Dental Bridges Benefits vs Risks

February 11, 2012 alexnguyen

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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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Another Case of Dark Crowns on the Front Teeth

February 4, 2012 alexnguyen

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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All I Want For Christmas is My Two Front Teeth ...

December 9, 2011 alexnguyen

This patient had two crowns put on his front teeth. One of the two crowns popped out shortly after, so he came to me to see what I can do for him. Restorations on the two front teeth are some of the most difficult treatments. Not only do they have to look like real teeth, they also have to fit within the functional parameters of the patient's bite.

I restored this case by eliminating interferences in his bite to stabilize it first. Then I restored the two front teeth with two new crowns which were done with complexity in color combination, contour, texture, and functional guidance.

The "after" photos were taken two days after delivery. The gum will continue to adapt well around the teeth, and the restorations will continue to disappear into his dentition as if they were his own natural teeth.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

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Cosmetic dentistry for men

November 12, 2011 alexnguyen

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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A Cerec crown failure. Brand or Technique problem?

October 8, 2011 alexnguyen

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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