Is it possible to have "perfectly" healthy teeth as an adult? Absolutely yes!!!!!!

Note the beautifully healthy texture of the gums, as well as the alignment. This person has had superior care from previous dentist and orthodontist. Obviously they played a big part in teaching her superior home care as well. I had the pleasure of meeting her a few minutes ago as a new patient. I felt as though she would be the star on my blog.












Close up views from the sides also demonstrate excellent health


















I know of people that have spend years as well as numerous amounts of dollars to be restored only to remotely resemble this natural beauty.











If only I had more patients like this, I would have an excuse not to work:)

Single tooth whitening.

The front tooth discoloration was due to a childhood injury. This particular tooth was treated with a root canal procedure due to the severity of the injury. This type of discoloration is very common considering the nature of the previous trauma.

After 3 session of internal whitening, here is the result!

Single Visit Smile Makeover! It is a reality in the very near future!

These are before & after photos of a smile makeover done in our office. These were done the conventional way. Impressions were taken, temporaries made, and the smile created with the skills of a team member who happens to be a "Master Ceramist". The turn around time was 2 days. With recent advances in CAD/CAM technology, we will be able to do this in a sinlge visit with predictable results.


Please note the "happier smile!".

To floss or not to floss! That is the question!

Decay noted in between the teeth due to lack of flossing. This was diagnosed in 2004. It was recommended for these teeth to be restored with conservative fillings. Our patient did not follow through with the recommended treatment, and did not floss either.

In June 2009 our patient returned to our office complaining of severe pain on the upper and lower right side. The decay on the previously diagnosed teeth had advanced to the nerve. At this point nerve damage was irreversible and root canal treatment was recommended and performed on both teeth.

The above images show the completed root canal treatment on both teeth. The image in the middle shows the final crowns that were done in a single visit immediately after root canal treatments were completed. The conclusion is: "all of this treatment could have easily been avoided by disciplined daily flossing". Yet our patient chose to go the difficult way and it was costly. We do not want anyone to have to go through this rigorous route, and we are fully in favor of preventive measures!

The truth about amalgam (mercury containing) fillings!

The photos belowe show defective amalgam (silver) restorations! Our patient was not experiencing any discomfort. When I presented my concerns, the response was "they are not bothering me". These restorations had leakage which in simple terms spells bacterial infiltration peripheral to exisiting restorations. Amalgam fillings are not bonded to the underlying tooth structure. Being metallic in nature, they conduct heat and cold much faster than white fillings which are either glass (ceramic) or plastic (composite) . Additionally there is microscopic shrinkage and expansion within the fillings in relation to the temperature changes in the mouth, much more so than their tooth colored counterparts. As a result a microscopic gap will develop on the margin of the silver restorations which will eventually allow bacterial invasion. As the bacteria form a colony, they will ultimately lead to decay and weakening of the otherwise healthy tooth structure. This is why many large silver restorations will eventually end in needing crowns . We like to take a proactive approach, and eliminate the potential need for crowns by preventive strengthening of the existing tooth strucutre. This is done by conservative removal of the defective silver and immediately restoring it with a single visit CAD/CAM ceramic restoration.

















The darkening peripheral to the above restorations indicates decay. These silver restorations were removed and restored to completion in a single visit utilizing CAD/CAM technology. In the past impressions would be taken, temporary restorations would be placed, and approximately 2 weeks later the final restoration would be seated. There is no longer a need for a second visit in the majority of the situations. This means no additional anesthesia and less time in the dental office. Below are the final restorations of the same teeth:

3D Imaging! Vital Information Prior to Procedures. Wisdom Teeth Application!

The above image was taken of our patient whom presented to our facility due to an infection peripheral to the wisdom teeth. I was a concerned regarding the proximity of the teeth to the mandibular nerve. I recommended our patient to have a 3D scan done of this area in order to find out exactly where the nerve existed. Although the wisdom teeth needed to be removed, I wanted to assess the situation in order to evaluate the risk vs. benefit of having the procedure done. I then informed the patient that it is best for him to seek a consultation from a qualified Oral and Maxillofacial Surgeon to have the procedure done. Wisodm teeth removals are done routinely in our office. Here is a case scenario where vital information was obtained prior to the procedure, so our patient had a thorough informed conscent. He can then make an intelligent choice regarding the procedure.











Here is the view of the lower right wisdom tooth and its proximity to the mandibular nerve.






The image below shows the lower left wisdom tooth and its proximity to the mandibular nerve:

Cross sectional/frontal views of both the lower left and right wisdom teeth and the position of the nerve is clearly demonstrated here. Equally important is to know that not all wisdom teeth are in this close proximity to the nerve. However, it is far better for the practitioner to have this information "PRIOR" to attempting the procedure, rather than to encounter it during!

Tooth decay under crowns. What is leakage? How serious is it?

This seemingly benign condition of the upper tooth drew attention from our patient. He stated that "there was a bad odor upon flossing". My response was that "since it drew enough attention to bring you in, it needs to be looked at carefully". A small gap was noted on the back side of the image taken. I recommended the removal of the crown mainly to explore the infra strucutre with direct vision, and the findings were quite a shock!

