Fractured teeth

 

July 28, 2013

Case of the month

Cosmetic Dentistry evolved with improvements in bonding and composite technology. Bonding of composite (filling) material to the enamel and dentin of the tooth structure means chemical bond between the filling material and the tooth structures. Enamel of the tooth is the outer layer of the tooth (“white” color) makes the tooth look pearly and beautiful. Bonding to enamel is stronger than to the Dentin. Dentin is a yellow colored part of the tooth located under the Enamel layer. Over the last five to ten years bonding to the Dentin significantly improved. Parallel to the improvements in bonding technology, new technology lead to the development of stronger cosmetic composite dental materials. Modern Nano composites are made up of microscopically small particles that can be polished to a very high degree of luster and translucency. All that means highly aesthetic filling materials that can be indistinguishable from a natural tooth structures.

As with any dental procedure, case selection is critical for success of a procedure. Case selection means good diagnosis of a problem and proper treatment plan in a given situation. Patient understanding of clear choices is crucial. In a case of our young patient, tooth fracture could be restored by direct cosmetic composite bonding, or minimum preparation ceramic veneers. Ceramic veneers is a good choice, even in a young age, because it can be accomplished with very little (or even without) tooth reduction. These restorations are very strong and long lasting.

Parents of our teenage patient chose direct composite bonding.

Patient is a 10 years old boy presented with fractured upper anterior teeth.

Because of a young age of the patient, Minimally Invasive Treatment was selected.

The two fractured teeth were restored with direct composite bonding and minimum cutting of the tooth structure

Before

After

 

Maryland bridge

August 30, 2013

Case of the month

“Maryland bridge”.

Tooth bonding is a modern technology coupled with modern dental composites and ceramics makes variety of conservative dental restorations possible. It puts a deeper meaning in the idea of Minimally Invasive Dentistry. Much less tooth reduction is necessary to achieve successful and long lasting aesthetic dental restoration. It must be said that case selection is critical for success of the “Maryland Bridge”.

Patient presented with complain on loose and very unaesthetic lower anterior teeth. X-ray revealed large pathology around lower left central incisor. Tooth was failing and had to be extracted. Because the tooth was located right in the front area, a solution had to be found how to immediately replace missing tooth right after extraction. Patient had to leave the country in several weeks and time was of the essence. It was recommended to fabricate a “Maryland Bridge” and to bond it immediately after extraction.  This type of dental restoration is called ‘Immediate”, because it is installed immediately after extraction. It requires high degree of accuracy.  In order to stop bleeding tooth was extracted with minimum trauma and absorbable suture was placed. After bleeding was stopped, the “Maryland Bridge” was bonded with the use of special composite cement. Patient was very happy with result of the treatment and opportunity to walk out from the office with a secure and aesthetic restoration.

Large pathology of lower anterior tooth.

Inside view of a failing lower anterior tooth

“Maryland Bridge” bonded to adjacent teeth immediately after extraction

Inside (lingual) view of a “Maryland Bridge” immediately after cementation