Month: May 2014

Prefabricated Post Buildup of a Broken Tooth

Post buildup of a broken tooth is a dental procedure in which a cylindrical post is inserted into the tooth so that a crown can be put on to restore the missing parts of the tooth.  I am going to demonstrate this procedure here with one of my recent cases, in which my patient came in with a broken tooth.  I will show how I restore the tooth.

The patient had this broken tooth for number of years.  The tooth had root canal therapy done but no permanent restoration, ie a crown, was put on for full coverage protection.  As the result, the tooth just keeps on deteriorating and now the entire clinical crown above the gum line is broken off.  Only the root portion of the tooth remains.  This can seen by the pre-operative dental xray radiographs:

Broken Tooth Had Root Canal Therapy

Pre-operattive xray image shows only the root portion of the tooth remaining.

Broken Tooth Bitewing Radiograph Xray Image

This bitewing xray image shows there is no tooth structure above the gum line.

 

 

 

 

 

 

 

The xray image shows that only the root portion of the tooth remains.  Typicall, a big filling or a crown can be used to restore the tooth.  However, in this case, neither of these two options can be used alone to restore the tooth.  There is no tooth structure above the gum line for filling materials to adhere onto.  This situation necessitates the use of a cylindrical post which is to be inserted into the root as an anchor.  I choose to use the prefabricated metal post for strength.  I first have to create a post space within the root and then the metal post is inserted into the root.  The post is cemented with permanent cement.  Then I will create a core buildup around the post on the tooth.  Core buildup is a dental procedure in which some filling materials are placed around the post onto the tooth to recreate the approximate shape of the crown portion of the tooth.  This is how it looks like after the post insertion and the core buildup is done:

Prefabricated Post Buildup Tooth

Metal Post is inserted into the tooth and core buildup material recreates the shape of the tooth

Notice that the metal post is inserted into the root canal area of the tooth.  The metal post is located at the center of the root.  The metal post is inserted into the tooth with sufficient amount of depth in order to have sufficient retention for the post to stay in the tooth. After the post and core are securely cemented onto the tooth, I would then prepare the tooth for the crown.  I have taken the impression the same day. Then after the lab finished making the crown, I would tell the patient to return and I would cement the crown onto the tooth.  This is how it looks like after crown is put on:

 

 

Dental Crown After Post Buildup

 

So from this post buildup procedure, we can see that the post gives new life to the broken tooth otherwise the tooth would have to be extracted.  The patient tells me that the new tooth looks and feels like a natural tooth.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dental Implant Bridge to Restore Long Span of Missing Teeth

Dental Implants can have many applications.  Most of the time, it can restore one single missing tooth.  In some cases, it can be used to restore multiple missing teeth.  Depending on the patient’s bone structure and patient’s occlusion, multiple implants can be used to restore multiple teeth (one implant for each missing tooth) or an implant bridge can be used to restore multiple missing teeth.

Whenever it is possible, it is ideal to place multiple implants to restore each single missing teeth.  For example, if a patient has three missing teeth, it is ideal to use three implant to restore all three missing teeth.  This option depends on the patient’s bone morphology and also increase the complexity of the surgery because greater care has to be given during surgery to make sure each implant to be placed in perfect alignment to each other and also in compatible to the patient’s bone morphology.

Another method is to create an implant bridge.  After the implant is placed and has been integrated with the jaw bone for several months, we will take an impression and have the lab create the implant abutment for each implant.  Then we secure the implant abutment on top of the implant fixture within the jaw bone.  This is how the implant abutments are oriented in the mouth after it has been secured in the mouth:

Implant Bridge Lateral view pre-opNotice that the patient has three missing teeth and only two implant abutments.  The advantage of the implant bridge is that it allows restoration multiple teeth with less implants, thereby lessening the complexity of the implant surgery.  After the metal implant abutments are secured, we can then take another impression of the implant abutments and then an implant bridge can be made.

 

Implant bridge is to be cemented on top of the implant abutments.  This is how it looks like in the mouth:

Implant Bridge Lateral view

Then this is the Xray image taken after the bridge is cemented:

Implant Bridge Xray Image

 

The comments that I get from my patient is that the implant bridge feels and functions just like her natural teeth.  She comes in for routine hygiene visit and she is doing just fine.

