Quadrant Dentistry

The One Visit Cosmetic Turn-Around

I routinely replace amalgam fillings for various reasons. For example, a restoration demands replacement due to a failing marginal seal. Particularly, others fail after many years of function due to simply being worn down. As a result, they just outlive their usefulness. Many patients are concerned about an amalgam’s chemical composition. Silver fillings consist of 50%mercury. Speaking about this, there is a legitimate concern of general health implications. By far, most patients want their silver fillings replaced because of esthetics. Indeed, silver fillings are just ugly.

The Process

With this in mind, I prefer to work on a quadrant at time. That’s to say: Upper right. Lower right. Upper left. Lower left. Quadrant dentistry is easy for me. Quadrant dentistry is a super process to replace a string of adjacent amalgams. By the same token, it’s easier for the patient and always fewer shots of local anesthetic. Thus, everybody likes that!

A “string of silver fillings” waiting to be evicted.

Treatment

For a start, one shot of anesthetic. Above all, I prefer to isolate the area with a rubber dam. Indeed, the is mutually beneficial. Even more, it protects you from me. My dental drill can be annoying to curious tongues. Regardless, the dam will catch any tooth and silver filling debris from being swallowed. Albeit a bit claustrophobic for some. Besides being cumbersome for myself to place correctly. Above all, it’s best when the opportunity presents itself.

Rubber Dam Isolation in place

Result

Filling replacement required about an hour’s time. Despite the dam’s isolation of “stretching” patients open, many patients actually appreciate it afterwards.

Lastly, the final restorations were tooth colored bonded composites. All teeth were restored to beautiful form. Furthermore, I expect many years of function.

Final Restorations 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

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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

Why can’t they make a drill without that sound?

If scientists  and engineers can design, fabricate and blast a small car-like high tech laboratory thru space and gently land it  on a tiny red planet 54.6 million kilometers away from the Earth, why can’t they make a silent dental drill?

Dentists have had access to “silent” drills for many years.  The reason why dentists use that noisy apparatus is because it works very efficiently. It blasts away dental caries and enamel very well.

A dental drill is powered by air compression. This compressed air pushes a micro turbine mounted in the head of the handpiece. This tiny turbine is pushed by the compressed air up to 200,000 RPM. That’s an incredible amount of spin action on anything that’s fixated to it; a dental bur. As the air gets tossed out from the dental drill exhaust you hear the shrill of the drill. It’s the work horse for everyday “drill and fill” dentistry.

Enamel is harder than bone. In fact,  enamel is the hardest tissue in the human body. A smooth cutting sharp diamond bur spinning at a minimum of 180,000-200,000 RPM is needed to cut away tooth structure due to enamel’s inherent durability.

On the other hand, the electric hand piece is silent. They are used for specialized procedures such as root canals and dental implant placement. Electric hand pieces produce a steady consistent slow rotation of the bur at a high torque. Higher torque tools are indicated to achieve different outcomes on tissues other than enamel, such as cementum and bone.

With that being said, next time in my office, grab one of my Bose headsets and plug into your iPhone and chill to a music playlist or book on tape. Tap the volume on extra loud and chill. It works for me!

 

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

 

 

 

Do I Still Need To Take My Antibiotics?

I recently had a wonderful elderly female patient who was complaining of jaw pain status/post Third Molar (wisdom tooth) extraction in my office.

The previous day, I had extracted the fractured vital tooth. Beautifully removed with minimal effort and stitched up to perfection by me. Her Past Medical History was unremarkable. She was taking no medications of concern that should have alerted me to potentially a risky post operative recovery.  I had no reason to believe there could be an issue with the post operative care of the area.

Dry socket is always a concern. Dry socket ( alveolar osteomyelitis) is a condition where the extraction site clot is dislodged and the underlying bone of the socket gets exposed to the harsh oral environment. This is a very painful situation such that the pain is unique and radiates thru your entire jaw, face and neck on the side of the tooth extraction. Although a rare occurence for my patients, clinical experience demonstrates a higher predisposition to dry socket in the lower third molar area than any other area in the mouth.

