Creating beautiful smiles to last a lifetime.
Decay Under Crown | Patient Profile
- Tooth #2 with PFM and Access Filling
Dee had just moved to town and was due for her cleaning. She wanted to make sure that there were no problems with her teeth. She chose to come to Adler Cosmetic & Family Dentistry at her daughter’s recommendation, who was one of Dr. Adler’s long time patients.
During Dr. Adler’s comprehensive exam using an interoral camera, he noted that tooth #2, her upper right molar, had a porcelain fused to metal crown, also known as a PFM, that was breaking down. A composite filling in the top of the crown sealing an access opening showed that the tooth had had a root canal done after the crown had been placed. The root canal was apparent in the x-ray but Dr. Adler also saw that there was decay on the distal or back side of the tooth under the crown. He recommended that the existing crown be removed so the decay could be cleaned out and a new all porcelain crown be placed.
Once the crown was removed, Dr. Adler saw that the decay was more extensive. The patient said that she had pain on the tooth which had originally prompted the placement of the PFM crown. When pain had continued later after the crown was done, an access opening was drilled though the crown and a root canal was performed.
Tooth #2 After Crown Removed
Tooth #2 After Laser Used
Root canalled teeth can sometimes be tricky to extract since the tooth is more fragile and likely to break a part during the procedure. Dr. Adler was able to successfully extract Dee’s tooth with no problems. Sometimes a tooth can not be saved despite a doctor’s best efforts if the decay has gone too deep. Dee is glad that the tooth no longer bothers her and that the decay was stopped in its tracts. She is now considering replacing the tooth by placing an implant, not only to replace the tooth but also to help keep the bone from receding. The implant acts like the roots of a natural tooth by supporting it and giving the bone something to attach to. Based upon Dee’s most recent experience she is making double sure that all of her old crowns are in good condition and don’t need to be replaced.
Tags: boulder, Colorado, dentist, porcelain crown, tooth decay
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
Creating beautiful smiles to last a lifetime.