Category Archives: Cosmetic Dentistry

Tooth Trauma (Part IV of IV)

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When a front tooth has been chipped, there are a few options on restoring the tooth. If the chip is small enough, the area can be repaired by bonding tooth colored filling material to the enamel. I have many cases where that repair has lasted over ten plus years.

Porcelain Crown

Large defects are better repaired by covering with a porcelain crown. The porcelain is extremely durable and color-stable and can last decades. With children, when a majority of these injuries occur, it is better to do a tooth colored filling, even with large fractures. The main reason is that at least a millimeter and a half of tooth enamel needs to be removed from the tooth in order to get a good cosmetic result and in a child, the nerve in the center of the tooth is extremely large. Taking 1.5 mm of enamel in a patient of that age group can be enough to either expose the nerve or injure it enough that root canal treatment would be needed later on. Also, in a child, the tooth continues to erupt out of the gums, so as the child matures, the edge of the crown can become exposed which can be very unsightly. When a tooth colored filling is done to repair a fracture, it is expected that it will have to be repaired or redone many times during the patient’s lifetime.

Tooth Trauma (Part III of IV)

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If a tooth has been displaced in a traumatic accident, as long as the x-ray doesn’t show any root fractures, then the dentist can usually move the tooth back into its original position. Then, the tooth is usually splinted to the adjacent teeth during the healing period. This is done by attaching a wire to the front teeth with composite. Composite is the tooth colored filling material routinely used to fill cavities.
When one of the teeth has been chipped, the primary focus tends to be on that tooth. However, in a traumatic injury to the mouth, it is not unusual to have multiple teeth having been injured. When a tooth fractures, then, the force of the blow is dissipated. Unfortunately, the intact teeth will transmit all of the energy of the insult directly onto the end of the root. The problem with this is that the end of the root is where the nerves and blood vessels enter the tooth. If the force is great enough, then the nerve and blood vessels can be severed. This will cause the nerve to die and will necessitate root canal treatment to save the tooth. It’s hard for a dentist to tell right away whether a traumatically injured tooth may need root canal treatment. Many times, it takes up to six months before a dead nerve can be detected, and there are times that the damage will show up decades after the initial injury.

How Does a Porcelain Laminate Stay in Place?

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Porcelain laminate veneers are a wonderful way to conservatively change the shape and color of teeth with a durable long-lasting restoration. The laminates are extremely thin (thinner than finger nails) veneers of porcelain. They are held in place by a bonding resin cement. The word “bonding” is somewhat of a misnomer as there is very little true adhesion involved. The enamel surfaces of the teeth and the inside surface of the porcelain are etched with an acid solution. This creates microscopic crevasses in those surfaces. A liquid plastic is flowed over these areas and filters down into the tiny crevasses. The plastic is then hardened with the rest of the cement with an intense light source. A silanating agent that has double bonds for porcelain and the resin cement will provide some mild adhesion for that interface and the new generation dentin bonding agents will also help adhere to areas where the dentin , the inner layer of the tooth, shows through. The resin cement can also help with the color of the tooth. The cement is naturally translucent, however, different agents can be added that can change the color and the opacity of the laminate, thus masking any problems with the underlying teeth.

Repairing Chipped Teeth

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Bonding To Repair a Broken Tooth

Before

A chipped front tooth can be a very unsettling thing for a person of any age.  Before the bonding era, the tooth would have to be whittled and a crown (cap) placed.  Now, front teeth can be restored to the point where the repair is virtually imperceptible.  The tooth is first cleaned up and any rough edges are smoothed.  A long bevel is prepared on the enamel surface to increase the amount of enamel that is available for bonding.  Then, an acid solution is applied to the surfaces.  After rinsing, thousands of microscopic crevasses are present.  Although they are very tiny, these areas allow for a liquid plastic to be flowed into these crevasses then hardened with an intense light source.  This alone is adequate to retain the repair in place for a number of years.

Bonding To Repair a Broken Tooth After

Dr. Gangwisch Repaired This Tooth With Bonding

 A composite (tooth-colored filling material) is then color matched with the remaining tooth.  It is built up in multi-colored increments in order to mimic nature.  Each layer is light hardened, then it’s time to contour and polish the restoration.  The resulting filling looks great when it is finished.  With proper care, this repair can last five to ten-plus years.  Since it is not as durable as porcelain, one must be careful not to bite on hard things with it.  The tooth may eventually require a crown, but repairing a chipped front tooth with a bonded filling can be a conservative, less-expensive alternative.

Clear Orthodontic Brackets

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There is a lot of talk these days about “invisible braces” and for good reason.  For selected cases, they work great. They can be removed to eat and to brush and floss.  However, these type of “braces” do not work on many cases because of the complexity of the case. The invisible braces do not allow for fine control of tooth movement and some movements such as raising a tooth from it’s socket or doing a lot of rotation cannot be done with that method. Many adults and even some teens avoid orthodontic treatment because of the “metal mouth” stigma. For those who are not candidates for invisible braces, there is still hope to get their teeth straightened without having to wear a silver smile. Clear brackets are placed on the teeth as an alternative to the metal ones. These are made of an extremely hard, ceramic material. A metal wire still needs to be used, however, that is so thin that it is not very perceptible from a conversational distance. The ceramic brackets can be more difficult to work with and some orthodontists will charge more due to that. They can especially be problematic treatment wise when torque is placed on them and they can tend to crack due to their brittle nature. But if the only other acceptable treatment is no treatment, the clear braces are certainly a very acceptable alternative.

