Tag Archives: Bay Area Cosmetic dentist
A bridge is a prosthesis used to replace one or more missing teeth. Usually the teeth on either side of the empty space are ground down to help anchor the missing tooth (or multiple teeth).
Pros:
1. The patient does not have to wear a removable appliance to replace the missing teeth.
Cons:
1. Sometimes perfect natural teeth have to be destroyed in order to anchor the bridge.
2. The bite force can destroy the integrity of the anchored teeth if it is inadequately controlled.
3. The strength of the roots of the anchored teeth can be compromised.
4. It can be difficult to keep the underside of the bridge clean.
5. The nerve inside the canal can be compromised from the trauma of the tooth preparation as well as the bite force when multiple teeth are splinted together.
As you can see, there are more “cons” then “pros”.
Let’s take a look at a real case:
In the case below a bridge was constructed by anchoring a root canal-treated molar to two smaller teeth in front. After a period of time, the molar roots were cracked into three pieces. The tooth structure underneath the restoration was also destroyed from decay and trauma. The xray also shows that one of the two anchored front teeth also has a small infection from the damaged nerve.
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Let’s think about the problems behind this bridge:
1. Three teeth were affected at the expense of one missing tooth.
2. By anchoring one weak root canal-treated tooth to two strong teeth, the root canal treated tooth was the weak link.
3. The bite stability of this patient was not taken into consideration when this bridge was done.
If we can turn back the clock, a better treatment plan could have been:
1. Properly develop the bone at the site of the missing tooth.
2. Treat that site with an implant and a crown.
3. Crown the root canal-treated molar individually.
4. Leave the two natural teeth in front untouched.
With the advancements of implant dentistry, bridges should be considered as the last option in restoring a missing tooth.
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Material choice and technique plays an important role in creating life-like restorations for the front teeth. In the case below, improper choice of material and technique resulted in 2 dark front teeth.
Material problem:
Using translucent porcelain over dark underlying tooth structure allows the dark color to bleed through. Not all materials fit all situations, and the dentist must understand when to apply the right material to the right situation.
Technique problem:
1. The margin (the demarcation between the porcelain and the root) does not fit properly. This results in excess accumulation of plaque right at the root area. This type of problem may cause the gum to initially become inflamed, then slowly deteriorate and shrink away from the crown.
2. The dark underlying tooth structure must be masked out.
3. The shape, size, contour, shade, surface characteristics must blend in with the patient’s existing teeth.
Since the smile’s center of attention is the two front teeth, it is important that the restorations look like they are your real teeth. It is crucial to seek the right clinician to help with your front teeth. Unfortunately, once the restorations are bonded to the teeth, they would have to be redone from scratch if you are unhappy with the result.
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Happy New Year !!! May 2012 be the year you achieve all your endeavors in Love, Health, and Prosperity !
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What better occasion than today to express my most sincere Thank You to the patients whom I have met, befriended, and will continue to care for. May you find Peace in your travels, Love in your family gatherings, and Health in your march into the 2011 Holiday Season !
Autumn in My Neighborhood
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Cosmetic dentistry is not only for women. A significant amount of my work involves enhancing the smiles of my male patients. Here is a case I finished 9 months ago. I just had the chance to see the patient again today for a follow-up visit and photos.
I did this case with a combination of bite adjustments, teeth whitening, porcelain veneers, and resin bonding. Some of the detailed characteristics of the teeth were done specifically to the patient’s request.
Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.
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Cerec is a brand of Cad-Cam machines which mill out porcelain crowns while the patient is waiting in the office. The concept is marvelous because who would not want to walk home with a brand new crown in just one visit? Let’s talk about this…
The sequence of treatment of a cad-cam fabricated crown would be:
1. The dentist prepares the tooth for the crown.
2. The tooth structure is scanned into the computer using a special camera.
3. The computer activates the Cerec machine to mill out the crown.
4. The dentist cements or bonds the crown onto the tooth.
This Xray shows a molar with a Cerec crown that crumbled during dinner one night… What went wrong?
Upon repairing the tooth I discovered some obvious problems:
1. There was extensive decay in the tooth structure underneath the crown. This could have severely compromise the strength of the bond and could have caused the crown to come loose over time.
2. The existing root canal on the tooth was under-filled.
3. The gum tissue around the remaining tooth structure was extremely inflamed. This is a sign that the junction between the tooth and the crown was not properly sealed.
When choosing dental work, it is important to not base your decision on a “brand”. Instead, it is crucial to find a dentist who delivers dentistry with strong emphasis on technique.
A crown on a tooth will only last if the following are handled properly:
1. Proper technique in treating the tooth with a root canal when needed.
2. Proper technique in building up the tooth structure underneath after the root canal.
3. Proper technique in scanning the tooth structure.
Technique, technique, technique !
