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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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.  

 

 

 

 

 

 

 

 

 

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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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.

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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