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 »

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 »

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 »

Composite Veneers vs Porcelain Veneers (Before and After)

Composite Veneers vs Porcelain, which one would you choose? By: Dr. Megan Mobley BEFORE This is one of our beloved employees. She had composite veneers placed about 5 years prior by a previous boss on her upper canines. She is congenitally missing her upper laterals ( #7 and #10) so she had orthodontic treatment to close the space and her upper canines ( #6 and #11) were reshaped as laterals. The struggle with composite veneers is they absorb stain over time and this is a perfect example of that. Porcelain restorations are color stable, meaning they do not absorb stain, they will remain the same color for the life of the restoration in your mouth. Our assistant was very sensitive to her appearance and would even cover her smile to try to hide her discolored… Read More »

Before and After Same Day Resin composites to close diastema

 Click the picture to see it enlarged Before and After Photos are favorites for people discovering what is possible. This patient presented with a history of her friends making fun of her and telling her that "she looks British." This jabbing hurt her feelings and she asked if there was anything we could do about it. Patients who have an open diastema, which is the technical name for the space between the teeth, have 2 primary options when closing the space. A minimal (or) no prep veneer, such as a Lumineer. Same day in-office treatment with a white resin composite. A porcelain veneer has a very beautiful finish and a very high shine. Porcelain veneers tend to last 10 to 15 to even 20 years. They stay very shiny. Usually they have esthetic failures at… Read More »

Before and After In-Office Whitening (photo with no flash)

Click to enlarge This is a before and after in-office whitening. This took 5 (15-minute) sessions all completed in one sitting. The teeth moved up the shade guide considerably. This was taken using 'No Flash.' Because it is hard for a camera to capture the real effect your eyes can see with an in-office whitening. This is because when a camera flashes it resets the white balance. So, these images with no flash are a better representation of what your eyes actually see when it comes to color change. It is harder to get a perfect focus without a flash. :) Read More »

Immediate Bridge Using Natural Tooth And Ribbond

The patient has had a lower anterior tooth that had gradually lost all the attachment around it as a result of localized periodontal disease. This left the tooth mobile and hopeless and it was starting to become uncomfortable chewing with it. [caption id="attachment_573" align="alignnone" width="300"] Before and Afters Of Immediate Bridge using Natural Tooth[/caption] Once we determined that the tooth was hopeless, we set out to make the mouth healthier by removing the tooth. Then, we used the removed tooth to make a bridge between the teeth that will act as an immediate bridge. To make this possible, we anesthetized the area and extracted the tooth. Because it was already mobile and had very little attachment remaining, there was not very significant bleeding. We then, sectioned the tooth to get it out of the unhealthy… Read More »

Fractured Tooth Emergency Repair with Same Day Crown

Patient presented with a fractured off tooth, which we were able to repair in-office same day with an all ceramic crown. [caption id="attachment_570" align="alignnone" width="300"] Fractured Tooth Repaired with All Ceramic Crown[/caption] We used the laser to lower the gums, so there is some slight coloration in the gums (right now temporarily) from the use of the laser. That mild discoloration at the gumline will be gone in 1-4 days. We used 1 cartridge of 4% Articaine given via infiltration locally on the tooth. This did not require a full Inferior Alveolar Nerve Block. The tooth was carefully prepped and the gums lowered to allow an adequate ferrule for retention. The 'A1' shade Obsidian Block was characterized with some cream coloration to help match the natural teeth which have mild light horizontal striations. We were… Read More »

Before and After In-Office Whitening

Enjoy the before and after: On this case we completed today, we moved a patient from a A4/C4 to a B3. In-office whitening uses a process where we retract the lips and isolate the gum tissues using a soft light cured resin. The process takes about 1 hour. We do 3 applications of 38% H2O2 bleach gel to the teeth. Each session of the three applications is kept on the teeth for 15-minutes. Then, between each set we clean the teeth off and reapply fresh whitening gel. [caption id="attachment_567" align="alignnone" width="300"] Retraction in place[/caption] To get a sense on the shade guide organized by hue, chroma, and value from lightest to darkest. Here is what it means to move from C4 to B3. So, the before and after on this case was really an awesome… Read More »