 

Xerostomia (Dry Mouth) Can Cause Tooth Cavity

Xerostomia (Dry Mouth) occurs when there is not enough saliva in the mouth.  Saliva is important because it can help cleanse and lubricate the oral cavity.  It also contains antigen which helps fight bacteria and fungal infection.  If there is decreased salivary secretion, this will increase the chance of bacteria infection, periodontitis and tooth cavity.

Xerostomia can happen to anyone.  Most commonly it can happen to the elderly person.  Some medication can cause xerostomia.  In some cases, chemotherapy for cancer treatment can cause xerostomia.

The solution to xerostomia is to drink plenty of water.  It is recommended to drink at least equivalent of 8 cups of water.  Alternatively, doctor can prescribe a different medication which won’t cause xerostomia.  For severe cases of xerostomia, doctor can prescribe saliva analogs to alleviate the symptoms of xerostomia.

Antibiotics Abuse — Dangerous Misuse of Dental Antibiotics

Antibiotics is a common way to treat oral infections in dental emergency situation.  There are many types of dental antibiotics and each type of antibiotics targets specific group of bacteria.  For example, antibiotics for treating periodontitis is not the same as the antibiotics for treating the root canal infections.  When the patient comes in with an infection, I would diagnose the type of infection and then prescribe specific type of dental antibiotics for that type of dental infection.

When people have toothache, they would come in for dental emergency visit and ask for antibiotics.  For some people, they want to save money by postponing necessary treatment such as periodontal treatment for periodontal infection or root canal therapy for root canal infection.  Or some people would ask for extra antibiotics for storing them at home.  Or they would ask for antibiotics before they go on a extended trip simply for the sake of “just in case” they become sick during the trip.  These are examples of wrong uses of antibiotics.

Antibiotics is not a cure-all medicine for infection.  They cannot be substituted for necessary dental treatment.  Antibiotics abuse can lead to more severe health problems.  Common antibiotics misuses are: wrong dosage, taking the pill at the wrong time, skip a dose or simply just take the antibiotics for a few days and then stop taking the remaining prescribed pills.  Antibiotic misuse or abuse can lead to antibiotics drug resistance.  Repeated misuse of antibiotics can lead to decreased efficacy of the antibiotics drug with each subsequent regimen.  In the worst case scenario, a person may become resistant to the antibiotics and the antibiotics have no therapeutic effect.  Bacteria become resistant to the antbiotics and the surviving bacteria become much harder to kill.  This is when super bacteria develops.  Annually, many people die from unstoppable bacteria infection.

If you have mouth infection, the most important thing is to seek professional help.  Always take the medicine, including antibiotics, according to the prescription and take all pills to completion, as directed by the dentist.  Please do not abuse antibiotics.  For further information on tips for antibiotics usage, click here.

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dental Implant Crown Restoration — A Real World Example Part 2

Dental Implant: For Part 1 of the same topic, click here.

This is the continuation of the real world case of restoring dental implant discussed in the previous article.  In the last article, we have taken impression of the dental implant.  From the impression model, the lab made a stone model of the patient’s dentition and the implant.  A custom-made dental crown is made based on the stone model.

Dental Implant Crown Stone ModelThe stone model consists of the patient’s upper and lower teeth.  Upper and lower teeth are arranged accordingly to the correctly articulated patient’s bite.

Commonly the implant crown is either cement-retained or screw-retained.  In this case, given the short space between the lower ridge bone and the upper teeth, I decided that only custom-made screw-retained crown can be used in this situation.  The type of implant crown is a custom-made screw-retained crown.  The implant crown is made in one piece.  No cement is needed to secure the crown with the implant fixture within the jaw bone.  The implant crown is fixated using a screw.

So the patient comes back in for crown-insertion appointment.  I first remove the cover screw.  Then I try in the crown and taken the xray images to check for correct fitment.   From the xray image, I can see that there is no space between the crown and the implant fixture.  This means that the implant crown is fully seated into the dental implant fixture.

Dental Implant Crown Xray ImageAfter the confirmation from the xray image, I then tighten the screw and use the torque wrench to measure the final torque strength to make sure the screw is secured.  A cover material is inserted into the screw access hole.  Finally I will adjust the biting surface of the implant crown so to make sure there is at least 30 micron of space between the implant crown and upper teeth.  This space is important because when patient’s bites down, the implant does not have the natural ligament around it to absorb the biting forces.

