Where to Start When it Comes to Implant Teeth

May 12, 2013 alexnguyen

When it comes to Implant teeth, the work should begin with proper diagnosis and treatment planning with the restorative dentist who will fabricate your final restorations. If the restorative dentist does not place the implants, he/she will coordinate with the surgeon so that the outcome of the treatment can be optimized for both esthetic and function. In the case below the patient went to an oral surgeon before coming to me for a consultation for crowns to be placed on the implants in her mouth. This is actually a reversed pattern of treatment. Sometimes the ideal final result cannot be achieved because the implants have been placed in the wrong position.

We will be gathering some detailed diagnostic records and studies to come up with a plan to restore these teeth, but there are obvious issues with the case.

In the X-ray you can see that Implant # 1 and # 2 were placed too close to each other. Here are the potential problems:

1. The crown for Implant # 1 may be much smaller than its ideal size.

2. The gum tissue between the teeth for Implant # 1 and Implant # 2 will not have any room to sustain a normal shape and healthy environment.

On the other hand, you can also see that implant # 2 and # 3 were placed too far from each other. Here are the potential problems:

1. The crowns between these 2 implants may appear unusually large/wide and may not fit the patient's smile esthetically.

2. It may also be impossible to create normally looking gum tissue between these two implant teeth.

Additionally, Implant # 3 was placed too close to the adjacent natural tooth. This may cause the natural root to resorb if indeed the threads of the implants have impinged on the ligaments and/or root of the natural tooth.

To ensure an optimal dental implant result, it is always recommended that the patient seek proper consultation with qualified clinicians prior to proceeding with the treatments.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

Dental Bridges Benefits vs Risks

February 11, 2012 alexnguyen

A bridge is a prosthesis used to replace one or more missing teeth. Usually the teeth on either side of the empty space are ground down to help anchor the missing tooth (or multiple teeth). Pros:

1. The patient does not have to wear a removable appliance to replace the missing teeth.

Cons:

1. Sometimes perfect natural teeth have to be destroyed in order to anchor the bridge.

2. The bite force can destroy the integrity of the anchored teeth if it is inadequately controlled.

3. The strength of the roots of the anchored teeth can be compromised.

4. It can be difficult to keep the underside of the bridge clean.

5. The nerve inside the canal can be compromised from the trauma of the tooth preparation as well as the bite force when multiple teeth are splinted together.

As you can see, there are more "cons" then "pros".

Let's take a look at a real case:

In the case below a bridge was constructed by anchoring a root canal-treated molar to two smaller teeth in front. After a period of time, the molar roots were cracked into three pieces. The tooth structure underneath the restoration was also destroyed from decay and trauma. The xray also shows that one of the two anchored front teeth also has a small infection from the damaged nerve.

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Let's think about the problems behind this bridge:

1. Three teeth were affected at the expense of one missing tooth.

2. By anchoring one weak root canal-treated tooth to two strong teeth, the root canal treated tooth was the weak link.

3. The bite stability of this patient was not taken into consideration when this bridge was done.

If we can turn back the clock, a better treatment plan could have been:

1. Properly develop the bone at the site of the missing tooth.

2. Treat that site with an implant and a crown.

3. Crown the root canal-treated molar individually.

4. Leave the two natural teeth in front untouched.

With the advancements of implant dentistry, bridges should be considered as the last option in restoring a missing tooth.

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Why Should Adults Consider Orthodontic Treatments?

August 28, 2011 alexnguyen

It is not uncommon that I recommend my patients to consider orthodontic treatments to straighten their teeth. Sometimes my adult patients' initial reaction would sound something like: "I am too old for that, and I never thought about the cosmetics of my smile..." Having straight teeth is not ALL about cosmetics.

The misalignment of teeth can cause a variety of problems ranging from TMJ issues, to bone loss, to excess fractures and wear facets on the teeth. This type of break down in the dentition can take many years to manifest. Unfortunately, sometimes when the patient starts to notice the problems, the solutions may require a complex combination of orthodontics and restorative treatments.

Properly aligned teeth actually follow very scientific principles created by nature to establish the most stable functional foundation. When teeth are properly aligned, certain functional movements of the jaw allow for optimum chewing, relaxed muscle state, and ideal joint health. The cosmetics of the smile is automatically achieved secondarily when the functional foundation is established. Finding the right orthodontist is key to successful treatment.

