Aesthetic Dentistry – Page 4 – prestige-dental-care.com.my

20/Feb/2011

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Topics

Intro..
What is a crown
Indications for full porcelain crown
The procedure
Cases of Full Porcelain done in our clinic
Advantages of full porcelain

Intro…

Full porcelain crown is a crown frabricated for highly aesthethic demand patient as people today want to see their crown to be as natural as possible and bleanch to the rest of his/her teeth.

This is where full porcelain material comes in!! It is made mostly of Zirconia or E-Max (lithium disilicate) material. The conventional porcelain is made of porcelain layer fused to a metal surface which make is less transucent and greyish.

With zirconia or E-Max material , no metal use, therefore, no greyish appearance and more natural!!

What is a crown?

A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below. They are few types of crown depends on the material used:

Full porcelain (highly aesthetic crown)
Porcelain fused to metal (commonly used)
Full metal crown (either precious/non-precious metal crown)

Indications

Because full porcelain crown is highly aesthetic, it is used to improve the appearance of the front teeth. For those that are insecure about the appearance of their teeth or their smile, porcelain crowns can be a one-fix-for-all-problems solution.

Full porcelain crown mainly used :

to brighten teeth
to make the tooth slight translucent thus making it more natural
indicated for the front teeth where aesthetic demand is higher
close gap narrowing
fix teeth that stick out
reduce crowding in the mouth

The procedure

To fit the crowns, a thin layer is shaved off teeth that are to receive treatment, and this prepares them for the crowns. On the patient’s first visit of the treatment a mould is taken of their teeth in order to get the perfect shape for the next session. The crowns are then bonded onto the teeth using a bonding material of some sort. Once the bonding has taken place, which will normally take one session at the dentist, the patient’s can eat as normal.

Cases of Full Porcelain done in our clinic

Case 1

This young lady presented with a discolour right lateral incisor and her right central slanting inwards. Two full porcelain crowns were fabricated to change the colour of the lateral incisor as well as to change the shape of the right central incisor (below).

Case 2

A case for prepared tooth (right lateral incisor) for impression taking. A full porcelain crown was fabricated and cemented onto the tooth (below).

Full porcelain crown cemented onto the tooth

Case 3

This young gentleman presented with poorly restore filling material on his front teeth. The fillings were removed and the front teeth were prepared for porcelain crown.

Full porcelain crowns fabricated on the model

The full porcelain crowns were constructed on the model and finally cemented into patient’s mouth (below).

Case 4

Another case of discolour tooth which was treated with full porcelain crown.

Case 5

This man had a non-vital tooth (left central incisor) which was root treated had showed badly discolouration. The tooth was treated with porcelain crown.

Case 6

Another case of discolouration which was treated with full porcelain crown

Advantages of full porcelain

Crowns are very popular because they have an excellent history of fixing dental issues, and their track record is proven to work in all countries in the world. Up until quite recently, crowns were bonded to the tooth using a metal-based framework (porcelain fused to metal) so that the crown could withstand the pressures involved with daily chewing of food in the mouth. Today, most of the time the metal framework is not required, since modern technology has advanced up to the point where pure porcelain is strong enough even for use on hard working molar teeth. The metal framework had an issue – after a few years the gum line of a patient would recede with age, revealing an ugly grey line at the top of the crowned tooth. Due to the color of the metal showing through, it was difficult to make crowned teeth look natural for more than a few years.

The advantage of using pure porcelain is that the crowns are near identical in color to the existing colors of the patient’s teeth, making it nigh on impossible for others to discern a crowned tooth from a real one. A dentist will match the color of the crown to the tooth color already in the mouth, and then they will place an order with a lab to create the tooth with the perfect color and shape, taken from the previously mentioned mold, and patients are very happy with the results, and their new smile.

Topics

What is a veneer?
Case study
Other Clinical Cases with porcelain veneer
Dental veneers vs dental crowns
How to care for your cosmetic veneers
Benefits of Cosmetic Veneers
Porcelain veneers vs Resin veneers
Traditional porcelain veneers vs Lumineers

What is a veneer?