 

 

Here is the final image of the implant crowns seated properly in patient’s mouth.  It looks and feels like natural tooth.

Dental Implant Crown Intraoral Photo

Oral Pathology — A Oral Symptoms of Shingles

I have talked about how dentist can be the first line of defense against oral cancer.  Many other illnesses can also manifest itself within the vicinity of oral cavity, head and neck regions.  I am going to talk about the real case which I recently encountered.

This patient comes into my office with the major concerns of pain on lower left jaw area around root of the tooth.  She is a 60 years of age with no previous history of significant illnesses.  She has had gallbladder removal, and currently under treatment of hypertensive medication.  She declines any other illnesses, allergies or surgeries.  Her medical history does not seem to correlate to her current symptoms.

Herpes Zoster virus, Shingles, Oral Pathology

Extraoral manifestation of Shingles a Herpes Zoster infection.

Next, I proceed to clinical examination.  Immediately I notice multiple crusted blister on the skin around the left lips, and lower jaw area.  Intraoral examination shows palpable nodules on the lower left mandible area around posterior teeth.  This nodule is movable and is not fixated.  This rules out the bone involvement.  I suspect this is some lymphatic hyperplasia due to some kind of microbial infection.  Then she relates to how her ears and eyes had some aches in the immediate past.

Her dental examination shows that the pathology is not dentally related.  Radiograph shows normal tooth structure and bone.

Her physician has done MRI and blood test for white blood cells count and they are returned normal.  I then asks what other blood test is done and patient is not sure.

Given her presentation of symptoms and history, I arrive at diagnosis of possible infection from herpes zoster virus.  Commonly this is called Shingles.  The virus spreads through the trigeminal nerve and rarely contagious to people who never had chickenpox immunization.  I then write down my findings and immediately refer the patient back to her family medical doctor for confirmation of the disease.  I also prescribe anti-viral medication to the patient.

After two days, the patient goes to her family medical doctor and confirm that it is indeed Shingles.

I am really glad that as her family dentist I can play an integral role in helping this patient.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Teeth Grinding and Jaw Clenching

Teeth grinding and jaw clenching are common but often people may not aware that they have such habits causing damage to their teeth.  Teeth grinding and jaw clenching can cause excessive stress to the teeth, the supportive periodontal bone structure, surrounding muscle and temperomandibular joint.  The symptoms of teeth grinding and jaw clenching are inter-related and can include: temperomandibular joint pain, toothache, tooth structural damage, ear ache, stress, and depression.

The most common triggers can be stress and depression related.  There are many ways to deal with the conditions and the purpose of treatment is to alleviate symptoms, pain and damage to teeth.  The treatment can be muscle relaxant, massage to the affected muscle, faithful wearing of the dental night-guard, etc.  These techniques can help prevent damage to teeth.  Also, it is important to learn how to cope with stress (since life can be inevitably stressful.)  Surgery on the afflicted joint is the last resort to correct the dysfunctional joint.

 

Written by Daniel Tee, DDS, MS

Practicing Family Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Medicated Mouth Rinse in Periodontal Treatment

Medicated mouth rinse is often used to treat the root surfaces of the teeth after the dentist has thoroughly performed the periodontal treatment on those teeth.  The purpose is to decrease the bacteria load in the periodontal pockets so that the normal healing process can occur to repair the diseased gum tissue.  Peridex rinse is one kind of the medicated mouth rinse.  It contains active ingredient chlorhexidine which is shown in clinical research that it is effective in killing the specific types of bacteria causing the periodontal disease and if used correctly, it can adhere to the root surface of the tooth so to prolong the effective anti-microbial action time.

The diseased gum tissue would be inflammed and swollen.  The diseased gum tissue would detach itself from the tooth and as the result the gum pocket would deepen.  The inflammation is caused by the bacteria growth around the root surface of the tooth and the gum pocket area.  The non-surgical periodontal treatment would be to remove the plaque and calculus which is full of those bacteria.  After removal of those plaque and calculus, the remaining bacteria is to be killed off by the medical mouth rinse.  This is to maximize the healing potential of the gum tissue.   Once the disease-causing bacteria is gone, the gum tissue can repaired itself and it will become more strengthened and reattach itself to the root surface of the tooth.