Creating beautiful smiles to last a lifetime.
Porcelain Crowns | Inlay Onlay
Jamie's Amalgum Filling - Note the discoloration
Inlay/Onlay
The Other White Crown
It is a common myth that silver amalgam fillings last forever. They are very durable but are not indestructible. There are several reasons why a silver filling can fail. Fillings have to endure an incredible amount of biting force and over time, they become worn and turn black, and their edges wear away. Moisture and temperature changes can also cause the filling to expand and contract. This expansion can create a wedging effect in the tooth, which can fracture or break off tooth structure. The expansion can also lift the surface of the filling slightly creating a gap where the filling meets the tooth and allow bacteria into the tooth.
Jamie had begun to have sensitivity when flossing in her lower right molar, which had a large silver amalgam filling. Dr. Adler diagnosed recurrent decay in the tooth and recommended that an inlay be placed.
An inlay is similar to a filling and lies in between the cusps of the tooth. They are custom-made to fit the prepared cavity and are then cemented into place. An onlay is a more extensive reconstruction that replaces one or more cusps of a tooth. Onlays are indicated in situations where a substantial reconstruction is required. However, more of the tooth structure can be conserved compared to the placement of a crown. To repair damage to the tooth’s biting surface, rather than using a simple filling, or a crown, Dr. Adler will often use an inlay, or an onlay. Inlays and onlays are made from porcelain because of its strength and ability to match the natural color of the tooth.
Jamie's Almost Invisable Inlay
Dr. Adler prepared Jamie’s tooth by removing the old amalgam filling and the underlying decay. He then painted a reflective powder over the prepared tooth. Using a special camera, he took an accurate picture of the tooth which was then displayed on a computer screen, where he designed the inlay. Then CEREC took over and automatically fabricated and shaped the restoration. CEREC is an acronym for Chairside Economical Restoration of Esthetic Ceramics. With CEREC there was no need for us to make an impression and send it to a lab. The inlay was then permanently bonded to Jamie’s tooth. The whole process took about an hour and Jamie was able to leave with a beautiful and healthy white tooth verses the discolored and decayed one that she came in with.
Tags: boulder, Colorado, cosmetic dentist, porcelain crown
Repairing Broken Tooth | Fractured Tooth
- Katie after the accident
With just a slip of the foot, Katie’s appearance was instantly changed. After slipping on ice and falling face first, Katie was left with at least two of her upper front teeth broken. A large portion of her upper left middle tooth was fractured off and her upper right tooth next to the middle was also chipped. She immediately sought treatment from Dr. Adler of Adler Cosmetic & Family Dentistry. Dr. Adler examined the damaged area using the aid of both x-rays and an interoral camera to help diagnose the multiple fractures that were not apparent to the naked eye and to determine the extent of the damage. Teeth #7 and 9 were visibly broken so Dr. Adler placed composite bond on the teeth as a temporary solution to restore the aesthetic look of the teeth until permanent restorations could be completed. Tooth #8 did not appear visibly damaged but the interoral camera did reveal that the tooth was fractured. Dr. Adler suspected that the tooth was more heavily damaged than it appeared since the teeth on both sided had visible damage due to the impact. A week after the fall, a portion of tooth #8 broke off due to the trauma it sustained during the accident. Dr. Adler determined that porcelain veneers should be placed on teeth #7-10 to restore the patient’s smile to its original brilliance.
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- Katie after the accident
Tooth #10 (upper left tooth, second from the middle) did not have any visible fractures but needed to be restored partly as a precaution since not all damage from a fall is immediately apparent and mostly for aesthetics. It is recommended that front teeth especially should be restored in sets of two to insure that the patient’s smile remains symmetrical. Tooth #10 was already shorter than its counter part #7, so if Dr. Adler was to only restore the teeth that had visible fractures (# 7-9), then tooth #10 would appear short and out of place, giving the patient an uneven smile.
A veneer is a thin shell of porcelain that is bonded to a tooth to improve its color or shape. A veneer generally covers only the front and top of a tooth. Veneers can be used to close spaces between teeth, lengthen small or misshapen teeth, or whiten stained or dark teeth. When teeth are chipped, as in Katie’s case, or beginning to wear, veneers can protect them from damage and restore their original appearance.
Katie's Teeth After
Katie’s four upper front teeth were first shaped and roughened to prepare them for the veneers. Impressions were then taken of the teeth and sent to Aurum Ceramic Dental Laboratory, where the veneers were artistically custom crafted. Once the veneers had returned from the lab, they were cemented onto Katie’s teeth using a durable adhesive bond. The bond was then cured with a harmless high-intensity light. The pain Katie initial experienced from the accident was relieved after the veneers were placed. The final results were a beautiful and natural looking smile.
