I want that Gap in Between My Teeth Closed!

The very common procedure of Bonding is routinely utilized for closing a front tooth gap.  For some people their front tooth gap defines their individuality; their face and attitude with a mere smile. For others, the gap represents a disfigurement; a cruel trick played by Mother Nature.

I do believe that bonding technology originated from the NASA Space Program. NASA scientists engineered the process of securing(bonding) ceramic tiles to the hull of the space shuttle. Bonding was proven to be  a reliable, durable, easily repairable, and most effective approach of securing ceramic tiles to the hull of the space shuttle. The ceramic tiles were crucial in heat displacement and essential for the survivability of our returning astronauts. The process of Bonding is both Science and Art.

Bonding is technically a process of fusing two like or unlike surfaces. In dentistry, we are constantly bonding enamel to a host of dental materials such as composite resin, ceramic, ceramic /resin hybrid material and metal such as gold alloy.

The process of bonding first involves surface preparation of the surfaces planned to be bonded. Tooth enamel is etched with 37.5% Phosphoric Acid for 15-30 seconds then washed off with water. This etching process creates a microscopic roughness of the surface enamel. Once etched, the surface is air blown super dry. A clear colored bonding agent (unfilled resin), gets vigorously scrubbed and applied with a tiny micro brush by me, to the prepared surface. This unfilled resin supersaturates the previously micro-textured enamel surface. The resin seamlessly fills into the micro-roughen landscape of the enamel engaging unbelievably small undercuts of enamel rods which make up the enamel surface you and I can not see with our naked eyes. A specifically engineered Ultra-Viloet Blue light is then shown onto the applied resin by the dental assistant. The light initiates and activates a polymerization (hardening ) shrinking of the applied resin. This “curing” acts to fuse or “bond” the unfilled resin with incredible adhesion to the enamel of the tooth. Once the bonding agent is fully cured in about 20 seconds, multiple incremental layers of tooth colored  material is artistically  added and contoured to mimic a desired shape, by me.

The Principle of Bonding is Classic. It’s been around since the 70’s. What has improved are the materials of adhesion and options of bondable materials.  The choice of materials to be bonded to enamel all require slight nuances in their preparation prior to being bonded to the unfilled layer of the enamel.

Pictured Below:

In this case of gap closure performed today, the surface materials are the patient’s enamel and composite resin material. It took me twenty minutes. No shot indicated. No Pain. Everybody happy!

 

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Before

 

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After

 

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

I Was Only Eating An Almond.

We all know the added health benefits to eating Almonds. Almonds contain the “good” fats, fiber, Vitamin E, Magnesium and protein. They assist in lowering blood sugar, lowering blood pressure and lowering cholesterol. They are just bad for teeth with large old silver restorations.

A patient came in today with a very saddened face. Her lower right molar tooth in question had no pain to touch or temperature sensitivity. As she stated, “something felt crunchy when I was chewing on an almond and soon after, I felt a sharp edge of my tooth with my tongue.”

The history of her tooth goes back over twenty years.  It had been previously filled twice with an amalgam filling. A radiograph check confirmed that the tooth was structurally remaining  in good condition. The nerve within the tooth was just fine.

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The side view
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Tongue side Fractured Off Cusp– towards the back aspect of the tooth.

This tooth had a tremendous amount of very healthy enamel.

In general, the functioning aspect of  Lower Posterior Teeth are the outer cusps, the “loading” cusps (buccal cusps). The inner “carrying” cusps (lingual) are non functional or non-loading cusps and are essentially bystanders in chewing. The opposite functionality could be said for an upper tooth.

I  felt that a Ceramic Onlay would be the perfect restoration. Ideally it would bring the tooth back to full function because the loading cusps were intact. There was no pain on chew, which would indicate a residual fracture line under the amalgam restoration. This would require a full coverage crown if it were the case. The nerve of the tooth was totally fine. No root canal procedure was indicated here.

An Onlay is sort of  a three quarter crown. After delivery of a simple local anesthetic, the process of creating an onlay requires that I clear away any pre-existing restoration, undermined, cracked, or weaken tooth structure resulting from the original insult. What remains should only be the sound tooth structure.

A ceramic restoration is created by my in-office milling machine (CEREC).  The CEREC created onlay restoration is super engineered to fit “into and onto” the prepped tooth with an accuracy of a 25 microns (0.025 of a millimeter).  That is a very small number. The seam in-between tooth enamel and restoration is tight, exact and imperceivable.

