Internal Bleaching

How Does Internal Bleaching Work?

Let me set the stage for you. You are walking with your friends. Suddenly, you fall and hit your face against the ground. You feel shaken, and your nose has a small cut, with blood on your upper lip. Your friends ask you, "Are you alright?" You quickly assess yourself, and tell them, "I am fine. It's just a scrape. We're good, let's keep walking." Unfortunately, sometimes the damage is unseen. The front tooth took the brunt of that impact spontaneously dies and later either requires a root canal or undergoes a sterile necrosis. Fast forward 3 years, and now seemingly out of nowhere, the tooth has turned brown and looks like it has died. The tooth probably died shortly after the accident and started walling itself off internally. The remaining pulpal tissue (old blood… Read More »

What’s Maryland Bridge?

A Maryland Bridge is a minimal prep bridge that can be used as an alternative to a full bridge and as an alternative to a surgical dental implant. Posterior Maryland Bridge in place, replacing #3 Maryland Bridge Prep, shown without Maryland Bridge Maryland Bridge Shown being held adjacent to the Model Maryland Bridge shown in place on the model (view 1) Maryland Bridge shown in place on the model (view 2) Teeth showing Maryland Bridge Prep (mirror) Teeth with Maryland Bridge in place (lingual aspect) Teeth with Maryland Bridge in place (highlighting facial aspect) Teeth with Maryland Bridge in place. [The farthest back tooth visible in this picture is porcelain from the bridge.] This case allowed a minimal prep design Maryland Bridge to be used to replace the missing 1st molar. The patient was able… Read More »
Discs make all the difference

The Importance of Being Polished

I was working on fillings for my patient and I noticed some of her old composite work, which was completed by a different dentist at her old office, was starting to show it's age. Composites, the white resin fillings, often look impeccable the day that they are placed. Little by little composites tend to lose their beauty because they discolor around the margins, due to stains collecting at these areas. I use discs to polish the margins of my composites because it makes a meaningful difference in their finished appearance. So, in this case, I was looking at the old composites and I asked the patient if she would mind if I smoothed off the edges of the old composites. She said, "Oh, sure. I guess so." I went over the edge of the composite… Read More »

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

Book An Appointment Or Call Us: 512-454-2744 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.… Read More »