A Big Thank You To My Lab Guy, Jimmy over at Nyberg Dental Lab

The Challenge

So often, cosmetic challenges may present. By the same token they can be beyond my technical abilities to troubleshoot directly due to lack of chair side material choices. In fact, I can always creatively envision a final outcome in my mind’s eye. The problem is that I may not have the tools and materials to deliver it right there on the spot on my office. CEREC has it’s limitations. At times, I will refer challenging cases to my local lab technician, Jimmy. The guy has a shop right down the street. Lucky me!

The Front Teeth

By all means, front teeth are animals. Particularly vicious. Specifically demanding and ultimately defining of a smile. Thus, they have to be right. For this reason, esthetics are driven by obvious factors: color, shape, size, proportion to adjacent teeth, and over all balance in harmony with the full smile. Some people just don’t care about their front teeth.

“It’s just a tooth.”

or My favorite,

“Who can see it anyway?”, I often hear.

My facial expression on hearing these bizarre statements is usually of incredulity.

My response usually goes like this, “That’s okay, but let me try to make it as perfect as possible.” This is a request to satiate my selfish quest for satisfaction. I always say in my office ,“God gave you the best.” However, with that being said . “Give me a shot. I like to be competitive.” That’s the passion. That’s the drive to make things interesting at my office everyday.

The Unsung Hero; The Lab Guy and his Shade guide

I very much appreciate when my lab guy comes in for the assist. In the first place, a single tooth can have multiple shades and physical attributes. Not to mention, it can look different in different lighting. Oh yeah….. What kind of light is shining on that tooth? Could it be natural sunlight, fluorescence light, or incandescence light? As a matter of fact, teeth can have “patches” of shades within a shade. In addition, there can be little lines running in various directions. These lines are called craze lines. Also, teeth can be very shinny or very dull upon light hitting them. In addition, a tooth can be square, ovoid or flat in profile. Unfortunately, shades of teeth do not always like to cooperate with my standard chairside shade guide or materials.

Sometimes we may need a custom blend of shades, a talented technician and a bit of imagination before we can realize “the one”.

Hence, my lab guy and friend, Jimmy from Nyberg Labs, sees all that stuff we take for granted in the makings of a tooth, for which I am very much thankful.

I placed the implant

Jimmy made the restoration

Credits:

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

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

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

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

You Don’t Have To Leave Without a Front Tooth

Fractured root underneath an old crown

This Happened today……….

After Hearing The Bad News

It was determined that his tooth was hopelessly fractured. Unfixable. In fact, non restorable. With this in mind, all options for tooth replacement were discussed. The patient was adamant . He stated forcefully, “I do not want to leave here without a tooth and I do not want a flipper .”

The Plan

“Kill Two Birds with One Stone”

my Thought process

Foremost the best strategy, was to make the patient happy by fulfilling his expectations by the end of the visit. A fixed tooth in place was what he wanted. In this case, my plan was to extract the fractured tooth and simultaneously ,”fix the color” of his adjacent teeth.

That’s to say, we were going to do some cosmetic dentistry in addition to oral surgery today.

Ultimately, once the extraction site completely healed in several weeks, I would install the permanent restorations. To put in another way, a “3” unit ceramic bridge over the extraction site and two individual crowns of the adjacent teeth.

In short, kill two birds with one shot of anesthetic…….

The Flow of Today’s Appointment

“Firm in principle and Flexible in Procedure”

The Discussion

No Doubt, the tooth had to come out. By all means, it was fractured beyond repair. Absolutely, I would have loved to place an immediate implant, but the patient just wanted to leave with a tooth in place. An immediate implant to the site would have been a bit risky in the sense that, I could not guarantee that I would have been able to place an immediate crown on the implant on this same very visit. There are many factors that play on making the decision of immediate implant placement versus delayed implant placement. This was the best option for the patient because he wanted a definitive immediate tooth. In addition, he received a cosmetic benefit of all ceramic crowns on the adjacent teeth.

At the end of the visit, the patient went on to his very happy merry way with a fixed temporary bridge of a refreshing shade.
He will return in several weeks for a digital impression and subsequent final ceramic crowns. Today’s visit took on shot of Lidocaine and One Hour’s time.
pre-op.
Fractured lateral central incisor
Plastic temporary in place after extraction of fractured root
Close up of area with temporary in place

Credits

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

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

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

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

Why does it hurt? I had the root canal.