Hence, when you choose to have orthodontic treatment done, you are stabilizing the most important aspect of the dentition: To allow you to sustain life by being able to chew effectively throughout the course of your life span. As the human life span continues to lengthen, it is extremely important to make sure that you will continue to have a stable dentition for your chewing needs.

In the photos below you will find a smile with "crooked teeth". Whereas the patient was never concerned with the cosmetics of her smile before, she has lately been concerned with the fractures lines and wear facets indicated by the red arrows. Her question to me at the last check-up was: "What would my teeth look like...say ten years down the line..."

My answer to her was: "They would look more broken down, and you will also notice problems with the back teeth as well."

So as you can see... My recommendation for this patient to choose orthodontic treatment was based on achieving proper function, and not ALL about cosmetics.

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So You Think You Can Crown? Don't Be Afraid to Smile Just Because You Have a Crown on Your Front Tooth ! ! !

January 6, 2011 alexnguyen

Three years after delivery, I saw this patient again yesterday for his periodic check-up. The patient had forgotten which tooth he fractured. I had to take a second look to refresh my memory on which tooth I had worked on. This is a crown success story. When science, art, and, care is coordinated between a dentist and a dental ceramist, nature is replicated in the form of teeth. To crown a tooth is one thing, but to give my patient back a tooth in the form of a crown is something else.

This photograph is a tribute to anyone who has crowns on his/her front tooth. It is also my way to say "Thank You !" to all the talented dental ceramists with whom I have had the opportunity to collaborate in the quest for perfection in our work. Thanks for supporting me in delivering nothing but the best result for our patients.

Smile on !

Before Treatment: Tooth # 8 was fractured, and it was the only tooth restored in this case.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

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Smile Makeover - From a Well-Informed Patient

December 19, 2010 alexnguyen

In a commercial market driven by advertisements and the desire for instant gratification, patients need to be well-informed about treatments involving cosmetic dentistry. A successful case must be built on multiple foundations which include: 1. Your bite

2. Esthetic principles

3. Your personal preferences

4. The science of today's materials and techniques

The following email was sent to me from a current case in progress. This patient has done so much research on his own that he knows all the details: from the tooth numbers, to the types of porcelain available, to the characteristic tooth shapes, etc. This is an example of what every patient should know before making a decision on important restorative treatments.

This type of clear communication enables me to coordinate the work with the ceramists who also need to hear the patient's concerns and feedbacks. I am privileged to have the opportunity to work with such well-informed patients.

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Email dated Dec 18, 2010

Hi Dr. Alex

Attaches is the "style guide" from where I took the smile that I showed you today.

None of the smiles match exactly what I'm envisioning, but a few come quite close: the Hollywood/Natural/Softened styles.

* Overall: something strong and youthful, but not overly aggressive or mature

* Central incisors: I like the shape/edges on the Hollywood/Natural (actually all three look the same)

* Laterals

* I like the shape on the Hollywood (similar to my current teeth), but they could go in (up) a little more deeper on the corners, especially the edges with the centrals. Actually, the right lateral (when looking at the photo, tooth #10) on the Natural is what I'm looking for. But I don't like the shape of the left incisor (#7) on the Natural--it's too round especially on the cuspid side

* I would play with the lengths of the central and/or lateral incisor to achieve an ever so slightly larger vertical difference (maybe 0.2-0.4mm more) so it looks like the Natural. What I said in the point above about the edges going up would probably achieve the look of more difference without really changing the lengths of the teeth all that much.

* Cuspids: I like the shape of the Softened: the Hollywood is too flat, and the natural too pointed/sharp. I also think the roundness on the Softened would fit in better with the shapes of my Bicuspids

* Bicuspids: I know we only discussed bonding only on #12 for now, but my thinking is that they would end up similar to the ones seen here (they all look more or less the same in all the styles)

I understand it needs to be customized for my mouth/face shape and my bite, but wanted to share my thinking/vision on some details of the cosmetics. Let me know if you have further thoughts/questions. I know its hard to discuss some of these details through email, we can also look at the image when I come in for the next appointment, if its not too late in the process then. I can also stop by sooner if you feel that would be helpful.

Have a good weekend!

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