number of techniques, ranging from education to sedation to ensure the best possible dental outcomes. Your kids will love his spaceship themed office too!

In terms of orthodontic offices, we are proud to work with Doctors Nagel Sr. and Nagel Jr. of Nagel Orthodontics and Dr. William Hang of Face Focused Orthodontics. Norm and Jeffrey Nagel bring together over 40 years of experience in orthodontics and pride themselves in combining the best parts of digital and hands-on dentistry. Likewise, Dr. Hang has spent his career developing the Face Focused program, an orthodontic system that develops straight teeth while respecting posture and opening airways. 

If you would like to know more about our fantastic network of specialists, please give us a call. We want our patients to know they are in good hands, whether with us or one of our specialists.

Link to Dr. Raza's office

Link to Dr. Nagel and Nagel's office

Link to Dr. Hang's office

Case Presentation: Calculus Removal

Today's patient is a great example of why you get regular dental cleanings. These teeth looked completely healthy and normal when viewed from straight on. However, a through exam revealed that the lower teeth were in definite need of dental care. 

Dental plaque tends to build up in hard-to-see areas; behind the lower teeth, around the molars, etc. Over time, this plaque hardens to form calculus (also called "tartar") and becomes impossible to remove with brushing and flossing alone (as seen here). Calculus harbors bacteria that cause periodontal disease, decay and bone loss. At a regular dental cleaning, we use instruments and techniques that rid the teeth of calculus.

This patient received a special type of cleaning called a debridement, where large collections of calculus are removed prior to a normal dental cleaning. They are well on their way to complete oral health! If you would like to know more about cleanings, gum disease or any other health topics, please give our office a call. 

Baby Bottle Tooth Decay

Bed time is certainly one of the most difficult daily struggles with infants. Fussy youngsters will pull out all the stops to avoid getting a good night's rest. Many parents resort to a warm bottle of milk to help ease them to sleep. However, we must warn that this seemingly innocent technique has some serious dental consequences. 

Breast milk, formula and cow's milk all contain carbohydrates like lactose and sucrose. While these aren't necessarily "sweet" like orange juice or soda, they contain enough sugars to fuel the decay causing bacteria in your child's mouth. When infants are allowed to fall asleep with a bottle, the teeth are essentially bathed in acid all night. This creates a typical pattern of decay called baby bottle mouth. Here, the cavities develop very quickly and can affect every single tooth. This is a particular problem with teeth such as the incisors, which erupt at 6-12 months and need to last until 6-7 years of age. 

Our recommendation is to avoid the temptation of sleeping with a bottle all together. Even a rare occasion could turn into a difficult habit to break. If you have any more questions about childhood tooth decay and how to keep your children's teeth healthy, please give us a call!

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!

Dental Questions: Why do we put braces on baby teeth?

You may have heard of a relatively new orthodontic technique that involves putting braces on baby teeth. This treatment probably sounds absurd- trying to create a perfect and straight smile only to have the teeth fall out within a few years. On the contrary, this routine (known as interceptive orthodontics) is  a very effective method for developing a life-long beautiful smile. 

Interceptive orthodontics take advantage of the fact that toddlers and young children still have developing bones in their face and jaws. Here, braces and orthodontic appliances tend to have a more drastic effect and can correct defects and malocclusions (conditions where the teeth are misaligned) more robustly. They are almost always used as part of a two stage treatment plan- where earlier braces help create symmetrical and properly sized jaws and later phases create the straight and cosmetically pleasing smile. Overall, this combined approach leads to less time in orthodontics versus single phase treatment. 

Not every child needs interceptive orthodontics or will be a good candidate. If your orthodontist recommends early braces, it is part of a long term plan towards your child's best dental health. If you have any more questions about interceptive orthodontics or how they are used, give our office a call! 

Use this, not that!

In our world of consumer choices, patients are presented with a number of products promising optimal dental health. The options can be overwhelming, with some making lofty promises. In this article, we will take a look at some common dental products and their superior alternatives. Enjoy!

1. Sugared Gum: Any gum containing sucrose, glucose or fructose is bad news for your oral health. Even if they advertise that they clean teeth or stimulate saliva, the fact of the matter is that these products bathe your teeth in sugar. This sends the bacteria in your mouth into a feeding frenzy, which in-turn causes demineralization and decay. Instead, look for gum made with sorbitol (good) or xylitol (best). Oral bacteria can't process these ingredients, and xylitol even inhibits their activity. 

2. Mall Whitening Kiosks: Underneath the advertising and marketing, these whitening booths are essentially selling OTC bleaching products with a significant markup. While they say they use professional grade bleaching material, its the same peroxide gels used in Whitestrips and other products. Instead, try either in-office bleaching procedures (quicker) or OTC products (more cost effective). 

3. Store-Bought Nightguards: Boil-and-bite nightguards will protect your teeth from nighttime grinding damage. However, they can cause headaches and jaw pains in the process. A nightguard made at a dental office is equilibrated so that all your teeth contact it at the same time. This allows jaw pressure to be evenly distributed instead of causing focal pain. Instead, get fitted for a custom nightguard or target the source of your grinding (stress, emotional strain, etc.)

4. Fluoride Free Toothpaste: In today's health-conscious society, many patients seek out fluoride free "all natural" toothpastes. Unfortunately, there is no compound (natural or man made) that can match the remineralizing power of fluoride. It is safe, effective and used universally in toothpastes around the world. Instead, try to find a toothpaste (any toothpaste) that contains some amount of fluoride!

5. "Floss Action" Toothbrushes: Any product that doesn't get physically inserted between the teeth can't match the cleaning power of floss. Some companies suggest or advertise that their toothbrush design can mimic the action of floss. Unfortunately, this is not the case. While these brushes are plenty efficient of cleaning the rest of your teeth, floss is the only way to get those in-between spaces. Instead, try to add flossing to your daily routine!

Case Presentation: Temporary Veneers

Check out this radical transformation! Today's patient came to us dissatisfied with the color and shape of their anterior teeth. After an exam and consultation, we decided to prepare the teeth to receive cosmetic veneers. For this procedure, only the front and biting surfaces of the teeth are modified to accommodate a thin sheet of esthetic ceramic material.

These before-and-after photos show our patient wearing their temporary veneers. While our lab fabricates the permanent ceramic restorations, these temporaries allow the patient to leave our office with a brand new smile. The final product will be even more natural, symmetrical and translucent- a perfect match to natural teeth! If you would like to know more about veneers, how they are made and if they are right for you, please give our office a call.