Good dentistry is all about good old-fashioned health care. Treat brands with a grain of salt. With a little bit of research you will discover your key to a long lasting dentition.
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The two front teeth are the most commonly restored teeth. They erupt into the mouth at about the age of eight, and being positioned in front of the mouth they often sustain the most damage.
Color is not the only parameter required to match the two front teeth with the rest of the teeth in the smile. Among other factors, we have to also match contour, surface texture, and shade variations of different areas of the teeth. Matching the front teeth is like sculpting a portrait of what they used to look like. That is the only way they will blend in with the natural dentition. Furthermore, the two front teeth serve as a very important guidance for joint stability and function. We must approach the front teeth in more than one dimension.
When done correctly, restorations for the front teeth will disappear into the rest of the smile. Here is a testimony from a recent case I delivered last week.
…………………..
Email dated 9/09/2011
Dear Dr. Alex,
I want to personally thank you for the wonderful job you did on my case. Although it took longer than I anticipated, it was worth the wait and I am very pleased with the end result. You definitely have the knack for how teeth should look and function. I really appreciate your thoughtfulness and professionalism. …Again, I want to thank you for a job well done.
P.S. you will soon have another positive review on Yelp 
Sincerely,
K
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It is not uncommon that I recommend my patients to consider orthodontic treatments to straighten their teeth. Sometimes my adult patients’ initial reaction would sound something like: ”I am too old for that, and I never thought about the cosmetics of my smile…”
Having straight teeth is not ALL about cosmetics.
The misalignment of teeth can cause a variety of problems ranging from TMJ issues, to bone loss, to excess fractures and wear facets on the teeth. This type of break down in the dentition can take many years to manifest. Unfortunately, sometimes when the patient starts to notice the problems, the solutions may require a complex combination of orthodontics and restorative treatments.
Properly aligned teeth actually follow very scientific principles created by nature to establish the most stable functional foundation. When teeth are properly aligned, certain functional movements of the jaw allow for optimum chewing, relaxed muscle state, and ideal joint health. The cosmetics of the smile is automatically achieved secondarily when the functional foundation is established. Finding the right orthodontist is key to successful treatment.
Hence, when you choose to have orthodontic treatment done, you are stabilizing the most important aspect of the dentition: To allow you to sustain life by being able to chew effectively throughout the course of your life span. As the human life span continues to lengthen, it is extremely important to make sure that you will continue to have a stable dentition for your chewing needs.
In the photos below you will find a smile with “crooked teeth”. Whereas the patient was never concerned with the cosmetics of her smile before, she has lately been concerned with the fractures lines and wear facets indicated by the red arrows. Her question to me at the last check-up was: ”What would my teeth look like…say ten years down the line…”
My answer to her was: ”They would look more broken down, and you will also notice problems with the back teeth as well.”
So as you can see… My recommendation for this patient to choose orthodontic treatment was based on achieving proper function, and not ALL about cosmetics.
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Today I will tell you that the answer to this blog heading is: NO !
Sometimes when a tooth comes into contact with the opposing teeth in a way that directs excess force to the neck of the tooth, this can cause micro-fracture of the enamel there. When the outside layer of the tooth (enamel) is stripped, the inside layer (dentin) is exposed. The tooth can become sensitive to substances that are cold, sweet, sour, etc…
There is no cavity in the photographs below, but the symptoms make the patient think that a cavity is there.
Take a look at the indentation (the notch) at the neck of this tooth:
Now…
Observe how the same tooth is the only one that contacts the lower teeth when the patient moves her jaw from side to side.
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Tetracycline is an antibiotic.
At the age of three, children have already developed tooth buds of the permanent teeth inside the jaw. When tetracycline is given to children, this drug penetrates the developing tooth buds and incorporates itself into the tooth structure. When the teeth erupt into the mouth, the result is bands of dark stains with usually a combination of brown, gray, and yellow colors. These stains make up the actual colors of the teeth and are impossible to bleach completely into normal white teeth colors.
Note: Once a tooth has erupted into the mouth and the root of that tooth has completely formed, tetracycline cannot affect that tooth. It is also a misconception that all antibiotics will cause yellowing of teeth.
The human eyes are used to seeing the smile with white teeth. Smiles with dark tetracycline teeth are not as esthetically pleasing as smiles with normal white shades of teeth.
Porcelain veneers done on tetracycline stained teeth are very difficult for many reasons. A clinician has to mask out the dark colors underneath, and create at the same time the proper tooth form, contour, texture, and details of the edges of the natural tooth.
Here are the before and after photos of a case where I used porcelain veneers to enhance a severely tetracycline stained smile. The after photo was taken two weeks after delivery. The gum tissue will continue to heal and adapt to the new porcelain, and the colors of the porcelain teeth will become even more realistic after some time. In this case the patient opted for a super white shade, yet with proper planning and execution we can still create a natural looking smile.
Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.
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