Dental Crowns and Bridges

Toothpick Can Cause Severe Damage To Teeth

Toothpick is one of the most earliest ways people use as a dental cleaning tool.  However, if used incorrectly, it may cause severe irreversible damage to teeth.

Toothpick is usually used to clean out food debris in gum in between two adjacent teeth.  Food sometimes would get caught in the gum pocket area.  If we use the toothpick incorrectly, the tip of the toothpick might create mechanical abrasion on the root surface area of the tooth.  Overtime, a hole is created and food again is more likely to get caught in it.  This creates a  cycle of continual food impaction.  Decay is eventually formed.  However, this type of decay is especially hard to treat because its location is almost at the gumline.  And sometimes, the decay can very easily spread very quickly and decay may progress into the nerve at the center of the tooth.

I would suggest to use dental floss, toothbrushes and medicated rinses for daily oral hygiene.  Also I would encourage routine dental visit where dentist can use special instruments to clean out the harded plaque from those hard-to-reach area.



Toothpick causes damage to teeth

Cavity is formed at the location where the toothpicks were inserted and irreversible damage to the root surface area of the tooth.



Toothpick Damage Repaired Xray Image

Decay at the root surface area can spread quickly and the tooth becomes painful. To treat, root canal therapy, buildup and crown procedures are necessary to be performed for saving the tooth.



Written by Daniel Tee, DDS, MS

If you have any questions or want to schedule an appointment, Please call 480-820-6131

Genral Dental Office in Tempe AZ — White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

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

Crack Tooth Syndrome: Crown as a Treatment

We talked about Crack Tooth Syndrome in the previous post.  Now we can talk about the type of treatment for the crack tooth syndrome.

The crack tooth syndrome begins with a tooth having the signs and symptoms of a crack tooth.  It can either be visually obvious or it requires xray image to determine the presence of a crack line.  The type of treatment depends on the location of the existing crack or defect and the patient’s symptoms.

The location of the existing crack or defect plays an important role in determining the type of treatment for crack tooth.  If the defect is away from the central nervous tissue within the tooth and the patient does not have any painful symptoms, a crown can often be the definitive treatment for treating the crack tooth and to restore the tooth back to its functional state.  I will illustrate this concept with a recent patient case.

This patient had an existing large amalgam filling done more than 10 years ago and now he bites into something hard and the filling cracked off.

Tooth with Large Filling

Tooth with a Large Dental Filling


Crack Tooth with No Nerve Exposure

Crack Tooth with No Nerve Exposure

Upon examination, patient does not have any unusualy painful symptoms.  The defect seems large so we have to take an xray image to determine if the nerve is involved.  The xray image reveals that there is a good distance (approximately more than 1 mm) between the defect and the central nerve pulp.  Since it doesn’t seem that the central nerve pulp is affected, the tooth does not need the root canal therapy.  The defect is large so the treatment of crown was offered to patient to restore the tooth.  Also the crown would help strengthen the tooth so to prevent the tooth from further fracture.

Even though the tooth seems to be infection free and patient does not have any symptoms, the tooth might become symptomatic if there are some unforeseen microscopic crack exists within the tooth which may lead to future infection.  This is the risk that associated with crack tooth.  Patient was warned of the need of additional root canal therapy if the tooth develops unforeseen infection problem after the treatment of crown is rendered.  The patient accepts the risk and agrees to proceed with the treatment of crown.

This is now the tooth looks like after the crown is put on.

Crown Fixing Crack Tooth

The patient is comfortable after the crown and to this date, the tooth is trouble free.


Written by Daniel Tee, DDS, MS

Genral Dental Office in Tempe AZ — White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

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

Cosmetic Anterior Crowns Can Dramatically Improve Your Smiles

Porcelain crowns can dramatically improve the appearance of your teeth and also provides structural protection for a broken tooth.  If the tooth has discoloration that cannot be removed by whitening and if the tooth has worn outer enamel, porcelain crown can be the option in addition to other dental prosthetics such as the veneers.

This patient has a chief complaint of disliking his yellowing lower front teeth.  Upon examination, he has a yellowish discoloration on his lower anterior teeth and also worn looking teeth.  Also the neck region of the teeth are worn due to slight gum recession.  Recession is due to his previous periodontal disease status.  However, he has no other pathologies and his current periodontal condition is satisfactory with healthy gum and bone support.


Whitening alone does not resolve all the problems.  Also the patient has a habit of bruxing his teeth so a veneer might not be a viable option because bruxism can damage the veneers.  So I suggest to the patient with the treatment of all porcelain crowns for his anterior teeth.  This is how the teeth looks like after the porcelain crowns are put on.

Zirconia Cosmetic Crowns Postop

The porcelain crowns are able to correct the uneven size and worn shape of his teeth and also provides a much more pleasing white color.



Written by Daniel Tee, DDS, MS

Cosmetic Dental Office in Tempe AZ — White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

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


Cosmetic Makeover for Seniors

Cosmetic Dentistry doesn’t have to be complicated.  Depending on the extend of existing dental problems, dentist can focus on one single cosmetic dental issue and the improvement can also be dramatic and satisfying to the patient.