The restoration is then bonded into place with a resin cement and fine polished to perfection. The process in my office, start to finish, takes one hour.

The advantages are many:

An onlay is a very conservative restoration. I don’t need to aggressively shape the tooth as I would for a Full Coverage crown restoration. Less drilling means, less of a chance that you will need a root canal procedure.

The material is a Composite Hybrid of Ceramic and Resin (Cerasmart). It has a very long track record. It lasts many years.

A bonded restoration translates into a whole stronger tooth, subsequently less prone to fracturing in the future.

Esthetically, they are beautiful.

TIP: There is hope after all for you Almond Lovers with big beaten down silver restorations. You do not need to live in fear………….. I have been informed by numerous patients this to be true.
Apparently, Organic Almonds are softer and are less likely to break your teeth.

 

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Final Bonded Ceramic Restoration

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

Missing Tooth Options.

A patient presented pain free with a fracture to the gum line ( upper left bicuspid tooth). He had minimal pain only  when he pressed his finger on the gum line of the remnant root area. There was no infection noted around the area. The incident when the tooth fractured, was unremarkable “The tooth just snapped off”, as he plainly stated.

Fractured Root canal treated tooth
Fractured Root canal treated tooth Pre-Op picture of Tooth #13

Options were discussed 

1- Doing nothing, essentially leaving the root in place. “Not a good idea”,  as I mentioned because the rotting root would act as potential source for a future infection.

2- Simple extraction of the remnant root. “A very good idea, but what about the space?” I asked. “You can’t walk around like a homeless guy. It’s near the front, for god sake.”

3- Simple extraction of remnant root combined with a bridge to span the gap. The question to ask one self when faced with this predicament, “Do you want to have two of your teeth ground down to stumps, in order to close the gap for the replacement of one tooth?”  I explained. The consequences of possibly creating an unwanted root canal in the process, seems to be an absurd option for a single tooth replacement.

4- Simple extraction of remnant  root and replacement with a removable device, a partial denture. “Terrible idea”, I said. “You are way too young to put your teeth in a cup at night!”

5-Simple extraction of remnant root, socket preservation combined with a staged implant approach…………….Excellent Idea…. we both agreed!

BINGO! And that’s what we did.

Extracted fractured tooth with bone graft
Extracted fractured tooth with bone graft
Post Op-Picture
Extracted Root with Bone graft and Barrier

The patient was informed to return for suture removal in 2 weeks.

I plan to place a dental implant fixture in 2 months via a guided surgical approach.

STAY TUNED !!!!  

You can Visit my You Tube site Robert Emilio DDS and Associates where you can find my entire official……Dental Implant Seminar for your review.

 

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

Lower Implant Over Denture……. AKA Snap On Denture

Mandibular Implant Over Denture

Dentures can be incredibly problematic for many denture wears. They slip and slide. They pinch and gouge soft tissues. You really can’t chew hard foodstuffs with them. Are you getting the hint? They are difficult to eat with, even the “best of them”. Quality of life can suck!

The lower denture tends to be worse that the upper denture. The upper denture is self retained via simple suction onto the roof of the mouth.  A seal of the soft palate is created upon insertion of the prosthesis. The lower denture has no such luck. The tongue and floor of the mouth always wants to lift the lower denture out of its stability. The bone of the lower jaw tends to be thinner while the overlying tissue is more so fragile than the upper jaw gum tissue. The lower jaw also has two major sensory nerves called the Inferior Alveolar Nerves that can at times become compressed by the hard merciless overlying mandibular denture acrylic creating a tremendous amount of pain; a feeling of shooting electricity thru the lip. This adds to the everyday misery of the wearer.

A simple affordable life changing procedure which I routinely deliver in my office is the Implant Over Denture. This is a fabulous solution which simply remedies all of the aforementioned problems that lower denture wears suffer with everyday.

The procedure requires a Cat Scan of the lower jaw. This scan is most beneficial because it allows me to choose the most appropriate sized implants and relative positioning to be best supported by the jaw bone. Also, there are several areas of anatomic concerns for me as a surgeon that I need to respect. Knowing where not to place my implants is equally important as knowing where to place my implants. It’s advantageous to have a road map before the journey begins and the Catscan offers that.