Nowadays there is a wide variety of treatments and methods that dentists can use to enhance a person’s smile. Cosmetic veneers have really gained in popularity over the last few years, and recently came to evolve into a veritable art form. Cosmetic veneers are usually sought by patients who have discolored, stained, chipped or uneven teeth. Placement of dental veneers requires the artistry, precision and skill of a talented cosmetic dentist.

Veneers are thin, semi-transparent facings usually made out of porcelain that are bonded onto the front of teeth to create a smile makeover. They create a beautiful result. Porcelain mimics tooth structure better than any other restorative material and it is a very durable and extraordinarily strong material that has similar texture, translucence and color to the enamel of your natural teeth. Dental artists can manipulate the color and translucency to re-create the look of any tooth. And it resists stain better than tooth enamel. Very rarely will it discolor, unless the surface has been damaged. These thin shells of porcelain are bonded to your frontal surface of teeth to conceal any discoloration, damage or altered alignment.

The procedure normally requires two or three appointments to be completed. The cosmetic dentist will begin the procedure by roughening the surface of your teeth to make sure the veneers will perfectly bond to the teeth. He will next trim down the outer surface of the teeth enamel to accommodate the veneers. Impression of the trimmed teeth will be taken. Your teeth will be covered with temporary veneers while the actual veneers are created in a dental laboratory. The lab technician will develop the permanent veneers after which your cosmetic dentist will have them placed in your mouth.

Case study

This young lady presented with a ‘space’ between her front central incisor which looked rather unnatural and unattractive especially when she smiled (below).

She decided to have all her upper front incisors to be veneered to close the gap. Before her teeth were prepared, the natural colour of teeth were recorded so that the porcelain veneer will match with the ‘neighbour’ teeth later.

Under local anesthesia, a thin layer (0.7mm) of tooth structure was removed at the front surface of each teeth (below). Then, an impression was taken to get a negative copy of her dentition and later, a dental model was produced.

The teeth were minimally prepared for porcelain veneers

The dental model was sent to lab where the laboratory technician would fabricate veneers over the dental model (below)

Finally, the veneers would be cemented onto patient’s mouth with strong resin cement.

Before and after result!!!

Other Clinical Cases with porcelain veneer

Another case of closing mid-line spacing with veneer

Crooked front teeth were corrected with veneer

Discolour front teeth

Discolour and malalignment 6 front teeth

6 porcelain veneers fabricated on the model

The veneers were cemented with resin cement to the front teeth

More cases of aesthethic makeover with full porcelain crowns and veneers, click here

Dental veneers vs dental crowns

Dental veneers and dental crowns are two different types of dental restorations that have similar cosmetic end results. Cosmetic dentists use these two dental procedures to correct similar dental issues. Each of these two dental techniques carries its advantages and disadvantages.

The main difference between crowns and veneers regards the amount of the tooth’ structure each restoration typically covers over. Dental veneers require significantly less reduction of the tooth structure than dental crowns. Porcelain veneers will cover over only the side of the tooth that shows when the patient smiles while dental crowns cover the tooth entirely.

While dental veneers are recommended to patients whose gums and teeth are generally healthy dental crowns are more appropriate for patients who wish to rebuild teeth that are decayed or badly broken. Dental crowns are ideal for teeth that are misshaped, worn down, cracked, broken or extremely weak. Individuals who have a tendency to clench or grind their teeth may want to treat their dental issues with dental crowns because bruxism can chip or crack dental veneers.

Make sure you find a knowledgeable cosmetic dentist who can determine which of the two techniques is right for your situation.

How to care for your cosmetic veneers

You should avoid extreme temperatures in food and beverages for at least two weeks following the veneers placement.
You should also stay away as much as possible from hard foods that may twist or stress the veneers.
Oral habits such as opening bobby pins or nail biting, could damage your veneers.
Frequent flossing will keep your veneers free of plaque so make sure you floss your veneers just like they were natural teeth.
Use a soft toothbrush to brush your dental veneers after every meal.
Don’t forget to keep up with your regular maintenance.
Make sure you have your teeth cleaned and checked every six months or so.
Your cosmetic veneers are designed to last up to fifteen years but it is up to you to make that happen.

