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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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.

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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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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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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