She was in pain. She was feeling drawn out and called me directly on my emergency contact. Timing was essential and aided in my diagnosis of the origin of post operative pain.

The patient stated that she was sore and feeling slightly febrile the very next day; I estimated, twenty-four hours since the surgical event.

“I need antibiotics to Knock Out the infection” , she stated with confidence. She continued on stating that she was ,”….. a bit febrile,,,,I’m running a bit higher than usual”.

I conceded and with a very slight reluctance, but obeyed to the wisdom of this implacable women. I prescribed the antibiotics because I respected the patient’s desires. I do believe that some patients can be their best and worst doctors. It’s definitely was possible she was in the early cascade of infection,,, most likely, not. She presented initially non infected. It was too early for in infection to be present so soon after the extraction. Typically, infection would start on the THIRD DAY after a surgical event.

I called her one day after the initiation of the antibiotic therapy and she stated, “I am feeling so much better now. Thank you.  Do I need to finish the antibiotics?”

MY ANSWER WAS…EMPHATICALLY…….. YES!

My feeling was such that she was not truly infected, but instead feeling beat up from the extraction  event (the message not the messenger). Post operative edema peaks 24-36 hours a surgical event; that’s when the post extraction pain was the worst.

Dental extractions are always traumatic. It involves, local anesthesia which initiates an Adrenaline rush through your system. In response to the needle shot in anticipation of the surgical event, corticosteroids get surged out from your adrenal glands to help cope and compensate for the traumatic event you are about to endure; this is the Flight or Fright response. This is a totally natural occurring biological response to an average dental visit (comparable to getting charged by a saber tooth tiger—-that’s a joke….). It’s Normal to feel zonked after seeing me for a denatl procedure.  You will be tired the next day, especially after an extraction.

The patient’s febrile component was most likely associated with a slight dehydration effect that impacts body temperature in the slightest fashion. That’s why it’s important to drink your fluids. It’s on the post op instruction sheet..

Upon follow-up phone call, on the Second day after extraction, and one single dose of antibiotic, she reported to be just fine…Her next question was,  “Do I need to finish my antibiotic?”

Yes, was my response the current theory states that :” Treating bacterial infections with an antibiotic kills those bacteria, but this may take a week or more to accomplish. If you stop treatment early, you have only killed the weaker of the bacteria, those bugs most readily wiped out by the antibiotic. The ones leftover are the tougher bacteria, which would have been killed if the treatment continued but now, in the absence of antibiotics, have room to multiply and pass their genetic-based resilience to their progeny. Next time around, the infection is that much tougher.” Finishing your antibiotic

However, the same article states the mindset of this theory is changing. Each situation of infection type needs to be addressed individually. The debate is duration time period of antibiotic consumption. An Excellent read. I suggest you read the details.

Dedicated To Regina.

 

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

Teeth in a Day, Really?

 

The real question is, ” If you could do something…,should you do it? 

“TEETH-IN-A-DAY™ is a revolutionary concept providing patients with fully functioning teeth on dental implants in one single procedure on the same day. This procedure can be done on a single missing tooth or multiple missing teeth. This allows for you to have a temporary fixed prosthesis immediately, eliminating the need to go without teeth.”Dralijanian.com

How is that possible?  Sure, it’s possible.  Increased accessibility to advanced diagnostic technology  is responsible for driving the rapid acceleration towards getting your teeth sooner than ever. This incredible 3-D rendering technology takes a bit of the “foreseen unseen surgical unknown” out of the equation during the preplanning of the surgical event. Assuming excellent skill level and acuity of the dental implant surgeon is consistent, this technology  dictates a better outcome. Less complications from being under prepared allows a seamless transition and the smooth execution of surgical care. The prosthetic application of this process has virtually not changed over the decades. A denture is still a denture.

