What to do when a crown or a bridge falls out?

April 30, 2011 alexnguyen

Crown and bridges are cemented or bonded in place. Although we can make them look exactly like the real teeth, they are not truly "permanently" attached to the teeth. They can de-bond (detach) from the teeth for many reasons, including heavy uncontrolled teeth grinding, chewing of strong sticky candies, etc... When a crown or a bridge falls out, it is best to try to:

1. Reinsert it into the exact place, EVEN if the tooth does not hurt.

2. Keep it in the exact place until you are able to see your dentist, EVEN if you cannot get to your dentist for an extended period of time.

3. Have your dentist evaluate the underlying tooth structure to make sure that decay is not the cause of the detachment.

Do not use glues such as Crazy Glue. Household glues do not work, and they will distort the fit between the tooth and the restorations.

Do not leave them out of the mouth: The adjacent teeth can easily move into the space where the crown or the bridge was occupying. When this happens, the restoration will no longer fit and the only solution may be to replace it with a new one.

As always, a little common sense will save you and your dentist both time and money.

Thanks again for reading my blog.

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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.

Allergies and Toothache

April 12, 2011 alexnguyen

The arrival of Spring induces allergy symptoms such as itchy/watery eyes, excess nasal irritation and drainage, dry cough, skin rash, etc. However, there is a unique symptom which occurs sometime in conjunction with excess drainage in the sinus: Toothache on the upper molars or bicuspids. The upper bicuspid and molar roots are embedded in the sinus cavity. When the sinus cavity is filled with excess drainage from allergies, pressure from the sinus on the roots can cause a discomfort which mimics a toothache. An improper diagnosis may result in unnecessary root canal treatments to alleviate the associated pain. Careful examination and tests should be done to rule out toothache associated with sinus drainage or infection.

In this case, a regiment of antibiotics and antihistamines may very well alleviate the toothache-like problem. Yes, sometimes you can blame pollen for your toothache !

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What is a Hybrid Prosthesis in Implant Dentistry?

March 26, 2011 alexnguyen

Implant dentistry can really change people's lives. In cases where there have been significant amounts of bone and tissue loss, this type of restoration allows the patient to regain both the function and the look of a real dentition. Here is a rough outline of the process:

1. Before the treatment was executed, proper diagnostics were done with study models, X-rays, CT Scan, etc.

2. The implants were then placed, and allowed to integrate with the patient’s bone.

3. An accurate impression was done to capture the implant positions and was sent to the laboratory.

4. The lab then created a duplicate model of the patient’s arch (with the implants replicated exactly how they are in the mouth).

5. A Cad Cam scan was done to design a titanium framework for the prosthesis. See my blog entry dated Dec 4, 2010 about the Cad Cam technology for this same case.

6. The titanium bar is tried in the mouth on the actual implants to ensure accurate fit.

7. Teeth and gum colored materials are placed over the titanium bar.

8. The final prosthesis was placed precisely over the implants in the patient’s mouth. The entire prosthesis was held in placed by screws that fit into the implants. Openings at the screw access were filled with proper composite materials to blend in with the surrounding areas.

9. Proper contacts and functional guidance of the bite were checked and fine-tuned.

The patient once again has a full arch of teeth fixated to his/her arch to replace the missing teeth. This type of restoration takes away the pain and inefficient chewing problem for patients who maybe suffering from the lack of ability to simply … eat.

Case Photos:

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

The titanium bar on the stone model:

The prosthesis on the stone model. Note the access holes where the implants were positioned.

The final hybrid prosthesis in the mouth. Note all implant access holes were filled.

The patient's smile at completion of treatment.

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Naturally Beautiful Smiles

March 5, 2011 alexnguyen

Occasionally I have the pleasure to invite some of my patients to do a photo shoot for ... fun ! Here are some samples of our latest collection of beautiful smiles. Whether it is a full mouth of restorative works or a few enhancements, I want the smiles to be simply beautiful and natural looking.

Thanks to Ivy, Alydia, and Saifon for allowing me to showcase your smiles.

My sincere appreciation to our stylist Jackie ( www.jolidejackie.com) and our photographer Paul (www.ferradasphotography.com).

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

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Can a Smile Makeover be Done in Two Visits?

February 14, 2011 alexnguyen

On December 19th, 2010 I posted a blog entry with a wonderful smile guide sent to me by a well-informed patient. Last Friday I delivered the porcelain restorations which completed his smile makeover process. I will still have to bring the patient back to fine tune and touch up some of the detail work. I could not have done the job in two simple visits like many advertisements claim to be able to do. The process cannot be done in two visits because a number of critical steps must be carried out:

- Diagnostic work-up of the case

- Laser contouring of the gum

- Equilibration of the bite

- Bonding of some of the teeth

- Preparation of the teeth for porcelain

- Working with the ceramist while the case is at the lab

- Tryin/delivery of the final restorations

Depending on what level of quality you are looking for, the process typically defines the end result.

Here is the feedback I received from the same patient today via email about his feelings regarding the end result of the case.

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From: S

Subject: teeth

Date: February 14, 2011 11:54:26 AM PST

To: Alex Nguyen

Hi Dr. Alex, just wanted to drop a quick note to express how happy I am with how my smile has turned out (the gums are much better and closer to normal now) The teeth are exactly what I wanted: shapes/edges are just as envisioned, and the whiteness and translucency couldn't be any more perfect. I noticed the very slight decalcification on the inciscor is exactly as I wanted. The bite feels solid and like my own teeth.

In short I can't stop myself from looking in the mirror and smiling :) Thanks for your hard work and attentional to detail. Looking forward to the fine-tuning and tweaking of the bicuspids and wrapping up the case.

See you soon

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