Trauma cause to a tooth in a fall can take several months before all the damage is known. A root can be fractured but not cause symptoms for several months after the accident. Dr. Adler was concerned that Katie might eventually need a root canal for that very reason. With this in mind, Dr. Adler specifically designed the veneers to allow an access opening for a root canal without damaging the porcelain restorations if one was needed at a later time.
Katie's Beautiful Smile After
Four months after the fall, Katie did begin to have symptoms in tooth #8 that warranted a root canal. The blood supply to the tooth was likely damaged in the accident but was not symptomatic until several months later. Dr. Adler referred Katie to Dr. Joseph Parsons of Boulder Endodontics, P.C. for the root canal. Dr. Parsons successful performed the root canal and the veneer was not damaged in the procedure. Because symptoms can develop long after the accident continuous follow up is needed to monitor the tooth’s nerves.
Katie is good as new and now her brilliant smile is the best ice breaker of all.
Tags: boulder, Colorado, cosmetic dentist, Cosmetic Dentistry, dentistry
Hidden Decay and Crown in One Day
- Hannah’s Teeth Before
Hannah, a college student in Boulder, Colorado, first came to Adler Cosmetic & Family Dentistry because she was experiencing cold sensitivity and pain while chewing on one of her lower left teeth. During the emergency exam, we took a digital x-ray of the area and used the Diagnodent, a painless laser that helps detect decay beneath the hard enamel layer. Tooth #19 (first front molar on the lower left) was determined to be the cause of the pain. Hannah had a stainless steel crown on tooth #19. She had worn holes in the top surface. Stainless steel crowns are commonly placed on young children’s teeth but they do not last permanently. It was also noted that tooth #18 had a dark stain on the top back surface and the Diagnodent got a reading that indicated the presence of decay. It was determined that the old stainless steel crown on #19 needed to be replaced with an all porcelain Cerec crown and that tooth #18 needed a composite resin (white) filling.
Decay Exposed Once Crown Was Removed
Only when the old stainless steel crown had been removed to prepare the tooth for the crown was the extent of the decay apparent. Decay underneath the crown had destroyed most of the tooth structure. Dr. Adler removed the visible decay and used decay indicator, a liquid dye that indicates areas of decay, to insure that all the remaining decay was then removed. Tooth #19 was then prepared for the crown by shaping the remaining tooth into the best shape for supporting the crown. In Hannah’s case, some of the tissue around the tooth needed to be cleaned with a laser due to the inflammation caused by the stainless steel crown. Optical impressions were taken using the high-tech Cerec camera which then allowed Dr. Adler to custom shape the crown to fix Hannah’s tooth and bite. The Cerec machine then fabricated the crown from a solid block of porcelain while Dr. Adler did Hannah’s filling on tooth #18.
Hannah's New Crown and Filling
machine was done milling the crown for tooth #19. The crown was fitted on the tooth before any cement was added to insure a proper fit. The tooth was then disinfected and cleaned. Using very strong clear cement, the crown was then chemically bonded to the tooth. In just one appointment, Hannah was able to leave with two much healthier and better looking teeth.
Cracked Tooth Syndrome | The Hidden Fracture
Cracked tooth syndrome describes the recurring pain, discomfort, and/or sensitivity that is caused by an incomplete fracture or crack in a tooth. The fracture involved is often difficult to detect and may be completely invisible to the naked eye and may not appear on dental x-rays. A cracked tooth can be caused several different ways. Clenching and grinding can weaken teeth causing them to fracture. Root canalled teeth that are not restored after treatment and large fillings can cause your teeth to loose strength, making them brittle. Every day your teeth endure a tremendous amount of pressure from biting and chewing, so if you bite down on something hard like a popcorn kernel, the force can cause the tooth to fracture, especially if it is weakened.
Treatment of a fractured tooth usually depends on the location of the fracture as well as the extent of the damage. If only the outer enamel is cracked then we remove the affected portion and restore the tooth with a crown or onlay to stabilize it and protect it from further damage. If the crack extends into the underlying dentin or pulp layers then more extensive treatment may be required, such as a root canal, before a final restoration can be placed to stabilize the tooth. In some rare instances, a crack will extend all the way through the tooth and under the bone. In these extreme cases, there is no way to restore the tooth and we have no other option but to extract it. Fortunately, most cracked teeth can be saved. The key is early detection and appropriate treatment. Since diagnosis is often based on patient symptoms, it is very important to tell your dentist of any pain or discomfort you have been experiencing as soon as you have it.