Are you a candidate for Teeth In A Day? The T.V. advertisements are a bit misleading. I do think they are potentially good because they start the conversation; not really informational in content. People are becoming more aware and educated of the possibilities out there. (That’s the purpose of my blogging BTW). Some of my colleagues frown upon the media advertisements feeling that dentistry has now been commoditized   like everything else in our society.  There is a very small percentage of our population who are everyday dental suffers who I consider as dental cripples who could benefit with this option.

Several Factors which need to be considered for this option are as follows:

You must have great bone quality and quantity to anchor those implants. I mean very good.

Non smoker ( smokers lose implants more than non smokers)

Infection free-no active disease process ongoing

Non Diabetic or Highly controlled diabetic healing is compromised with is this disease.

I.V. Sedation preferable ( It’s a 6-7 hour day in that chair) Two hours for the surgical. event and 2-3 for the prosthetic aspect where the screw down acrylic dentures is fitted.

Can not tolerate an upper dentures’ palate aspect. ( you gag easily)

Your job does not allow you to tolerate a non movable appliance ( T.V anchor?). It’s very arduous and emotionally challenging to retrain yourself on how to eat, and chew with newly acquired removable dentures.

 

The real question is, ” If you could….,should you?

My answer is no. I like the thought of staging a case 4 months to 1 year. First, removal of infected teeth, then natural healing of the surgical site, implant placement and then finally prosthetics from the ground up. This takes time.

There are many advantages of a staged approach to reconstruction/rehabilitation. Treating infection first, is one.  I will always push to remove those decayed infected teeth and eliminate all sources of draining  purulence first. Implant placement into an infection free mouth is critical. I don’t want the pathogenic destructive bacteria, that incidentally were  responsible for the original tooth loss, to “jump on to” the newly implanted sterile fixtures during the surgical process.  This jumping of bacteria  is called cross contamination and can be a big problem. Not all bacteria is bad. It’s the bad bacteria what we are concerned with contaminating implant threads in the surgical process. In addition, if no immediate emergency exists, anesthetic should not be directly injected into localized actively acute infected sites. Needle sticks physically displace and spread infection via facial planes remnant from embryological development. The surgeon must eliminate active infection first and then carefully prep for future implant placement with minimal trauma to the mouth. Allowing the patient to heal over several weeks eliminates the possibility of surgical cross contamination and infection spread.

Acrylic dentures can suck for most and for the few others, they are just perfect. No more cavities, no more tooth aches, no more of the bad memories relived in the chair. (Denture wears should still come in for a hygiene check or dentures reline once a year. Dentures do crack and sometimes need to be refitted due acrylic tooth wear, weight changes and medication changes. Sorry, you are not done with me yet!). After the extraction surgery in the non-immediate implant placement scenario (staged approach), you may be that unbelievably incredible patient doing just fine with that immediate temporary denture.  You never know.  One can never assume that you will or will not adjust to the dentures without implants. It’s hard to guess how you are going to feel emotionally and physically in the process. No one authority can force that issue of adaptation other than yourself. Assuming you do acclimate to the dentures, there is no possibility of buyers remorse. You can save yourself a boat load of money without the implants. A single arch fully implant supported implant fee can run $25,000-$40,00. A complete denture without implant support will be 10% of that. That’s something to think about.

Another advantage of staging is better esthetics. I want you to look great and feel great when it’s all done. There’s a big guess on how you should/could look upon delivery of the final acrylic dentures in the “Teeth in A Day Scenario”. A stranger laboratory technician decides for you denture tooth shape, shade and positioning of how you, “should look”. That’s a big jump to an unknown.   Esthetics need to evolve  during the healing process. Your facial features change dramatically after full mouth extractions and rapid bone loss occurs around non implant sites dramatically within the first several months after surgery. Most of the time, going slower in the prosthetic phase yields a better end result because the bone and soft tissues that support the final product will have healed to place. Harmony of the smile, bones and gums can best come together with a little patience.

In Italian, there’s a beautiful expression take rhymes and makes sense.

“Chi va piano, va sano e va lontano”

Translates into ” He who goes slowly, goes sanely and goes far”

Too  many more advantages to slow it down to mention. Come in for a consultation

 

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