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

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

At What Age Do I Bring My Kid In?

The answer for this question is ambiguous on the web ranging from 6 months to 5 years old. Here’s the reality.

Baby teeth should all be in place at or around two years old, plus or minus 4 months. That’s a total of twenty decidious teeth (primary teeth).

Girls tend to be much more mature and cooperative in a seated position for a dental evaluation, more so than boys. In general, it’s almost impossible to get a vulnerable supine child to sit firmly while that overhead light shines down onto their face for more than 30 seconds, let alone cooperate with requests by strangers wearing blue lab coats.

Therefore, it is my experience that the first visit for a girl should be at around Three years of age and a boy probably closer to Four years of age. Girls tend to be more gentile and passive at this tender age, more cooperative for sure.

Children have better nutrition today. In general, unless there is an underlying systemic issue or medically undiagnosed acid reflux, it’s rare to see caries laden teeth in the mouth of a four or five-year old; although I have been tricked. Massive decay in between the teeth can be hidden where my explorer can’t reach. It’s a horrible feeling for patient and doctor when missed. Traditionally, radiographs can only tell if there is something brewing in between teeth. That’s the rub. Children’s skeletal development is fragile.  I am remiss to expose children to radiographs at this early fragile age, plus they just can’t bite down hard enough on the bite block to get a meaningful diagnostic radiograph. It hurts to bite down on that thing. Frustration has driven me to search out cutting edge  technology. I recently purchased advanced non radiation halogen light technology which eliminates the deleterious effects of exposure to your child.  This device essentially offers a bypass to exposing your child and aids in the detection of inter-proximal decay. Dexis CariVu Caries Detection.

My advice is to bring your child in on your approaching recall visit as the “covert introduction”  to the dental office. The child would benefit from engaging in the new environment with  positive encouragement from staff strictly as an observer. This will set  the stage for a return visit as a young new patient in the nearing week or two. It’s best to solidify the experiences from the covert visit while still fresh in the mind of the child.

During the child’s first visit as a patient, no X-rays will be taken. If anxiety levels are minimal, light technology can be utilized to view inter proximal areas of teeth. A cursory clinical evaluation to confirm tooth number, alignment  and home care quality to be determined, reviewed and reinforced. Nutritional discussion is also handled on this visit if indicated. The primary focus is on creating a positive non threatening environment early on with positive cues and reinforcement thru dialog and reward.

Toy Chest 🙂

 

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 want a tooth.”

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Being a dentist, I do get that request by patients frequently.  My sportive response usually goes like this.  “Do you want that new tooth to stay in your mouth or do you want it to go into that tin cup on the side of your bed on  your bed stand?”

You have got several options to confront that gap.

1) You can Do Nothing. You are not going to die without that previously extracted tooth. An option,  but not a very good one. According to the Mayo Clinic: People who keep their teeth live an average of  10 years longer than people who lose their teeth due to proper nutrition….. Tooth loss can affect ones self confidence and can be emotionally traumatic. It’s a fact. People constantly judge everyday. Upon meeting you, a stranger will access you on your weight, choice of vocabulary and smile.

2) Removable Partial Denture. Its plastic, uncomfortable, difficult to chew with, traps food attacks to adjacent teeth with metal clasps. That same metal clasping will wear adjacent teeth down.  Yes, it’s in a cup at night. Relatively inexpensive. You should not sleep with the device in. “Do you sleep with your sneakers on?”  Life Span 5-10 years. A Four Visit Procedure.

3) Fixed Bridge. Looks natural. All Ceramic. Easy to chew with. Fixed into place with resin bonded adhesion. Adjacent teeth effected in the preparation of the bridge.  Can be a great option. More expensive than the removable option.  Life Span 5-10 years.  Two Visit Procedure.

4) Dental Implant. Looks great. Increased bite power. Fixed into place via osseointegration. Natural in form and shape to previous tooth. Preservation of surrounding bone. Competitive pricing with comparison to the fixed bridge option. Can last a lifetime. Multiple visit procedure.

Every Closure of Space Different and requires a complete discussion of pros and cons. Ask me on your next hygiene recall visit or request a dedicated consultation.

Go To My New YouTube Channel and You Will see My Seminar on This Topic

Robert Emilio DDS Seminar

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Implant Fixture

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Removable Partial

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Fixed dental Bridge

 

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