I enjoy seeing my patients who reside in the Charlotte area.  But I am particularly honored when patients travel from afar to seek dental care in our office.  This 22 year old patient came to see us from the North Carolina coast. 

A fine young man, he wasn’t happy with the space between his two front teeth.  Several years ago, he had fractured his left front tooth, needed a root canal and had a large composite bonded filling placed.  Over the years, the filling discolored. 

While it may seem a simple idea to “close the gap”, cases like this require careful planning and attention to detail.

Widening the teeth to close the gap without considering the length of the teeth would have resulted in the appearance of teeth that looked too wide.

When it comes to the front teeth, the attentive dentist normally considers their dimensions in terms of ratios.  For the two front teeth, we normally like for the width to be approximately 75% of the length.  If we adhere to this ratio, the teeth will look “normal” in size.

Because of the amount of damage to the patient’s left front tooth, we needed to re-build it and do a porcelain crown.  But the other front tooth was essentially whole so we were able to be more conservative by placing a porcelain veneer.

While a veneer is more conservative, it makes it more difficult to match the colors with the crown because of different thicknesses of porcelain.

In this patient’s case, we slightly increased the length of the two teeth but it made a big difference. 

As is usual in a case like this and particularly since the patient was traveling from the coast, we used our CEREC computer technology to make the crowns in one visit.

We also customized the color of the crowns using additional colorants to match to the adjacent natural teeth.

The patient loved the final result.  The colors blended beautifully and the shapes of the teeth were very natural.  Last, the patient was thankful that we were able to minimize his trips to and from the coast.

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I am so blessed.  I’ve got the best patients, my staff is awesome and I am fortunate to work with some talented laboratories and specialists.

The case I am showing you today exemplifies the importance of the teamwork that is necessary for a stellar treatment result.

Congenitally missing front tooth

This teen patient initially presented with mal-aligned teeth and a missing lateral incisor tooth (the tooth next to the two front teeth).  The tooth was congenitally missing, which means it never formed in the jaw.  For this case, a dental implant was a great option to replace the missing tooth but long before the crown was placed, it was up to the specialists to “set the stage”.

A beautiful and natural looking implant crown

We consider this area of the mouth to be in the “esthetic zone” where appearance is very important.  Thus, we wanted to do everything we could to make sure the replacement tooth would appear natural in position, shape and color. 

As I have come to expect with the specialists I work with, the stage was set as perfectly as the clinical situation would allow.

Now it was up to us to bring it all home by creating a natural looking crown.  For this case we used our CEREC CAD/CAM one-visit crown technology to make the crown.  In the right hands, this technology can shine when esthetics is important because I can use various colorants and stain to customize the crown to match the adjacent teeth – and we do this right in our office.  While matching a single front tooth to the adjacent natural teeth is one of the more difficult things to do in dentistry, I have come to enjoy the process. 

As a team, we wound up hitting a home run with this case.  The crown looks like a natural tooth and not like – well, a crown!  The patient was very happy and can now smile with confidence.

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In my previous article, I discussed concerns that patients have regarding the safety of amalgam fillings (dental mercury fillings).  Specifically, patients have voiced concerns about mercury vapors from the fillings entering the body and potentially causing health issues. 

In my dental practice, it has been over 15 years since I placed an amalgam filling.  Simply, I believe there are superior alternative materials available today.  

amalgam fillings

porcelain fillings

One of the problems I have with the amalgam material is that it must be of a minimum size to resist breaking or falling out.  For the same sized cavity, composite resin tooth-colored fillings can be more conservative.  Essentially, I only need to remove the “bad” tooth structure.  The less healthy tooth structure that has to be removed, the better it is for the health of the tooth. 

There is also less drilling and the filling can be smaller.  This is usually not possible with amalgams.

For small cavities, composite resin tooth-colored fillings have come a long way and are now not only esthetic but very durable. 

Let’s look at the other end of the spectrum.  What about large fillings?  While large amalgam fillings appear to hold up, over the years, significant damage can occur to the underlying tooth.  Realize that amalgams aren’t bonded to the tooth and do nothing to strengthen a tooth; they just plug a hole.  In addition, when I remove an old amalgam filling, it is rare that I don’t find a cavity underneath the filling.

On the other hand, composite fillings and porcelain restorations bond to and strengthen the tooth.

The most compelling reason though that I no longer place amalgams is patient preference.  At one time, amalgam fillings were the norm but no longer.  I can’t remember the last time a patient asked me to place a grey amalgam filling instead of a tooth-colored filling.  We are a society that values our appearance including that of our teeth.  Choosing composite or porcelain over amalgam can make a smile much more pleasing to the eye.