Benefits of Cosmetic Veneers

Dental veneers can completely conceal the imperfections of your front teeth, providing a total smile makeover. The change in your smile will help you project an image of confidence and high self-esteem.
Cosmetic veneers can cover a wide variety of dental flaws including misalignment, discoloration, stains caused by excessive smoking or antibiotics, trauma-damaged and fractured teeth, diastemas, crooked, chipped or broken teeth, etc.
Dental veneers are compatible with most other cosmetic dental procedures. For example, you can place veneers in combination with TMJ treatment, teeth whitening, neuromuscular dentistry, or a full-mouth reconstruction to completely reshape your smile.
Many patients consider dental veneers a great alternative to traditional braces. Unlike other alternatives, cosmetic veeners wont’t compromise the strength and integrity of your teeth.
Porcelain veneers act as a barrier between your teeth and staining agents such as tobacco products, chocolate, sugary foods, wine, tea or coffee. Veneers can strengthen old filings and teeth that have been weakened by root canal treatments.
Cosmetic veneers can last up to 15 years if you maintain a proper oral hygiene through daily brushing and flossing.
Veneers can change the appearance of your smile within as little as three visits.
Anesthesia is usually not required as the procedure normally causes no pain or discomfort.
Cosmetic veneers are designed to look and feel just like natural teeth. Veneers however will not discolor over time as natural teeth do.

Porcelain veneers vs Resin Composite veneers

If you are considering dental veneers to restore your teeth, you may have to choose between the two types of cosmetic veneers that are currently available today, ceramic or porcelain veneers and composite resin veneers. Other dental restorative materials such as gold and amalgam cannot offer the same natural teeth color. The question is, which of the two is a better choice? Composite veneers are inexpensive, insoluble, insensitive to dehydration and aesthetically pleasing. In terms of durability however, porcelain veneers have a life span of about 15 years while composite resin veneers can break or chip more easily and may require touch-ups. While porcelain veneers are more durable, composite resin veneers are easier to repair.

Porcelain veneers possess a much more natural color compared to resin veneers which don’t look exactly as normal teeth. That’s what makes porcelain veneers an ideal option for front teeth while resin veneers are more suited for back teeth. Both composite veneers and porcelain veneers can be indirectly fabricated but only resin veneers can also be directly fabricated inside the patient’s mouth. Even though ceramic veneers can be up to 10 times more expensive than composite veneers, resin veneers will require much more aftercare that will add up to the initial, affordable cost. Make sure you find a qualified cosmetic dentist that can help you determine the best solution for your individual needs!

Topics

Vital Bleaching

Non-professional home bleaching
Professional home bleaching
In-office
Risk/Complication
Limitation

Teeth Whitening

Bleaching or teeth whitening provides a conservative treatment for mild to moderately discoloured vital teeth or root filled teeth. It is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. A child’s deciduous teeth are generally whiter than the adult teeth that follow. As a person ages the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications (like tetracycline) can also cause teeth stains or a reduction in the brilliance of the enamel.

Vital bleaching

Bleaching treatment which is done on healthy teeth. There are few methods done for vital bleaching:

Non-professional home whitening
Professional home bleaching
‘In-office’ bleaching

1. Non-professional home whitening

There are many teeth whitening product sell over the counter in dental store/pharmacy or even online and is much more cost-effective than the in-office procedure: bleaching strips, bleaching pen (eg: BriteSmile To Go whitening pen), bleaching gel, or even whitening toothpaste. Traditionally, at-home whitening involves applying bleaching gel to the teeth using a standard guard trays. At-home whitening can also be done by applying small strips that go over the front teeth. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are used in these products to lighten the shade of the tooth. The oxidizing agent penetrates the porosities in the rod-like crystal structure of enamel and oxidizes interprismatic stain deposits; over a period of time, the dentin layer, lying underneath the enamel, is also bleached.

