What to Do When an Inlay Falls Out ?

July 14, 2012 alexnguyen

I know this is totally random, but do you know any place I can buy some adhesives to attach an metal inlay back to a tooth? The inlay is either Au-Ag-Pd alloy or nickel chrome alloy... An inlay is a restoration made to fit the space in the tooth where a typical filling would occupy. Sometimes inlays are chosen over fillings because they are stronger, and depending on the extent of the decay they may adapt to the tooth better than a filling. An inlay can be made out of porcelain or a type of metal such as a gold alloy mix.

My answer to the patient's question above was:

Temporary pastes are available at the drug store, but they do not work very well long term.

When an inlay falls out, it could be due to two possible causes:

1. There is decay underneath the inlay. If this is the case, cementing the inlay back will not work long term because the decay is soft and has moisture.

2. The bite force is causing the inlay to debond from the tooth structure. If this is true, then you will have problems with other teeth and not just this inlay.

I would recommend having it checked by a dentist as soon as you can to determine the best course of action. In the mean time, you should leave the inlay in the tooth so that the adjacent tooth will not move into the empty space.

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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.

Is the Gum Contour Crucial in Creating a Better Smile?

May 20, 2012 alexnguyen

I was recently asked this question following a consultation I did for a patient. A front tooth is beautiful not only because of the white part of the tooth, but also because of how the pink gum tissue drapes around the neck of the tooth. In your smile, there should be a harmonious proportion which flows from the front teeth to the back teeth.

For people whose front teeth have been traumatized, often time the lip line is unconsciously restrained to limit the display the front teeth. If we do not plan for proper gum contouring to create the right proportion and gum tissue drape for the front teeth; when you are happy with the new teeth and begin to smile more openly, then the gum line may throw off the otherwise-could be perfect smile line.

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Crowns Gone Wild !

April 1, 2012 alexnguyen

This patient received a total of 22 crowns to mask out her tetracycline stained teeth. The case result was compromised on multiple levels. The most severe problem in this case is the inflammation of the gum around each tooth.

The margins of the crowns were placed too deep inside the gum pockets. This problem is known as "violation of the biologic width." In such situations the gum is unable to remain healthy. Severe inflammation occurs in the initial stages, and the inflammation will eventually cause bone loss in the same area. You can see a line of redness around the neck of the teeth. Light pressure in these areas is enough for the gum to bleed profusely.

Furthermore, the diagnostic X-rays reveal root canals were done for all the front upper and lower teeth. According to the patient, the root canals were done in conjunction with the crown treatments... for no apparent reason.

This truly is a case of "Crowns Gone Wild!"

To change a tetracycline stained smile, we do not need to crown every single tooth. We also don't need a root canal for every crown we place. Likewise, the gum should not be chronically inflamed.

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Anterior Teeth Restorations - It's Not Just About Color Match

March 17, 2012 alexnguyen

Restoring anterior teeth is all about recreating what nature has intended for your teeth to look like. We have to match the adjacent teeth as well as the opposing teeth in multiple dimensions: Shape, Contour, Length, Surface Texture, Color, and even the Gum Position. Here is a case where the patient's specific request was to recreate the original two front teeth.

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

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How Long Do Veneers and Crowns Last?

March 3, 2012 alexnguyen

This is one of the most common question I hear during a veneer and crown consultation. The most simple answer I can give you is: "It depends."

If a crown or a veneer functions in a perfectly healthy dentition, then the restoration will last a long time. If the restoration functions in an unstable bite and/or in an unhealthy bone/gum environment, then it will not last as long.

The best thing to do is to not be fixated on a certain number of years as a life span for your restoration. Rather, find out the existing status of the overall health of your dentition, then treat the dentition comprehensively in order to assure the longevity of not only your restorations but also of your natural teeth.

It is a red flag if your consultation involves zero discussion about the status of your bite and focuses only the cosmetic of the case.

Accurate diagnosis, proper treatment planning, and precise delivery will result in optimum lifespan of your restoration.

Here is a case of two veneers on two front teeth which I delivered on Feb 8th, 2001. Eleven years in the patient's mouth, and this picture still shows no sign of wear on the porcelain. The gum tissue is perfectly healthy around the neck of the tooth, and the veneers look beautiful in the patient's smile. The photo was taken on March 1st, 2012.

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

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