Dr. Beyer's Fractured Tooth As It Is Revealed
Dr. Craig Beyer of Beyer Laser Center is a good example of a those rare cases where a fracture extends through the tooth. Dr. Beyer came to Dr. Adler complaining of that he was having pain when he was biting down. Based upon the symptoms Dr. Beyer described, photographs, and x-rays, Dr. Adler determined that Dr. Beyer had a fractured tooth and recommended a crown. The tooth was prepped and fitted with an all porcelain Cerec crown. The fracture became even more apparent once the tooth had been prepped for the crown and had decay indicator placed on the tooth. Decay indicator is a dye that helps make decay more visible, it can also be used to see tooth fractures because the dye will run along the crack. Interoral pictures allow the doctor to get an up-close look at the teeth allowing him to see cracks that might otherwise be missed. If the fracture had been an oblique fracture, extending into the enamel or dentin but not the pulp layers, as was first assumed then the crown would have solved the problem. Unfortunately, Dr. Beyer continued to have symptoms of pain. Dr. Adler then performed a root canal believing that the fracture extended into the pulp of the tooth. During the root canal procedure, Dr. Adler saw that fractured propagated through the tooth and that the root canal would not be sufficient treatment to save the tooth. Since the fracture extended through the tooth splitting it, the tooth could not be saved and had to be extracted and replaced with a titanium implant.
Bill's Uncovered Fractured Tooth
Bill is a common example of cracked tooth syndrome. Bill had been having sensitivity with a tooth on his upper left side for about one year whenever he would bite down but didn’t think much of it since it only hurt when he bit down and wasn’t a constant pain. After mentioning to the hygienist at his cleaning that he was having this continuous problem, the doctor diagnosed a fracture in the tooth. An old filling was removed from the tooth and a decay indicator was placed on the tooth in order to see the extent of the fracture. The decay indicator along with the interoral pictures allowed Dr. Adler to see that the fracture, an oblique fracture, extended across and into the tooth but had probably not yet entered the pulp chamber. Dr. Adler placed an all porcelain Cerec crown on the tooth to stabilize and to help prevent the fracture from propagating further through the tooth. The crown also kept the fracture from expanding and contracting which can increase the pain or sensitivity that a patient experiences. Since the crown was placed, Bill has been symptom free.
Colorado Invisalign | Boulder Dentist Dr. Michael Adler Announces Invisalign Special Offer
Nationally recognized Boulder Colorado based cosmetic dentist Dr. Michael Adler launches Invisalign invisible braces promotion beginning August 2009.
Boulder, Colorado, August 29, 2009 – Boulder, Colorado-based cosmetic dentist Dr. Michael Adler today announced a special limited time discount for Invisalign invisible braces treatment. Invisalign is the virtually invisible way to straighten your teeth without braces. The Invisalign system uses a series of clear, removable aligners to move your teeth over time to give you the smile you deserve.
Dr. Michael Adler specializes in Invisalign treatment. Actual patient cases studies with before and after pictures are available on the Adler Cosmetic and Family Dentistry website. Among the chief advantages of using Invisalign are:
- Absence of ugly, metal bands and brackets
- Results in months instead of years
- Aligners are virtually invisible, so it’s nearly imperceptible to others that you’re undergoing orthodontic treatment.
Among the conditions that are treatable using Invisalign are: 1) Overly crowded teeth. This occurs when there is simply a lack of room within your jaw for all of your teeth to fit normally, 2) Widely spaced teeth. This occurs with abnormal continued growth of the jaw bone, 3) Crossbite. This occurs when the upper and lower jaws are both misaligned, 4) Overbite. It occurs when the upper teeth bite over the lower teeth, and 5) Underbite. This occurs when the lower teeth protrude past the front teeth.
Adler Cosmetic and Family Dentistry is open weekdays by appointment. Additional information about the practice and services offered is available at www.adlerdentistry.com.
About Adler Cosmetic and Family Dentistry
The cosmetic and family dental practice of Dr. Michael Adler is based in the Colorado community of Boulder, a convenient and scenic drive from most locations in the Denver and Front Range areas. Boulder, Colorado is also an inviting destination location for visiting out-of-state patients seeking Dr. Adler’s specialized attention. Dr. Adler is nationally recognized for his work and is committed to providing his patients with the highest level of care in both cosmetic and family dentistry. The practice maintains a website at www.adlerdentistry.com and regularly publishes information on its blog at www.adlerdentistry.com/blog.
Contact
Name: Heather Ramsey
Email: heather@adlerdentistry.com
Phone: (303) 449-1119
Adler Cosmetic and Family Dentistry
1810 30th Street
Boulder, CO 80301
Tags: boulder, Colorado, cosmetic dentist, Invisalign
Creating beautiful smiles to last a lifetime.