On the day of surgery, I usually place 3-5 implants in the lower jaw in one surgical event. This takes me about an hour appointment. After placement of implants, tissues are approximated and the surgical site is closed tightly with numerous sutures of  both resorbable and non resorbable types. One of my assistants takes the existing denture and temporarily relines it with a medicated packing to aid and accommodate the post surgical tissue changes. The patient is given 600 mgs. of Advil in the chair, instructed in the basic post operative care by another of my qualified assistants, appointed to return for a 15 minute suture removal appointment in 12-14 days, leaves the office with their existing lower denture in place and an ice pack on their face. Total appointment time takes about 90 minutes completed with simple local anesthetic only.

It is important that the patient is instructed to wear the denture overnight and everyday as they normally do after surgery. The denture in place keeps compression on the surgical site and facilitates the healing process. It’s okay. The implants will be fine  submerged below the gum line beginning the process of osseointegration (fusing to the bone). For the first two weeks, until the wound seals closed,  I emphasize wearing the denture, without denture adhesive paste for the obvious concerns of wound contamination.

At the two month mark after surgery, I dremel  divots out of the patient’s existing acrylic denture base to create space for future female housing attachments that are engineered to accept the male counter component of the previously placed implants.

A chair side cold cure acrylic process of fusing the female attachments is done with in 10 minutes time.

The “Snap” is the sound of the male and female components engaging. A First Snap always garnishes a smile from me and a bewildered look of curiosity by the patient.

The patient is free to leave an enjoy a slip free lower denture. Inevitably, patients return for follow-up, happier, more enthusiastic about life and 10 pounds heavier. I am most satisfied everyday knowing that my staff and I are responsible for improving the quality of life of one human at a time.

Four Implants with Locator Male attachmentsUnknown-1.jpegimages-1.jpegUnknown.jpegimages-4.jpegimages-2.jpeg

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

My Implant is Loose

A  hygiene recall patient came in today for routine maintenance (he had an implant placed by me, fifteen years ago).

While he was heading towards his prepared operatory, I was coincidentally passing through the hallway to visit another patient when he exclaimed with a slight concern,  “Hey doc, my front tooth implant is loose.” Before I had a chance to say good morning, I instantly snapped on a right-handed glove and reached across to wiggle his front tooth with my index finger and thumb  “Any pain,” I asked?  My young new hygienist, stared in both confusion and curiosity.  The patient replied, “No”.

I asked my hygienist to take a radiograph to confirm my suspicions and low and behold…. they were correct! I assured him not to worry and that all was well with his implant and that it was simply a LOOSE ABUTMENT SCREW. I was able to accommodate his issue and concerns,  right after his cleaning appointment.”

The abutment screw is a tiny screw that engages the implant abutment. The implant abutment is the structure that is above the gum line and is seated on top of the dental implant platform. An implant crown, is usually cemented onto the screwed down abutment.

On occasion, the little tiny abutment screw “backs out”, thereby releasing the abutment/crown complex from the implant fixture. Patients will interpret that as a wobbly implant crown that clicks ( the clicking is the sound made when the base of the titanium abutment tips on and off the titanium implant screw platform).

Pain is usually an indicator of bad things. Pain upon manipulation of the tooth complex would have indicated a failing implant fixture requiring it’s immediate removal.

In this situation, not to worry. No shot needed to fix the problem. Usually a simple fix. A small access hole needs to be created with the dental drill thru the existing crown to yield a direct straight-line access to the top of the abutment screw head.  Then a quick retightening of  the screw with a special miniature implant screwdriver. Seal the access hole with a composite resin and done….A ten minute fix!

The abutment screw can loosen due to unbalanced forces on the implant abutment crown or a patient para-functional habit such as bruxism ( tooth grinding).

It’s best that the dentist replaces the abutment screw with a new one. Then, a final bite adjustment is important to minimize extraneous forces on the implant crown (which  minimize chances of that recurrence).  An abutment screw replacement is suggested because one must assume that the original abutment screw was previously torqued down to the manurfacturers specifics ( 35 Newton/Cms ). When any screw is torqued, it is essentially stretched to a maximum twist before stress tolerances are destroyed yielding a snapping screw. The inherent nature of the screw’s metal contracts back creating tension onto the opposing implant’s internal threads giving a compression force in addition to a mechanical locking of threads of both implant and abutment screw.

A bite guard may be recommended after the new screw is replaced to minimize occlusal lateral forces that could potentially be responsible for stressing the abutment screw and weaken it’s integrity..

 

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com