Invisible Braces (Invisalign®)

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Invisalign Aligner

Invisalign Aligner

Invisible braces (such as Invisalign®) are a fantastic way to straighten one’s teeth. There is no “metal mouth” look. People can’t even tell that you are having orthodontics done. You can take the aligner out to eat so there are no restrictions of sticky or hard foods. You can also take them out to brush and floss your teeth. Oral hygiene is so much easier to do without all of the nooks and crannies to negotiate around with the brush. No more smiling with a big wad of lettuce hanging from your teeth. The process is started by making precise molds of the person’s teeth. A lab makes a 3-D computer image of the mold and a technician manipulates the teeth in tiny increments until the final result is achieved. A clear, thin, plastic aligner is contructed for every incremental step. As each aligner is worn, the teeth are slowly moved to their intended positions.

Invisible braces are not for everyone. They have a difficult time raising teeth out of the sockets, a movement called extrusion. They will also not be able to treat a tooth that is severly rotated. Teens can be treated with this method, however, all of the 2nd molars (12 year old molars) have to be fully erupted. With all of that being said, for patients who are candidates fo invisible braces, it can be an extremely satisfying experience.

Risks of Tooth Bleaching

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Teeth bleaching has become a very popular way of lightening one’s teeth. It is a great technique that can be done minimally invasive and for low cost. As with any dental procedure, it does come with some minor risks. The most common one is tooth hypersensitivity, in other words, that next cold drink could shoot you through the roof. We use an at-home bleaching technique which greatly lessens the sensitivity. The bleaching agent that we use has potassium nitrate in it which which significantly reduces the problems with cold food and drink. You can also use a toothpaste that is specifically made for hypersensitive teeth, such as Sensodyne.

Before Bleaching

Before Bleaching

After Bleaching

After Bleaching

Scanning electron microscope studies have shown no appreciable damage to the tooth enamel, however, there can be some roughening of composite resins which are used for the tooth colored fillings. It’s not significant enough to avoid bleaching altogether, although you may need to be prepared to have any large fillings in your front teeth replaced since they probably won’t match after the bleaching is done.

Contact with the gums can cause some irritation, especially with the stronger concentrations of bleaching agent. Make sure that the tray that holds the bleach has been properly contoured so as to not cover the gums and wipe any excess gel off the gums.

Teeth Grinding

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Worn Teeth From Night Grinding

Damage Due To Night Grinding

Damage Restored With Beautiful Porcelain Crowns

Damage Restored With Beautiful Porcelain Crowns

 

 

 

 

 

Teeth grinding is a very common problem. It’s not unusual for someone to not be aware that they are even doing it. It is more common at night since during the day, most people can catch themselves in the act. Stress is the most common reason for grinding. While sleeping (called nocturnal bruxism), it becomes an outlet for the normal stresses involved in everyday life. Another cause can be an uneven bite and the body’s reaction to try to even it out by subconsciously gnashing the teeth together in an attempt to even everything out.

Untreated teeth grinding can cause pain in the jaw joint (temperomandibular joint) and the surrounding muscles. It can also lead to premature extreme tooth wear necessitating major dental reconstruction.
To counter the problem, if the grinding is present during the daytime, I tell my patients to try to catch themselves doing it. If they find that they are clenching, then they should have “lips together, teeth apart”. This has been very successful for many of my patients. However, most of the grinding problems occur at night. In that case, it is best to build a nightguard, a plastic mouthpiece, to help prevent any further damage from occurring.

Alternatives for Porcelain Veneers

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Invisalign aligners - Invisible Braces

Invisalign® Aligner

Porcelain laminate veneers are a fantastic way to create an utterly dazzling smile. Since a small amount of tooth structure generally must be removed, it is not a reverisable procedure. If the teeth themselves look good, and the cosmetic concern is the alignment, then there are other alternatives available to get a great smile. Invisible braces (for example, Invisalign®) are now available for many types of alignment problems. This way, the teeth can be straightened in such a way that there will be no changes in the front of the tooth surface. Therefore, it is a reversible procedure. Many a beautiful smile has been created by simple straightening and bleaching.

The pros of the invisible braces approach are cost and reversibility. Fees tend to be about 60% less than porcelain laminates. The cons of invisible braces are retention and inability to mask stains. Once invisible braces have been completed, the teeth must be retained in their position by wearing a retainer each and every night. It’s not as daunting a task as it sounds, but it still requires one to put the retainer in every night. If the teeth are stained in such a way that they cannot be adequately improved by bleaching alone, then porcelain laminates are usually the better alternative.