The Test Drive

Excellence in function and aesthetic dentistry is never achieved by accident.  It is with heavy planning in the form of data collecting, diagnosis and communication that leaves to highly predictable outcomes that helps us meet and exceed our patient’s aesthetic expectations. 

Whenever someone comes to our office as a new patient, your first visit is for data collection.  The goal of data collection consists of acquiring medical and dental information.  We obtain prior dental history, photograph your existing dental condition, check for oral cancer, establish caries risk, evaluate how the teeth come together, and the health of the periodontium (the gum and bone, supporting structures of the teeth). 

Aside from gathering clinical details, the most important data we collect is the needs and desires of our patients.   From there, we establish whether our office is the best solution for your needs.   Existing and new patients that have cosmetic needs will get the opportunity using photography and digital smile design to get a preview of any requested or proposed changes. 

So what is digital smile design?  Digital smile design utilizes your photographs, from there we can alter the teeth shape and color in accordance to your desires.  From there we can preview the proposed changes digitally.  After the patient signs off, we will then send molds of your teeth and the appropriate photographs to a ceramist who will then create in wax (diagnostic) the proposed changes.  Once we receive the diagnostic wax-up back, we will then do a test drive in the mouth, using temporary material you will get to evaluate the proposed changes while staying in a reversible state. 

The following video highlights the process of evaluation to diagnostic wax-up to the test drive. 

Whitening Traumatized Teeth

Do you have a front tooth that has turned dark over the years? As we age, our teeth naturally become more yellow, and in some instances more grayish due to the natural wearing of enamel. There are certain situations where a tooth can become dark very quickly, its cause being trauma or a root canal.

In a healthy tooth with a healthy pulp (the nerve), blood is cycled in and out. In a tooth that has lost the vitality of the nerve, blood is no longer able to be cycled in and out and so the expired cells become to accumulate leading to the dark color.

In the past, many would immediately restore these rather unaesthetic presentations with a conservative veneer or a crown. In many situations, dependent on the amount of healthy tooth structure available, these are still the preferred methods of treatment for root canaled or traumatized teeth. In situations where the teeth are preserved, the root canal treatment is done conservatively, then the treatment options to address color issues can be even more conservative.

In this situation, we have elected to whiten the tooth from within. The process is as easy as two or three visits. The first visit is an evaluation after the tooth has been seen by an endodontist (a root canal specialist). Once the tooth is determined healthy enough to proceed to bleaching or "restoring", can we begin the process. For internal bleaching, we will make a small access hole without the need for anesthetic so we can place a special type of bleaching material. Depending on how dark the tooth is, there may be a need to have multiple follow-up appointments to reapply the bleaching material inside the tooth.

Once the tooth color has become stable, we flush all of the bleaching material out, place a temporary and wait for 10 days before placing a final filling. The reason we need to wait between flushing out the bleaching material and placing a filling is to allow for all of the bleaching material to stop oxidizing, as this can interfere with the adhesion of the bonding system. If the bonding is unable to be at its maximum strength, we run the risk of decreasing the life of the restoration. The following is a video of our latest case that outlines the steps involved. Enjoy!

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Less Is More

“Wearing a veneer of perfection never did me any good.” -Liz Phair

I frequently get asked by friends and patients what I think about veneers. Before I go into my answer, let me define what a veneer is. A veneer is a thin shell of medical-grade ceramic (or resin) that is traditionally attached to the front surface of a tooth. Veneers are individually crafted by a skilled lab technician who uses man-made materials to mimic a natural tooth. Dentists use veneers for a variety of dental issues including  color correction and orthodontic adjustments.

Due to Hollywood, veneers are synonymous with cosmetic dentistry. (Literally, in the 1920’s, Hollywood actors and actresses were known to get false front teeth.) Generally, when a patient comes to my office inquiring on how to improve their smile, they always ask about veneers. But are veneers really the best choice for everyone in every situation?

Honestly, it depends on the situation. If it's a color modification you seek, a simple course of teeth whitening may be all that is needed. If the goal is to correct the alignment of your teeth, a visit to your orthodontist is a much more conservative option. Although veneers are a conservative alternative compared to crowns, in most cases you still need to give up some tooth structure for the veneer to properly bond.

In summary, more is not always better. Ask your dentist to explore less invasive options before you begin an irreversible procedure. Keep in mind that in some cases, ultimate results can be achieved with a blend of the veneer alternative treatments discussed above. There are instances where good intra-professional collaboration of teeth whitening, orthodontics, and good planning can yield optimal cosmetic results as conservatively as possible.