June 22, 2016
You will see my post from several years ago about teeth and white spots. Some white spots are due to acid damage and a period of reduced brushing effectiveness or higher sugar diet. This can be common after braces because it is harder to clean around the wires.
Other white spots are more natural occurring as a hypomineralised layer of the tooth surface that appears frosty. Some of these are very superficial and and be removed in less than 5 minutes with a mild acid that we use for tooth bonding, followed by a fine mineral particle that helps clog the porosity and allow the tooth to regain it’s transluceny. Here is another case we did last week.
July 22, 2013
This patient started getting sharp pain every time they bit on this tooth. It had never been filled but it started to split This can happen from grinding (bruxing) at night, clenching, eating hard foods, or often old fillings have weakenbed the tooth. In this case the patient admitted a very stressful period over the previous 6 months and an awareness of heavy clenching.
You can see natural grooves and small enamel cracks in both teeth. The pain was localised to the second premolar by biting on a hard object.
After removing the enamel a verticle crack can be seen extending into the tooth. Without support this will continue down through the nerve and root of the tooth and the tooth will need to be removed. Below is an image of a tooth where this has already occured.
A porcelain shell like a helmet is made that can fit over the tooth and protect it. We use only Australian laboratories and don’t source crowns from overseas.
Thanks to Jade Dental Laboratory in Buderim ,Queensland, for this artistic creation.
The crown is glued onto the remaining tooth to seal the crack and reinforce the tooth.
I have used eMax for this crown. As it is cosmetic and translucent, I don’t have to agressively remove tooth structure all the way to the gumline like a traditional crown. This leaves the tooth much stronger in the long term.
You can see where the tooth was reduced on the side. Traditional crowns would mean removal of tooth all the way to the gumline.
February 17, 2013
What a difference a smile makes! This patient was missing her lateral incisors – a common genetic occurence. Her options were a denture, bridges, or implants. I would prefer inplants but there was no room in the bone to fit them. She had worn the denture since a teenager and hated it – why wouldn’t she. That only left us with bridges. A bridge is a false tooth that is attached to the exisitng teeth on either side or both sides. Traditionally this meant cutting the tooth significantly. Newer techniques give us more options. These bridges have been made with Zirconia, a very hard and strong porcelain, with a wing wrapping around the back of the front teeth. By use of a new spray on porcelain bond, we were able to bond the Zirconia wing onto the back of the front incisors without any prepping or danage to the existing teeth. The porcelain bride cantilevers out over the space. I have also closed the dark triangle between the front teeth with tooth coloured composite resin bonding as the patient found it unattractive. I think we have ended up with a lovely result.
October 30, 2011
This lady had worn and chipped her upper teeth on the inside until they were so thin they were about to break. The yellow tooth on the right second from the middle is an old crown which the patient couldn’t afford to redo so we had to match it in colour and shape. Crowns are hard and durable but bonding often means less tooth needs to be removed and they are cheaper. Because all of this patients teeth had worn we were needed to build them all up (or at least 10 of them) – compare $250-$300 per tooth for bonding vs. $1500 per tooth for crowns. They may not last as long or be quite as perfect in appearance but they can be a great low cost option without losing teeth and getting dentures. It was done in one day and crowns would take weeks or even months. I would be happy to get 5 years up to 10 years for this kind of procedure. Despite the cost, in the long term I would still prefer porcelain crowns.
November 10, 2010
This dental patient was missing her lateral incisors and the adult canines erupted into the space, with the baby teeth canines still in place. You can see the baby teeth have worn down severely, and the adult eye teeth look bulky in this position.
The best way to treat this would be by extracting the baby teeth, moving the eye teeth to where they should be with orthodontics, and then placing implants in the spaces. Unfortunatley this would be expensive and take many months to complete.
While our patient is saving for the best long term solution, we were able to provide a great compromise using dental composite resin. This will prevent further wear and is completely reversable. It was done in one appointment for the cost of less than 1 crown.
You can see the compromise is the position of the gum due to the adult eye tooth being so large. That is why orthodontics and implants in the long term will be the best option for the missing insicor teeth.
July 10, 2010
I’ve shown this young guy before. We are just picking away at it a bit at a time. The most rewarding thing is this patient has listened to everything about home care and prevention and is looking after things beautifully. See how the gums are pink and healthy and the remaining decay is so clearly visible. Without good home care, nothing will last.
This was the first day we met.
The front 2 right teeth we managed to avoid exposing the nerve in the centre of the tooth despite severe decay. They have temporary fillings to keep things stable until we sort out the remaining teeth. The 2 teeth further back have permanent composite resin restorations placed.
This was today before we started to tackle the upper eye tooth and tooth behind. So far this has been four visits at about $300 a trip. We are just going at a rate our patient can afford. I’ll keep future updates as I get time.
Here is the latest.
April 5, 2010
Just a patient I saw this week. The second back tooth was chipped and needs more extensive repair. We placed an interim repair in the chipped area. The back tooth was decayed around the existing metal filling. The most important thing is to take the time to get a smooth, well sealed, and anatomic shape to the filling so it doesn’t catch food or leak and increase the risk of further decay or damage. I am loving the challenge of creating beautiful work that stands the test of time.