This is a pre operative photo of the affected tooth. As can be seen, there is some recession of the gum on the periphery of the tooth, but the open margin of the crown is not visible to the naked eye. The following picture will reveal what the condition was within the tooth structure.



As shown in the photo to the right, extensive decay was noted under the crown, causing the bad odor. Had this tooth been left untreated, it was certain to head for root canal treatment. Root canal treatments are the last resort. Although they can be a blessing when teeth are in dire condition, they need to be avoided as much as possible. I commend my patient for paying close attention to this matter and presenting it to me!
The tooth was successfuly restored with a new crown after the decay was thoroughly cleansed.





The final crown was done in a single visit using CAD/CAM technology. A digital scan of the tooth was done after the decay removal, and with the aide of CAD/CAM software the new crown was made in a single visit.

The final image of the crown is demonstrated
to the right.











The final radiograph is demonstrated to the right.

Tooth wear! Should you be concerned? What are the long term mainfestations?

The irregular edges of the front teeth indicate severe wear because of "bruxism". This occurs when the way the teeth come together is not is support of the jaw joint's (Tempro Mandibular Joint, better known as TMJ) ideal position of function. This is equivalent to 4 tires in an automobile not functioning in proper alignment. As can be imagined, eventually the wear on the tires will lead to a blow out and vehicular failure. It is all a matter of time. The earlier the steps are taken, the easier it is to stabilize the situation.

The right side is shown here.

The occlusal (top) view of both the upper and lower teeth are showing the wear facets caused by the improper alignment of the upper and lower jaw. Note that the left side shows relatively more wear as compared to the right side. The specifics of the cause of this type of dysfunctions can and will be diagnosed and properly treated!

Full frontal view clearly indicates the irregular edges caused by years of "bruxism". At least 2-3 mm. of healthy tooth structre has been worn off over the years, and the pattern will continue unless steps are taken to stabilize the jaw function. Although the reasons for the treatment and correction of this type of conditions are NOT COSMETIC IN NATURE, esthetic enhancement is a side benefit. Patients must not be confused regarding the main reason behind any proposed treatment. It is done primarily to stabilize and improve the function of the masticatory system.

Immediate Implants. Pros and cons!

We are witnessing a typical case scenario where a front tooth is faced with an unpredictable situation. Conventional dental treatment would not serve this situation in a predictable manner.

What this means is an investment needs to be made towards long term health and stability of the affected area. By long term health and stability, I mean as close as one can get to the remainder of the life of our patient. This is our vision and goal. With proper continued care and maintenance, this can and will be achieved.

The radiograph of the above situation shows a darkening around the tip of the root, demonstrating an active infection that further compromised the long term health of the tooth. What I recommended and performed on this particular patient was to have the tooth removed in a very gentle manner in order to preserve the periphery of the affected area as best as possible. this was achieved successfully as the following photos will show. Of vital importance to this approach is gentleness!

This is the temporary that was made immediately after the patient presented originally with a broken tooth. Immediate steps needed to be taken in order to have our patient smile comfortably, without ever being concerned about a gap in the smile. This temporary restoration was bonded to the remnants of the root. Although it appears stable, it will not predictably serve the patient long term. This was done prior to the surgical phase.



The following images will present the results immediately after the surgery was performed. Despite the very common fears that the public may have about any dental surgery, as the result below clearly demonstrates, our approach is quite gentle in nature. It allows the patients own cells under proper guidance and monitoring to heal the treated area in way to resemble nature as closely a possible.

Here are the post surgical photos:



This is the provisional crown placed immediately after the implant was surgically placed. This was done on the same day, so the patient did not have to be concerned about having a removable prosthesis. Therefore, there is not even a concern of ever showing a gap within the smile. The radiographic image shows how the implant is completely surrounded by healthy bone, which is a vital element in the long term success of the procedure.

Donor tissue versus own tissue for root coverage

In this photo, there are multiple areas of root recession caused by excessive pressure form the tooth brush. Here our patient opted to use her own tissue taken from her palate to be used for the regeneration of the lost gingiva. This approach is considered by many practitioners to be the most predictable way to restore health.












This is the post operative photo of the above patient approximately 6 weeks after the procedure. The regenerated gingival (gum) tissue has added significant coverage to the previously denuded areas. The patient also stated that there is a noticable decrease in the amount of sensitivity to cold stimuli around the previously denuded areas.

Gum Recession! Is root coverage necessary?

Before & After views of root coverage procedure using donor tissue.

There are multiple reasons for receding gums. Tooth brush abrasion is a very common culprit. Our obligation as dentists is to first and foremost educate our patients to avoid putting excessive pressure on their tooth brushes. Also the amount of tooth paste used has a significant influence. Tooth pastes at large contain abrasive materials that in conjunction with too much force not only remove plaque, but also remove healthy underlying tissue. The result is denuded root surface as shown in the above photo. This tooth was previously restored with composite (tooth colored restoration) for good cause of covering the denuded surface. However, nature tells us that the best coverage for the teeth is healthy gingiva (gum tissue).

The same root surface has been treated by donor tissue in our facility with a special plastic surgery like approach in order to strengthen the underlying structure as well as gaining significant root coverage. The photo comparison clearly reveals the benefits from this treatment.