Wow! Beautiful Bridges.

I love it when we get a "Wow!" from patients after seeing their new smile for the first time. Here are two bridges we recently cemented. Can you tell which teeth are part of the bridge?

BRIDGE 1:



This patient's natural dentition has traces of white spots. The bridge matches this pattern wonderfully.
This bridge is made up of the three middle teeth in the picture. The middle tooth is the fake one (pontic).

 

BRIDGE 2:



This bridge is the last 4 teeth (to the right) in the picture. The missing tooth/ pontic is second from the last. There is one support tooth behind the missing tooth and two supporting teeth in front. This patient was ecstatic with the results.


 

Rampant Decay Before and After

Rampant decay, meaning cavities everywhere, is a challenging problem to fix. Causes of the disease and time and cost of treatment are all obstacles to overcome. Many times, without definitive action to correct, these patients will end up losing most if not all their teeth. 

Before: Notice decay near gumline and in between teeth. Areas of white/opaque enamel and loss of translucency indicates decalcification and the beginning stages of decay.

After: Day of delivery. Crowned/ bridged all upper teeth. One canine tooth had been extracted and is a pontic (fake tooth) on a bridge. Patient was extremely happy with results. 

"Doc, My Filling Came Out." (w/ PICTURES)

When someone visits our office and reports that a "filling came out," in most cases, it is actually part of the tooth that broke and not the filling.

Having been an ENGINEER before becoming a dentist, I look for tooth problems created by chewing and grinding forces. I look for clues that teeth might be weak and need reinforcement. One of my goals is to evaluate structural integrity of teeth, and to help every patient keep and enjoy their teeth for a lifetime.

The below photos show some broken teeth. Documentation helps to calibrate my understanding of when a tooth is truly at risk, so I can make better recommendations in the future. As they say, a picture is worth a thousand words. Enjoy!

CASE 1: "BUT IT DOESN'T HURT"

Yellow A: Corner of tooth broke and missing.
Red B: Worn spot on adjacent crown. Metal showing through.
Green C: Shiny wear spots on filling.
Despite multiple clues indicating occlusal problems, the patient was not interested in treating tooth at this time. The patient stated it was not hurting them. 

Yellow A: Original break.
Red B: New break causing pain.
Green C: Tongue.
The second break (Red B) was much more severe, and it was unknown at this point if the tooth could be saved. We needed to numb the patient and remove the tooth piece to see the extent of the break. 

Yellow A: Very deep break.
To restore the tooth, it required root canal therapy and gum surgery in addition to the originally needed crown procedures. The patients was sorry they didn't get just the crown when that would have prevented this more extensive treatment.

Outside view of broken piece.

Inside view of broken piece.

CASE 2: SURPRISE!

Yellow A: Wear patterns on teeth. Enamel layer worn off. Softer dentin showing through.
This tooth was weaker than I expected. Before we were able to replace the filling, the tooth broke. I did not give enough urgency to these wear patterns.

Yellow A: This outlines shows the extent of missing tooth.

Saliva is filling the hole left by the missing tooth piece.

Outside view, broken tooth.

Inside view, broken piece.
Notice how sharp the break is at the bottom.

CASE 3: BACK TOOTH BREAK

Back, tongue-side cusp of back tooth is broken.

Numbed patient and removed broken piece of tooth.
No root canal therapy was needed. Crown procedures restored function and strength.

Outside view, broken piece. Note gum attachment at bottom of piece.

CASE 4: NON-RESTORABLE BREAK

Top back tooth presents with crack under old filling.

Filling was removed without needing to drill. Older silver fillings are not bonded and are only mechanically retained.

Depth of crack prevented ability to restore tooth. Tooth was extracted.