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

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What Color Do You Want?

The Story

A new patient in her 60’s came in today with a broken piece of her tooth in a mini zip lock baggie. She was really bent out of shape. “Not another tooth….I can’t lose another tooth “, she frantically screeched.

The Evaluation

She sat uncomfortably in the chair, when I said,”smile”. With a slight demure hesitation she released her puckered lips and showed the faintest smile. It was her upper left first bicuspid that suffered a shattering. The tooth was within her esthetic zone (it showed BIG when she smiled). She reported no pain or temperature sensitivity. “Those damm almonds”, she said (you can read about that one in one of me previous blogs).  I quickly instructed my assistant to take an X-ray, but deep inside I knew before evaluating the digital radiograph, that she was keeping the tooth based upon her clinical symptoms. In my head, I knew with my technical talent and technology that I could save the remains of her tooth and her, the torment of another extraction, but that was not the problem. What freakin color do I go with? That was the biggest problem…….

Fractured First Bicuspid

The Assessment

Radiographic confirmed that the overall remaining  tooth structure  was sound and No Problem for me to restore. 

The Plan

I told her that I could save the tooth easily with the CEREC technology. One visit crown. Done! I then asked the question, “What color do want?

The Discussion/Options: The Following are only THOUGHTS  that go through my head when faced with the complexity of tooth shade selection.

Option #1  Do I match the pre-existing previously selected  dentistry tooth shade?

1a

This is always preferred. On the other hand, what if there is no other pre-existing dentistry? This may be the patient’s first crown. How about, what if the patient has tetracycline stained “ribboned colored” teeth from taking antibiotics as child? I have never met a patient who loved their wrecked enamel dark stained teeth.

or

1B

What if all the pre-existing crown dentistry  was simply mis-matched? A classic checkerboard smile. It’s my experience, when it comes to color that some patients just don’t care…. “Ahhh doc, it’s a back tooth. Who’s going to look back there anyway?” A patient may have many dentists over a life time. For instance, different lighting in operatory rooms will offer different shading. Some days may not offer the benefit of natural lighting for optimal tooth shade selection. Incidentally, some dentists are just bad at color selection. I have multiple assistants come to a consensus to pick color for dental work. They are experts at that.

Option #2  Do I CREATE a new potential tooth shade Standard?

Do I say to the patient,”Get rid of that  corn cobb yellow.  Just screw it! Go for those bright white teeth that you always wanted. Now is the time to commit. Let’s do them all!” (some what exaggerated perhaps)

Option #3  Do I keep everything the same and custom shade and blend ceramics?

This option requires multiple visits and time. Many returns back and forth to a specialized local laboratory sculpted by my kind, patient, valium induced ceramist.

ANSWER: Not for me to decide. I’ll give you all the options. They are your teeth, your body. Your Choice.

The End Result

Restored tooth via CEREC Crown

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.

IMG_6377
The side view

IMG_6378
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.

 

IMG_6384
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