The Presentation

An existing patient of my practice presented today complaining of soreness on chew, especially something hard. “It hurts somewhere up there, on top to the left”, she said.

The Analysis

The first thing to remember; there was no swelling of the patient’s face, nor around the gum of the teeth in question. Another key point, was that there was no response to cold or hot stimuli. Specifically, the patient exhibited a dull pain upon chewing down on my carefully positioned cotton roll. Subsequently, a radiograph of the maxillary first molar area was taken by my assistant. Behold! Not to mention, THIS TOOTH WAS PREVIOUSLY TREATED BY ME WITH ROOT CANAL THERAPY SEVERAL YEARS AGO. Moreover, the radiograph demonstrated an area of radiolucency (black shadow) just at the tip of the roots of the first molar. In other words, this indicated inflammation/infection.

The Assessment

Failing Root Canal of the Maxillary First Molar

The Plan

For that reason. I initiated antibiotics to keep area in “check” until I can get the patient back to Re-root canal the First Molar.

The Discussion

A root canal is a technically difficult procedure performed by a dentist. The process consists of two parts. First, the dentist mechanically removes infected biological material( nerve) utilizing very fine nickel titanium files from within tooth’s core. Second, the dentist packs inert material (gutta percha) to hermetically seal this evacuated space. In effect, the dentist removes the nerve of the tooth via a micro rotor-router approach and fills the emptied nerve chambers with rubber.

But Why Did That Previously Root Canal Treated Tooth Fail?

A previously root canal treated can fail creating that annoying discomfort for any number of reasons:

The most dominant reason of failure is due to insufficient irrigation by the operator in removing the infected biological debris from within the nerve chamber and canals. In short, bleach irrigation floats debris out of the shaped canal space. In essence, remaining debris can set up an environment for reinfection. In summary, every thing biological must come out from within the tooth.

On occasion, an Accessory Canal can be missed. Incidentally, canals are extremely small; the width of a human hair sometimes. Moreover, I use magnifying loupes in practice and I still miss identifying them, although rarely. By the way, the maxillary first molar has accessory canals 69.2 % of the time.

Sooner or later, an Improper fill can lead to a seepage of bacterial laced saliva back into tooth to reinfect. This is one reason why I strongly recommend to cover and ultimately seal your root canal treated tooth with a crown.

Generally speaking, a cracked root will lead to a failure of a previously treated root canal tooth. In a word, that’s a bad failure. In the final analysis, out comes the tooth and in goes the implant.

Above all, many retreatments can be successful. In reality, a failing root canal treated tooth can be resurrected with a little bit of patience and clever skill.

Below is another one of my many successful root canal treated cases in chronological order.

There is a large infection at this lateral central incisor( Black spot at root)

The Day of Completion of Root Canal Procedure -Day 1-

Three months out. Day -90-
Look and see how black spot at tip is fading away. That’s a good sign…..
One year out. Day 365- Healthy Bone fill has replaced the previously infected black spot

Credits:

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

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

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

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

“I don’t want braces, but can you fix this one tooth?”

The Demand

This is a common request in my office. Often, patients just don’t want to go through the hassle of straightening their teeth via conventional orthodontics. In addition, the time to get teeth straightened can take years. Not to mention, such an endeavor can cost a small fortune.

The Thought Process Prior To Treatment

First, I evaluate every situation unique to that patient. Before any treatment begins, there needs to be a discussion of the pros and cons. Equally important, esthetic expectations are shared. When patient and dentist are in alignment, we can then begin.

Treatment Flow

To begin with, I inject usually one shot of lidocaine locally. Next, there’s about seven minutes of preparation with the drill. Finally, there is a quick digital impression of the area with the CEREC capturing wand. The virtual design of the restoration takes me about 4 minutes. Soon after, milling of the unit may take another 8 minutes. Without delay, the unit is carefully placed by my assistant into the ceramic furnace for a 15 min cure. In due time, the restoration gets bonded into place, which takes me about 4 minutes flat.

Final analysis

In conclusion, many times there can be a simple solution. From time to time, a simple change can be delivered in a seamless manner with minimal cost, time in the chair and no complications. In this case, a single Emax ceramic veneer was bonded to place. LOOK CAREFULLY. IT IS THE LATERAL UPPER INCISOR. The key is that it should fit in and be not so “perfect”. Intentionally so. It’s important to realize, the entire visit took less than an hour. With this in mind, the patient left with a smile.

