Incisal Chipping from Bike Accident

When you have a bike accident, you have options. Sometimes the fractured teeth require veneers or crowns. In this case, we were able to restore the teeth with composite. I wanted to try a brand new composite that claims it can match any tooth. So, we placed this as the first layer, but, it was too dark, although adequately translucent. So, I moved this initial composite toward the lingual side, and we blended in Filtek Supreme Plus 'B1' with Filtek Supreme XL Bleach shade. The three composites together acted to created a visual layering effect. Before and After: (left) showing result of fracture from bike accident (right) showing layered composite restoration. If you need an appointment, call us 512-454-2744, or Book Online. [instagram url=https://www.instagram.com/p/BynJNTilXfK/] Hope you like it, J. Russell McFarlane Read More »
Deep Bite Correction

Before and After Invisalign Class II div 2

Here is a wonderful case that illustrates how effective Invisalign can be. One of the challenges we face when completing orthodontic treatment, (formerly braces,) is the resistant idea from some patients saying to themselves or out loud, 'A clear plastic tray couldn't move my case.' (or) 'My case is too tough for clear plastic trays.' So, here is a before and after that shows how significant changes to the bite, archform and tooth position can be completed with clear plastic trays, using a clear aligner strategy. AfterAfterAfterAfterAfterAfterAfterAfterBeforeBeforeBeforeBeforeBeforeBeforeBeforeBefore [instagram url=https://www.instagram.com/p/BxymVmGFVfT/] I hope you enjoy this case. Thank you to the patient who graciously encouraged us to share her before and after photos so that other patients could be educated about what is possible. If you need to book an appointment, please call 512-454-2744 (or) Book Online… Read More »
Root Surface Care Options

Remineralization is Real: reversing bracket scars and discolored roots

Shows demineralized roots with and without intact root surfaces and treatment using a remineralization protocol and alternatively with a composite. This case epitomizes how many options we have as restorative dentists to repair, restore, and in this case remineralized root surfaces. The outcome may look similar to the naked eye, but, the long-term impact of our approach to treatment really matters. Let me explain it simply, the remineralized teeth did not require any cutting with a drill or any other cutting tool. The remineralized teeth were treated with topical applications, (which I will describe in technical details below.) The teeth that are eligible to be remineralized in the photo above meet the following criteria: 1. They have discolored and demineralized tooth structure (limited mostly to enamel,) **2. They have an intact outer surface without physical… Read More »

Saving an Otherwise Condemned Tooth

A patient presented after being told by another dentist that they could not save her tooth. I understand that some teeth are more difficult to save. But, the patient was not interested in getting an implant so we saved it. We placed 2 minim pins to retain the build-up in the area of the missing palatal cusp. I have successfully saved several teeth using the very small titanium minim pins. Because you carefully pilot the holes before placing them, when placed successfully, they do not significantly increase the risk of root fracture. [Note: if you complete a root canal and place a post in the root space, this is different than placing minim pins in the tooth, posts in the root space have been shown to increase the risk of root fracture. Luckily, we did… Read More »

Fractured Teeth – Conserve Tooth Structure with an Inlay

When a tooth fractures, an inlay can be a conservative option if a full crown is not required due to structural requirements. Inlay to restore a fractured tooth adjacent to an old amalgam In this case a tooth had a thin area of tooth along the MB of #14 (photo taken in patient mirror.) The thin remainder of tooth fractured vertically and horizontally immediately adjacent to the old amalgam. This fractured off box of tooth structure was small enough that by extension, using the old preparation of the amalgam, we were able to replace the amalgam with an all-ceramic inlay. This inlay was completed with Vita Enamic (a dual matrix ceramic) milled in-office on the TS150e, same day. This restoration was scanned into the computer and completed immediately, without having to temporize the tooth. We… Read More »

Erosion, the Slow Path to Tooth Destruction Reversed

This case shows one of the dental conditions that is very familiar to anyone who has had a history of grinding and clenching. One of the complicating background factors of this case is a history of dry mouth. Dry mouth tends to accelerate erosion because there is not adequate salivary flow to flush off acids and sugars from the food we eat. Above: Images 1 and 2 show wear through the enamel and into dentin, which are scooped out. Below: Images 3 and 4 show the (4) lower anterior teeth with Obsidian-type all-ceramic crowns. Restoring the tips (incisal edges) of these teeth with composite was completed a few years ago. The composites were a stop gap restoration to slow the continued erosion. Because the teeth continued to erode around the edges of the composite, the… Read More »

Comparison of Porcelain Veneers Vs Invisalign

[instagram url=https://www.instagram.com/p/Bvg_fYGFfqz/] This case was finished using porcelain veneers. [Summary: 1. Patient has naturally small laterals that were restored initially with composite and slight tipping of the centrals. This case was completed with 4 veneers.] This case was corrected with porcelain jacket crowns. [Summary: 2. Patient had previous restorations with composite, which was improved with 2 all-ceramic crowns.] This case was improved with esthetic composite. [Summary: 3. Patient had space between her centrals (diastema), which was improved with composite filling material to close the gap.] This case was completed using a no-prep veneer (Lumineer). [Summary: 4. Lumineer used to correct the spacing and improve the smile line. This approach used a minimal prep (virtually no prepping on the teeth.)] This case was repaired using a blended esthetic composite. [Summary: 5. Composite used to correct the… Read More »

Fractured Front Teeth Repaired with Composite

Fractured anteriors #8 and #9 repaired with composite (before and after) Accidents happen: 10-yr-old fractured his front teeth in apparent fall accident. The patient presented for emergency evaluation of his front teeth. The coronal portion of the tooth fractured in half, but, did not break into the pulp chamber. The teeth were fully erupted and a typical central incisor is 11mm long. His teeth were broken off at an oblique angle leaving only 2mm of tooth remaining on #8 near the midline and 1.5mm of tooth remaining on #9 near the midline. At some point in the future, we may elect to place all-ceramic restorations, e.g. an Obsidian-type crown (lithium silicate,) but, since the patient is young and still very active with sports and athletic recreation, we have elected to place composites on these teeth… Read More »
Bonding to Veneers

Replacing old composite bonding with porcelain veneers (Lumineers) Minimal Prep Veneers

By: Russell McFarlane In 2011, we completed composite bonding on the patient's peg laterals. A peg lateral is a tooth that naturally is smaller due to a genetic variation. Peg laterals or even missing laterals (Tooth #7 and #10) are very common. So, patients with peg laterals or missing laterals are often looking for a solution. Minimal Prep or No Prep Veneers can work very well on a case like this, so, for this case we used Lumineers with a guided minimal prep. Photo from 2/7/2019 showing composite bonding (completed 2011) on the laterals. Photo from 2/7/2019 showing the peg laterals with the composite bonding removed. Photo from 3/7/2019 case follow-up, after seating the porcelain veneers on 2/26/2019, then, letting the gums heal before the final photos were made. This case shows how attention to… Read More »

Bicycle Accident – Dental Implant Replacement Case

X-ray: Patient presents after bicycle accident with fractured teeth. (2/19/18) One tooth was completely avulsed and the others adjacent were fractured in half. The patient was in a bad bicycle accident, which left her severely injured. Her most notable injuries were the fracture of her front teeth. One tooth (a central) came out completely, while the other three anterior teeth were fractured off. It was determined that the other central (think: front middle tooth) would also have to be extracted as the tooth was fractured in the root. The other teeth, the laterals would need crowns to restore them, but, could be saved. So, we proceded to extract and bone socket preservation graft the sites for #8 and #9. NOTE: If you are looking for the blurred out picture from the Instagram video, it can… Read More »