In some whitening toothpastes contain small particles of silica, aluminum oxide, calcium carbonate, or calcium phosphate that used to grind off stains formed by colored molecules that have adsorbed onto the teeth from food. Unlike bleaches, these whitening toothpaste does not bleach or alter the intrinsic (internal) color of teeth.

We have BriteSmile To Go whitening pen

2. Professional home bleaching

opalescence_takehome_new-11 — Professional home bleaching system

For professional home bleaching (eg. Opalescence, Discuss), clinician/dentist have more control over the usage of the bleaching agent on patient. Usually patient’s teeth will be assess and the expected result should be agree before treatment started. Patient will be prescribed bleaching gel (in syringes) and a customized bleaching tray and he will be taught to used the product properly at home.

bleaching tray2 — Bleaching gel is dispensed onto the tray and loaded into your mouth

Basically, patient has to clean his teeth before bleaching. Then, the bleaching agent has to be dispensed into the tray and wore it onto his teeth for 8 hours each day for several week (usually 2 weeks). After treatment, he has to brush his teeth again. He has to reduce or stop smoking and the ingestion of dark colored liquids like coffee, tea and red wine as these factors that decrease whitening.
Home bleaching gel contains 10-15% carbamide peroxide. This agent cause less irritation to the gum because it can be contained just on the teeth surface with custom-made tray. Bleaching result is usually better than the ‘over the counter’ product.

Home bleaching technique

Take an alginate impression
Ask the laboratory to make a bleaching splint
Fit the splint, dispense the carbamide peroxide (10%), and give instructions
Advice 6-8 hours treatment per day
Review weekly

3. ‘In-office’ bleaching

In-office bleaching (Eg. ZOOM!! Whitening system) in a treatment done in the dental clinic; usually required patient to be seated on the dental chair for 1-3 hours. Immediately after treatment, patient can see the final result!!. Because In-surgery or in-office bleaching is in total control by the clinician/dentist, the bleaching gels used are highly-concentration (25-38% of carbamide or hydrogen peroxide). The gel is caustic, hence, protective eyewear and isolation of gum with a resin-based, light-curable barrier required before treatment starts.

Dental light curing lights are commonly needed to activate the bleaching agent. This ‘Light cure’ unit usually use halogen, LED, or plasma to produce light energy to accelerate the process of bleaching. Most in-office teeth whitening treatments can be done in approximately 30 minutes to one hour, in a single visit to a dental physician. Treatment times and recommendations are dependent on the condition of a person’s teeth at time of treatment.

‘In-office’ bleaching technique

Polish teeth with pumice
Isolation of gum/soft tissue with a resin-based, light-curable barrier
Etch enamel, wash and dry, although the need to etch has been questioned
Apply the bleaching agent according to the manufacturer’s instructions
Bleaching gel is activated with light energy from ‘light cure’ or laser unit
Wash teeth with copious amounts of water
Remove gum/soft tissue barrier and polish teeth
Advice patient to avoid tea, coffee, red wine, cigarettes etc, for a week and that some sensitivity may occur
Can repeat as required

Case of in-office bleaching using ZOOM whitening system…Click here

Risk/Complication

Side effects of teeth bleaching include:

Chemical burns from gel bleaching (if a high-concentration oxidizing agent contacts unprotected tissues, which may bleach or discolor mucous membranes), sensitive teeth
Overbleaching – noticeable chalk white spot on the bleached teeth which usually lessen in a period of time
Pain if you have “sensitive teeth” caused by open dentinal tubules.

The side effects that occur most often are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums. Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are temporary and disappear within 1 to 3 days of stopping or completing treatment.
Individuals with sensitive teeth and gums, receding gums and/or defective restorations should consult with their dentist prior to using a tooth whitening system. People who are sensitive to hydrogen peroxide (the whitening agent) should not try a bleaching product without first consulting a dentist. Also, prolonged exposure to bleaching agents may damage tooth enamel. This is especially the case with home remedy whitening products that contain fruit acids.
Bleaching is not recommended in children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Tooth whitening under this condition could irritate the pulp or cause it to become sensitive. Tooth whitening is also not recommended in pregnant or lactating women.