BEFORE___”Tucked behind” front lateral incisor
AFTER___Smile Line. The Veneer “fits in” with the other teeth
AFTER___Retracted lip

Credits:

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

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

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

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

Avoid Perimplantitis: Dental Implants and their Maintenance

ICOI World Congress XXXVI

The International Congress of Oral Implantologists ( I.O.C.I. ) is an association of general dentists, oral and maxillofacial surgeons, periodontists, prosthodontists, endodontists, orthodontists, laboratory technicians, auxiliaries, industry representatives, researchers, faculty members, pre and post doctoral graduate dental students as well as the general public.


The I.C.O.I. is Devoted To Dental Implant Education.

Last year’s meeting was centered around Implant Failure. In particular, the seminar focus; Cause For The Dental Implant Failure. Coupled with remedies for dentists to manage failing implants.

The Take Home Message for Me.

Prevention and implant maintenance is critical. In the first place, failures are more common than early reported in the literature. By the same token, do not be despondent if you currently have dental implants or choose to embark in future implant dentistry. On the contrary, the future is bright.

Recent Findings for Implant Failure

1-PERIODONTAL DISEASE can cause Implant failures. When it is diagnosed, it must be eradicated PRIOR to implant placement. The mouth must be periodontal disease free……… The reason : Periodontal disease is a bacterial infection. These bacterium will “jump” from your natural teeth onto your new implant. Subsequently, you will get periodontal disease on the implant. Under those circumstances, this inflammatory condition of bone loss around an implant is called periimplantitis.

2- Smoking causes a higher incidence of implant problems. In other words, non smokers retain more implants. For this reason, smokers should consider a cessation program.

3-Poor Metabolic Control patients. Diabetics have a greater loss of implants. In addition to Immunocompromised patients ( H.I.V.) and those with Chronic Obstructive Pulmonary Disease C.O.P.D

4- Less Than Ideal Placement by the Dentist, can be a factor for failure. The implant needs to placed in the most functional, accessible location to your toothbrush by the dentist. Less than ideal placement, may contribute to its demise. Guided surgery, which I preform in my office helps avoid this complication. Many of my implant cases are driven via guided surgery. Look to my future YouTube posts at Robert Emilio & Associates for my actual guided surgery procedure.

5-Cement contamination remnants. In several words, lack of removal of all dental cement upon placing the final crown can be problematic. Infact, this cement irritant will act as a nidus for bacterial infiltration. Subsequently, an infection around the implant can ensue.

6-Lack of better quality bone. High cholesterol patients tend to have “fatty” bone, of lesser quality. Essentially, not all bone is the same in quality. Lack of Vitamin D is drawing a lot of attention. The data is still formulating. Stay tuned.

Strategy that I have Executed in My Office To minimize failure is pretty simple. This is what I tell my patients……………..

“I want No Problems as much as YOU want No problems. This is what You Must Do!”

My Recommendations Implemented in My Office For My Existing Patients with dental Implants and Future Recipients .

1- With out delay, periodontal disease must be treated prior to implant placement. In this case, scaling and root planning under local anesthetic.

2-For my smokers, I understand it’s an addiction. I am not perfect either. I am not here to judge or point a finger. As a brief aside, I will enjoy a Padron 1926 cigar, if it’s an occasion,,,,but the question to ask yourself…”Are you ready to deal with the consequences?”Consider a Smoking Cessation Program. That’s to say, consult your MD on getting that started.

3-Check Up with your M.D. It must be remembered there is a connection between teeth and body. A good idea is to make sure your cholesterol, Vitamin D levels, and sugar are in normal range.

4-With this in mind, I would prefer an additional Vitamin D uptake of 2000 IU/day.

5-Professional Hygiene Maintenance 3x year by may talented hygienists. In the final analysis, they are my gatekeepers who are responsible for your maintenance education and early the detection of potential problems.

6- Purchase a Waterpik device. For the most part, they are great when used properly. In the long run, a fabulous investment. In brief, you will be amazed “how much you missed”, after you brushed. Are you up to the challenge?

7-In light of the afore mentioned, use a Chorahexadine rinse once a week. In reality, it is industrial strength mouthwash. This is the next best thing to safeguard those implants.

Credits:

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

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

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

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