I have recently finished a cosmetic dental case with this elderly lady.  Upon looking at her teeth, she gives the chief complaint of crooked front teeth.  She points to her front tooth that is sticking out.

Frontal Dental Bridge Pre-Treatment Cosmetic Dentistry

Pre-Treatment: Crooked front tooth



Of course, there are numerous other dental cosmetic problems such as discoloration of her teeth, stanining, receded gum, etc.  However, those full mouth reconstruction dental procedures such as veneers on multiple teeth, are often complicated, time-consuming and can be quite expensive.  The patient chooses to focus on her front teeth.  I then try to work with her, by using her existing dental condition as the starting point.  I would propose a conservative cosmetic dental treatment option, ie dental crown/bridge for her front teeth.  Her crooked tooth has bone loss and has some mobility due to some local trauma in the past and also some bone loss due to periodontal disease process.  The tooth has guarded prognosis and so I propose to remove the tooth and then give her a new dental bridge.

The new bridge would serve two purpose.  First purpose is to restore the extracted tooth.  Second purpose is to reshape her other two adjacent teeth so that they will be more cosmetically agreeable to her rest of other upper teeth.

This is how she looks like after the entire treatments are fnished.   She is very pleased with the result.



Front Dental Bridge Post-Treatment Cosmetic Dentistry

Post Treatment: Cosmetic Dental Bridge is put on her front teeth.


Dental Trauma and Blackened Tooth

Usually dental trauma causes no harm because teeth are resilient that it can readily recover with sufficient healing time.  However, if the trauma causes severe injury to the tooth that it affects the nerve within the tooth, the nerve will slowly die and the nerve is said to be necrotic.  The tooth won’t get the nutrient it needs.  Overly, the tooth will become darker in color because the deaden nerve causes intrinsic changes to the internal tooth structure and as the result, the tooth would lose its original luster.

This type of changes in tooth color is called intrinsic staining.  Simply external bleaching the tooth is not effective in alleviating the problem.  The deadened tooth needs root canal therapy and then dentist can use the internal bleaching technique to change the tooth color from the inside.  This internal bleaching could improve the appearance of the tooth.  However, for a more complete masking of the darkened color, dentist could put on a dental porcelain crown.



Written by Daniel Tee, DDS, MS

Dental Office in Tempe AZ

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


New Crown Replacement: Decay Under Existing Crown Margin

A typical crown can last a long time; however, there are some situations that a crown needs to be replaced by a new crown and one of the common reasons is decay.  Crown is typically placed to protect the weakened tooth.  Even though the tooth is covered by the crown, the tooth still needs to be cleaned and brushed just like any other tooth in the mouth.  If there is inadequate oral hygiene, bacteria can cause tooth decay under the existing crown.  Initially this tooth cavity goes undetected because it does not cause any symptoms.  The patient may not feel any pain until the tooth cavity has gotten bigger.

One way to prevent this from happening is to have a periodic dental checkup by a dentist.  I would periodically take xray images when patient comes in for checkup and cleaning visit.  The xray images would reveal if there is any cavity in between the teeth.  For example, the following xray image shows that the tooth #15 has a large cavity under the crown margin of an existing crown.  The crown margin is the interface between the crown and the tooth structure under the crown.  Often food can get stuck in between the tooth and decay develops at the margin of the crown.


Recurrent Decay under existing crown margin

Xray image shows decay under existing crown.

I recommend to patient that the tooth needs a new crown replacement.  Also I would recommend better oral hygiene and encourage patient to use dental floss to clean out food in between teeth.  I also advise periodic dental checkup and cleaning.



Written by Daniel Tee, DDS, MS

Dental Office in Tempe AZ

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


Cosmetic Dentistry — Full Porcelain Crowns

Comsetic dentistry is a special branch in dentistry in which the aim is to improve the cosmetic appearance of a person’s smile.  The tooth may or may not be diseased or broken.  It could simply be that the tooth is discolored or the shape of the tooth is not harmonious to the rest of other teeth in the mouth.I enjoy doing cosmetic dentistry because I like the challenge of evaluating each individual case bring forth by the patient and deliver a pleasing result that could make some positive change to the patient’s life.

So let me present a recent cosmetic dental case.  This patient presents to my office with the two front chipped teeth.  She told me she has a heavy bite and may have habit of grinding.  Typically, a person with chipped front tooth could be getting either composite bonding, veneer or crown.  However, in this case, I suggest patient to go with the crown for full coverage strength and for esthetic purpose, I offer her full porcelain crown.  The porcelain is a strong type of porcelain called the lithium disilicate or by tradename of eMax.

This is how she presents with in her initial visit.  Her front two teeth are chipped.

Cosmetic Dentistry Chipped Front Teeth

As I am also a cosmetic dentist, I have to carefully design the crown so that the shape is harmonious with the other teeth and the bite has to be correct.  This is where the dentistry ends and where artistry begins.  I have numerous experiences in cosmetic dentistry and I am able to deliver a pleasing result.

This is how the final result looks like with her two new front crowns:

Cosmetic Dentistry Two Front Porcelain Crowns

Upper Front Two Crowns. (She still has some other planned dental work to be done on her lower teeth.)



Written by Daniel Tee, DDS, MS

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

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.


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