Limitation

In certain cases where the teeth are severely discolour, bleaching treatment might not be the best solution as it not achieve what patient desire. In this kind of situation, Porcelain veneer or full porcelain crown might be a better options. Therefore, you have to discuss with you dentist and tell him what you really and the pros & cons for each option.

Topics

To read on dental bridge click here
Crown – What is it?
How do we do it?
Picture on cases done in our clinic
Maintenance

Crown – What is it?

A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below. In other words, the decayed or damaged area of your tooth is removed and replaced by synthetic material, such as porcelain, to create a new ‘tooth’ with permanent results.

crowns2 — A crown is a replacement of the outside casing of your tooth

Crowns are often used after a root canal treatment, because the removal of a nerve causes a tooth to discolour. However, there are other reasons your dentist might crown one or more of your teeth: to restore a damaged or fracture tooth, to protect a weakened tooth so that it does not fracture under stress or to reinforce a large filling where there is not enough tooth structure left below.
Crowns are also made out of various material: gold or non-precious alloy, porcelain or ceramics, acrylic or composite resin, or even a combination of porcelain on metal. Obviously the material chosen will be in line with what will work best for your particular problem.

Currently, most dentist use porcelain fused to metal crown or full porcelain crown as both crowns produce good aesthetic result

How do we do it?

When crowning a tooth, your dentist starts by filing away away between 1mm and 2mm on every surface of your teeth, and then the entire surface is smoothed. Next, an impression is taken of the prepared tooth by syringing an impression material into the space around the tooth and holding an impression tray in position until the material has set. This gives the laboratory a perfect negative copy of your tooth, which allows them to make up the permanent crown. The dentist also ensures he sends the laboratory details of what the colour porcelain to use, to ensure the crown looks natural.

tooth prep — 1) Tooth are prepared and smoothen

impression1 — 2) Impression material is syringed into the space around the tooth to get the copy of the tooth

impression2 — 3) Negative copy of the teeth produced by impression material which is hardened on the impression tray

4) The crowns are fabricated on the model by laboratory technician

4.1.1 — 5) Finally, the crown is cemented onto the prepared tooth

Your are then fitted with a temporary crown, which is really just a rough space-filler, while you wait for the laboratory manufacture the permanent fixture.
At the following appointment, the dentist will have taken delivery of the permanent crown. The temporary crown is then removed, and the prepared tooth below thoroughly cleaned and dried. Then the new, permanent crown is cemented onto the tooth below. Any excess cement is removed, and the treatment completed.

Picture on cases done in our clinic

Here is a example of a discolour tooth that is replaced with a full porcelain crown (E-Max)

The young gentleman dislike his front discolour right central incisor

His tooth discolouration was due to old filling and the tooth is non-vital

After the tooth is prepared, colour of the porcelain crown is chosen to match his neighbour teeth

The full porcelain crown is cemented onto the tooth

Final Result – natural looking crown!! (Treatment done by Dr. H.W.NG)

Maintenance

You do need to take care of your crown and not overstress it by biting or chewing very hard food. You can also floss normally around a crown. If at a later stage, your crown should break, you need to see your dentist as soon as possible, especially if the tooth inside becomes sensitive. Save the fractured piece if you can, as this can be glued back on temporarily until a new crown is made.

More info on General Dental Treatment

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Dr. Chong

11/Jan/2011

Topics

Introductions
Composition of composite resin
Restoring Composite Resin

Introductions

White filling or composite resin is getting more and more popular currently as it produces a nice aesthetic result. Previously silver filling (amalgam) is preferred due to low cost, easy to handle and it has a good mechanical properties (amalgam is strong and durable). However, current composite resin is as strong and durable as amalgam and on top of that, it produce a ‘hard to see restoration’ on the tooth making it a preferred choice for dentist and patient. Anyway, Nobody wants their filling to be seen!!

