SEM proves zero bond between Amalgam and Tooth

I have warned a patient that this particular part of his tooth will break at some point.  It finally broke. With the patient being a Chemical/Mechanical/Material Engineer... the fractured tooth was placed under a Scanning Electron Microscope. Interestingly enough,  my patient reenforced my everyday discussion that "Amalgam fillings have no true bond to tooth structure."

Based on the information interpreted by the SEM,  the fractured piece of enamel showed no bond to the silver filling.

Thanks BM for your insight and photos.

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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.

A Dental Implant Case

Today I had the opportunity to explain to a new patient about the proper treatment protocol for a tooth that she is losing.  Here is a great lesson about what to do when you are about to lose a tooth. The patient was told by her previous dentist:  "Your tooth has a infection.  Let's put you on antibiotic.  Then...you come back for us to extract the tooth and to do some bone graft.  Then...TWO WEEKS LATER ... we can prep the adjacent teeth for a bridge to replace that same missing tooth."

I have never heard of any bone grafting material that can fully stabilize an extraction site in TWO WEEKS.  A typical bone grafting site requires any where from 4 to 6 months of healing time.

In addition, the tooth behind this failing tooth is also compromised.  Using it to anchor a bridge also will not provide the patient a predictable long term result.

In a case like this where an active infection is present due to a failed root canal treatment with compromised root structure we must be even more careful with our treatment plan.  A Gum Specialist (periodontist) or an Oral Surgeon would be best to handle the surgical aspect of this tooth.   The proper treatment sequence would follow something like this:

1.  Antibiotic Regiment to suppress the infection

2.  Extraction of the failed tooth with proper bone grafting done at the same time

3.  Wait for proper healing.  Typically 4-6 months

4.  Placement of the dental implant to replace the missing root

5.  Wait for proper healing.  Typically another 4-6 months.

6.  Placement of a new crown on top of the dental implant.

As a patient, you need to be educated enough about a complex procedure before agreeing to the recommended treatment.  Dental Implant treatments require proper coordination between a surgeon and a restorative dentist in order to achieve a successful outcome.  This patient had made a very wise decision to seek multiple consultations with different dentists before choosing her own treatment choice.

Let's take a look at the tooth:

√  The furthest left arrow points to the compromised root which was proposed to be the anchor for a new bridge.

√ The middle arrow points to the fractured root of the tooth in question.

√ The right arrow points to the infection and bone loss around the infection.

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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.

Do you like Lumineers?

I personally don't. The makers of Lumineers target the psychology that people do not want their tooth structure removed for porcelain veneers work.  With this technique, thin layers of opaque white porcelain pieces simply get bonded on top of the existing teeth; Very little to no tooth structure is removed.

Unfortunately, to make porcelain veneers look good, the ceramist really need to layer different shades of porcelain to create the life-like look of a real tooth.  Shade progression and translucency characteristics on a tooth must be present on the porcelain in order for the final result to look real.

Lumineers, being monochromatic in nature, cannot give you that realistic look.  Well...that only matters if you want your smile to look real.

When you consult with your cosmetic dentist, ask to see photos of actual cases that were done by the same dentist.  After a few consultations, you will have a better perception of good cosmetic dentistry versus bad cosmetic dentistry.

It is all about making a conscious informed decision.

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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.

Sensitivity Problems with tooth colored fillings?

Do you have sensitivity problems after you had a tooth colored filling placed? Tooth colored fillings are also known as resin fillings or composite fillings.  When done correctly, this material can be made to look like your tooth was never touched.  We can make a filling blend in well with a tooth.  It can look very beautiful.  However, when resin fillings are mishandled, the tooth may feel more sensitive to temperature than before the filling was placed.

Here are some possible causes of your sensitivity after a resin filling was placed:

• Improper removal of decay
• Improper bonding technique
• Improper placement technique
• Improper adjustment of the fillings after it was placed

Yesterday a patient came in to see me because she had sensitivity to cold and sweet on her upper left quadrant.  This xray revealed a resin filling was placed with folds within it, and there was a gap between the filling itself and the tooth structure.  In addition, there was decay underneath the filling when I removed it.

In this scenario, the cause of the sensitivity with this filling was due to 3 of the above 4 reasons.  The remedy was for me to remove the entire filling and all decay underneath.  Then a new perfect filling was placed, and the sensitivity went away!

In the xray below, note the arrows pointing toward the improper contact between the filling and the 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.

Photos of Beautiful Smiles

Beautiful smiles must look real.  The objective is to mimic nature.  That is the inspiration for my work.

Spring time outside our office serves as a beautiful backdrop for this portrait of my patient Ruthann.

This was my first attempt to photograph portraits of my smile design work.

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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.