Form, function, appearance and patient satisfaction are superior with this solution.

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Harry is a 14 year old high school student who had recently completed orthodontic treatment.  He is a fine young man, very personable and polite.

In Harry’s case, the orthodontics was done well to place the teeth in their proper position.  However, there were other concerns that could not be corrected with braces alone.   The upper front teeth were undersized and as a result, spaces remained after the orthodontics.  In addition, Harry and his mom had concerns regarding the general discoloration of his teeth.  The teeth appeared stained.

Spaces between teeth

As we always do with cases such as this, I sat down with both patient and parent, in this case, Harry and his mom to discuss their objectives and the options for treatment.  Harry and his mom desired for the spaces to be closed and his smile brightened.

In this kind of a case, there are usually two options to discuss: porcelain veneers and composite bonding (resin veneers).  Each option has its’ own set of advantages and disadvantages and we like to take the time go over these with our patients so that they can make the best decision for their particular situation.

A bright and happy smile!

In discussing the options for treatment, we decided to whiten the lower teeth a bit and then place composite resin veneers on the upper front teeth. 

As a rule, whenever we do a “combination” case where we want to place veneers and whiten the remaining teeth, we always want to whiten the teeth first.  These kind of cases can many times be completed very conservatively as well with minimal removal of any tooth structure.

The result was awesome!  The treatment was completed in just a few hours, but made a dramatic improvement in Harry’s smile.  Harry and his mom were ecstatic with his new and vibrant smile.

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Before Teeth Whitening

We do a lot of cosmetic consultations in our office and during those appointments, we go to great lengths to make sure that we understand exactly what the patient is looking for.  I like to tell my patients that they are the “pilot” (telling us where they want to go) and we are the “navigator” (telling the patient how we can get there).  Cosmetic dentistry is definitely not one size fits all. 

We look at the tooth position, shape and color of the teeth.  We also look at the gum position as often irregularities in gum position can itself affect the appearance of the overall smile.  And we especially take a close look at the bite as many times it is the bite that is the underlying cause of the esthetic problems.

For the patient who is happy with everything but the color of their teeth, teeth whitening is typically the answer and I have never found a process that has been as effective as KöR Deep Bleaching™.  Believe me when I say that I’ve tried a bunch of systems and products over the past twenty plus years.  This teeth whitening system was developed by a friend and colleague of mine in California and it has certainly taken off.  KöR Deep Bleaching™ was recently ranked highest as the most effective, reliable way to whiten teeth by a respected dental products journal.  I’ve even seen this process work on tetracycline stained teeth. 

After Teeth Whitening

As you can see with this patient, the results are pretty dramatic.  In the “after” photo, I used the shade tab that shows how dark the teeth were prior to the KöR Deep Bleaching™ just to emphasize how effective this teeth whitening process is.  By the way, for this patient, the teeth whitening process required only two weeks time.

If you’re too embarrassed to smile, have dark-stained teeth, or just simply want a whiter smile, the superiority of KöR Whitening is just what you need.

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Undersized lateral incisor tooth

Matching a single veneer or crown on a front tooth to the adjacent natural teeth is one of the most difficult procedures to do in dentistry.  This patient had recently finished wearing braces for a few years but found himself dissatisfied because of an undersized lateral incisor tooth.  He wanted the gap filled but wanted the treatment to be long lasting.  Together we decided that a porcelain veneer would fit the bill.

Whenever we do a case like this, we carefully evaluate the adjacent teeth first.  We don’t just look at the color or shade, but also the size and shape and even little nuances such as the white splotching on the teeth so that the veneer seems to disappear when it is placed.

Porcelain Veneer to fill the gap

Using our CAD/CAM technology, we made the actual porcelain veneer in our office and then color-matched the veneer to the patient’s natural teeth.  We have the technology that allows us to do that as well.

The result was awesome, the patient was happy and it was all done in one appointment.  I love it when a plan comes together!

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I got a call last night from a new patient in a panic. She was just playing with her dog and it jumped up on her – the dog’s head hitting her front teeth. Low and behold one of her porcelain veneers chipped. To make matters worse, she was heading out of town this week on an important business trip.

 With her regular dentist being out of town, she turned to me for help. Fortunately, we begin seeing patients at 7 a.m. on Tuesdays, so I scheduled her for an early appointment this morning, allowing us to immediately assess the damage.

The bad news was that the veneer had to be replaced. The damage was beyond the point where we could just smooth it out. The good news was that with the technology we possess, we were able to create the new veneer for her in 90 minutes. By balancing artistry with technology, the new veneer is a beautiful color match to her existing veneers. 

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