- Ryan after the accident
Ryan suffered a traumatic fall that severely damaged his front teeth. Tooth #8 (his upper front tooth on the right) had sustained the most damage and had had a third of the tooth broken off. Ryan was suffering pain and sensitivity due to the fracture. Tooth #9 (located to the left of #8) was also fractured but not to the same extent.
Dr. Adler performed a root canal on tooth #8 as part of his emergency treatment to get the patient out of pain. The teeth were temporarily bonded to make the teeth look normal while Ryan was completing his treatment. The root canal was necessary because the severe fracture exposed the pulp of the tooth to bacteria that live in the saliva. If left untreated, the tooth would continue to be a source of infection and eventually weaken the body’s immune system. The pulp is contained within an inner chamber of the tooth called the pulp chamber. Pulp is commonly referred to as the nerve but is actually a soft tissue make up of nerves, arteries, and veins. The pulp extends from the pulp chamber down through narrow channels, called the root canals, to the tips of the roots. The fear and pain associated with root canals are over rated. For most patients, getting a root canal is no more traumatic that having a filling done. During the process of the root canal, the doctor goes into the tooth and removes the pulp, cleaning the cavity.
Once a root canal has been performed, the tooth is structurally weakened and prone to fractures and breaking if left as is. Crowns are a common option for a root canalled tooth. In Ryan’s case, both tooth #8 and 9 were both crowned not only because of the root canal but because of the fractures caused by the accident. The teeth are prepared for the crown by removing any damaged areas and/or decay. In the case of tooth #8 a carbon fiber post was placed to adequately support the crown so the bite force would be properly distributed so that the tooth did no fracture. The tooth is then shaped to securely hold the crown. The crown is either custom fabricated in the office using CAD/CAM Cerec system or sent to a laboratory. Ryan’s was sent to a laboratory and an impression of the tooth was taken so the dental lab could make an accurate model of his mouth, and then created a crown that precisely fit his mouth and bite. Ryan received all porcelain crowns on #8 and 9. Unlike porcelain fused to metal crowns, all porcelain crowns are translucent and allow light to pass through the tooth like a natural tooth opposed to reflecting all the light which can make the tooth appear dark. Porcelain fused to metal crowns can also have a dark ring near the gum line which is not present with all porcelain crowns. The shade of the teeth is also very important to maintain the natural appearance. An underlying shade is taken of the prepared tooth, known as a stump shade, to better match the natural and subtle hues of the tooth. The shade of the crown is also determined by the adjacent teeth. Whitening is done before this outer shade is taken to make sure the crown closely matched the other teeth and because crowns are not effected by the whitening process and so will remain the same color as they are made.
Prior to the crowns being custom made, Ryan had his teeth whitened using our in-office ZOOM laser whitening. The main ingredient in Zoom is hydrogen peroxide, which works by oxygen enter the enamel and dentin was it breaks down. The oxygen bleaches colored substances and doesn’t harm the tooth structure.
The Zoom light aids in activating the hydrogen peroxide and helps it penetrate the surface of the tooth. It is a simple procedure that can produce great results. With this new brighter smile, Ryan was ready to have the shade taken and the crowns seated.