This patient cracked his molar biting a chicken bone. I was able to save the tooth, and without a root canal, but it did require a crown lengthening periodontal surgery and a crown.
This next patient bit down on a mint candy and fractured her molar down the root. The tooth could not be restored and was extracted and we will place a dental implant.
This was a challenging implant restoration case due to the alignment of implants. In order for the implant to osseointegrate firmly into the jaw bone we like to place the implants where the jaw bone is the thickest and strongest. In this case the best bone was not lined up nicely so we had to stagger the implants. I was still able to make the final implant crowns line up perfectly in the mouth.
Before and After
On these 2 crowns, the first porcelain and second gold, that I did last week in my office I show how I place retention grooves in my crown preparations to help lock my crowns in. These grooves prevent rotation and help secure the crowns in place. These slots allows for more surface area for the cement and results in a longer lasting restoration that holds firmly in place. This is especially important in short weak teeth. With this technique I am able to save teeth that otherwise would need to be extracted or require periodontal crown lengthening surgery.
The first patient was concerned about his broken down front upper teeth and the gap between the teeth.
The next patient broke her lateral incisor tooth. It is very dark since it was traumatized and had a root canal many years ago.
CBCT systems used by dental professionals rotate around the patient, capturing data using a cone-shaped X-ray beam. This data is used to reconstruct a three-dimensional (3D) image of the of the patient’s head and neck. CBCT uses more radiation than regular dental teeth x-rays, but still less than 10% of the radiation used in conventional medical CT scan of the same area.
This is the Carestream 9300 Imaging machine we have at the University of Maryland Dental School. I mostly use this to plan dental implant placement.
Dentists use Cone Beam CT imaging for the following:• 3-D observation of overall oral/facial bony characteristics, allowing easier diagnosis and placement of dental implants • Surgical guide fabrication for implant placement • 3-D observation of teeth for endodontic diagnosis and treatment • Diagnosis and treatment of tooth impactions • Identification of inferior alveolar nerve and mental foramen location • Identification of the location of the maxillary sinus • Identification of the presence of odontogenic lesions • Trauma evaluation and treatment • Analysis of temporomandibular joint characteristics leading to diagnosis and treatment • Integration with CAD/CAM devices for fabrication of prosthodontics or orthodontic appliances • Identification for referral of numerous conditions or diseases not normally within the realm of dentistry, but that can be shown on typical cone beam images.
These last 2 pictures show how we use information obtained from the Cone Beam CT to plan placement of dental implants.
Sincerely,
This patient fractured the lingual side of his first molar tooth biting down on a Skittle candy. Dr. Gentry was able to restore the tooth with a porcelain crown and was able to avoid a root canal and crown lengthening periodontal surgery.
In this case report Dr. Gentry demonstrates the importance of taking a radiograph when seating the custom abutment and crown before final torquing of the gold implant interface connecting screw.
Here’s an example from a case I was doing with a dental student involving the 2 upper front teeth. In the first x-ray the impression copings were not fully seated. I re-positioned the copings and another x-ray was taken to confirm proper alignment. You cannot tell without an x-ray since this is below the gum-line.
Here’s an example of another implant check x-ray to verify proper seating.
Porcelain veneers are thin pieces of porcelain used to recreate the natural look of teeth, while also providing strength and resilience comparable to natural tooth enamel. It is often the material of choice for those looking to make slight position alterations, or to change tooth shape, size, and/or color.
The first step is to schedule an appointment with Dr. Gentry to determine if veneers are the right option for you, or if there are alternate solutions available. Communication about what you want corrected is critical for a successful result. Spend time clearly identifying what cosmetic improvements you want to accomplish.
You’ll often hear people say that celebrities have veneers and this may seem like the best way to replicate picture-perfect teeth, but each mouth is different and veneers need to be carefully researched. We begin with a smile analysis and diagnostic wax mock-up that will allow you to see if the final result is actually what you’re looking for. Deciding that porcelain veneers will create the look you want is only one step in the process. There is much more to learn before proceeding further.
Porcelain laminate veneers consist of a compilation of several thin ceramic layers which replace original tooth enamel, and an adhesive layer. To apply a veneer, a very small amount of the original tooth enamel must be removed, usually about a millimeter. This is essential as it creates room for the porcelain veneer to fit within the mouth and most accurately restore natural tooth function while creating an even better appearance than the original tooth.
The bond between original tooth and porcelain veneer is critical as it not only provides the esthetic perfection desired, but also a strong bond which is essential for correct veneer function. Light-sensitive resin is placed between the original tooth and the veneer and then hardened using a special curing light.
Porcelain veneers are a very successful option in many situations where the original tooth has developed poor color, shape, and contours. It is also a good choice for fractured teeth, gaps between teeth, and in some situations where the tooth position is compromised and there are minor bite-related problems. For some people, superficial stains do not respond well to tooth whitening or bleaching. In these situations, a porcelain veneer may be the best option.
Since veneers are individually sculpted for each patient, it is nearly impossible to tell the difference between a veneer and a natural tooth. Unlike natural teeth, custom-made veneers resist coffee and tea stains, and cigarette smoke because they are made of high-tech materials.
With veneers—as opposed to crowns—your natural teeth remain largely intact with only a minimal amount being altered to fit the veneer.
For teeth that resist whitening, veneers can make even the darkest teeth appear bright white.
Dentists may also recommend veneers to quickly fix minor twists, overlaps, and small gaps.
Because a portion of the original tooth enamel is reduced, a veneer is not considered a reversible treatment. Although adjustments and even new veneers can be made, you can never reliably return to the original condition of the tooth.
Creating porcelain veneers requires some laboratory time, so expect at least a week before they’re ready to be applied.
After the porcelain veneers are attached you will probably have some sensitivity to hot and cold temperatures due to the removal of that thin layer of enamel. This typically disappears within a few days. In a healthy mouth properly treated with porcelain veneers—and where destructive forces are minimized or eliminated—a patient should be able to use porcelain veneers like his or her own teeth. Although they’re very strong, veneers are also brittle. You should avoid the same excessive stresses you would avoid with non-veneered teeth: don’t bite your fingernails, chew ice, or open beer bottles with your veneers!
Maintaining porcelain veneers is actually quite simple: Treat them as you would your original teeth, with routine brushing and flossing. Using non-abrasive fluoride toothpaste will typically be suggested by your dental professional.
One week after your veneers are placed, you will be required to return to the office for a follow-up visit and evaluation so the dentist can see how your mouth is reacting to the veneers. Even if you feel the veneers are a success, this appointment is vital to your future oral health.
If you have a habit of grinding or clenching your teeth, we will make you a nighttime bite guard so you do not damage your veneers.
You should also return for regular professional maintenance because porcelain veneers should be polished with a specially formulated, non-abrasive paste, and because we need to inspect your dentistry for any sign of potential failure.
To understand root canal treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it
A root canal is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, or a crack or chip in the tooth. In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gum tissues. Sometimes, however, there are no symptoms.
The dentist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the root canal, then fills and seals the space. Afterwards, a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.
Many root canal procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment is completed.
Root canal treatment can often be performed in one or two visits and involves the following steps:
1. The dentist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, a small protective sheet called a “dental dam” is placed over the area to isolate the tooth and keep it clean and free of saliva during the procedure.
2. An opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.
3. After the space is cleaned and shaped, the dentist fills the root canals with a biocompatible material, usually a rubber-like material called gutta-percha. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed usually 1 week later.
Most teeth can be saved. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored.