Composition of composite resin

Composite resins are composed of:

Bis-GMA monomers or some Bis-GMA analog
a filler material such as silica and in most current applications,
a photoinitiator
Dimethacrylates are also commonly added to achieve certain physical properties such as flowability.
Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.Unlike Amalgam which essentially just fills a hole, composite cavity restorations when used with dentin and enamel bonding techniques restore the tooth back to near its original physical integrity.

Composite Set02 (Copy) — Variety of colours of composite resins

Composite Set04 (Copy) — Empress Direct – Highly aesthetic composite material

Dental composite resin

In our clinic, we have multiple shade (or colour) to choose to mimic the original colour of the tooth in the mouth. For every restoration, we use different shade for each ‘layer’ during restoration.

Below are some of the cases done in our clinic.

Restoring Composite Resin

(Illustration in great depth)

An old amalgam was removed from a upper right molar and the tooth was ready for filling placement

Firstly, the enamel surface of the molar was treated with phosphoric acid 35%

Then, it was followed by the dentine which was located at the center of the tooth

Next, the cavity was cleaned and dried. A thin layer of adhensive solution was applied over the cavity

Light cure unit was used to activated the adhesive which was photo-sensitive

A metal band was used to wrapped around the molar

The metal band was checked to ensure that there was no gap between the tooth and the metal band. This was to prevent the filling material from overflow out from the cavity.

‘Dentine shade’ composite resin was placed at the center of the cavity to cover the darkish stain in the dentine area.

The composite was light-cured to make it harden

Next, ‘enamel shade’ composite was placed over the ‘dentine shade’ composite (layering technique) to get the translucency effect.

‘Enamel shade’ composite was placed at the side-wall of the molar and was cured (with light-cure unit)

The metal band was removed and more composite was placed at the side-wall of the molar so to achieve a nice contour and bulbosity.

This was the result after the composite harden

The composite excess was removed with a rotary white stone

The restoration was checked to look of any interference with the lower teeth during biting and chewing (with a bite registration tape)

And the red markings from bite registration tape was removed

Finally, for aesthetic reason, grooves and fissures was make on the tooth surface

And ‘stain’ composite was placed on the fissure to make it looked like the neighboor teeth

Lastly, light-cure unit used to harden the rest of the composite

The restoration was polished to make is glossy and shining

The Final Result!!

Before and after picture.

Another case: Replacing old silver (amalgam) restorations with composite restorations

This young gentleman came complaining of sensitive to hot and cold at his bottom right molars. On examination, he had a few siler fillings which cracked and had gaps noted at the margin fo the fillings.

The silver fillings were removed and replaced with white fillings. The fillings match with the colour of the tooth very well as if there was no filling done!!

Read more

Dr. Ng SN

24/Oct/2010

Clinical cases with white filling

We are using high quality filling materials which are not only strong but match with your teeth perfectly. No one will even notice it. Take a look at some of cases that were done in our clinic…

Gaps between teeth can be reduced with veneers or crowns. However, the simplest way to have them done is by using white fillings.

Any fractured tooth can be restored with composite fillings. You will be able to enjoy your food better and smile big smiles.

Even a chipped tooth due to a fall can be restored!!

Composite filling material was used to improve the shape and colour of old veneers of all the front teeth.

Decay and gap seen at the right central incisor was restored with aesthetic fillings.

Multiple old silver restorations was replaced with composite fillings which resulted in the fillings almost undetectable.

A large cavity on a molar was restored with white filling.

The malformed canine was contour into a nice tooth.

Another old silver filling was restored with white filling.

Extensive cavity of the tooth was restored with composite filling.

Topics

Intro…

What is a crown?

Indications

The procedure

Cases of Full Porcelain done in our clinic

Case 1

Case 2

Case 3

Case 4

Case 5

Case 6

Advantages of full porcelain

Read More

Topics

What is a veneer?

Case study

Other Clinical Cases with porcelain veneer

Dental veneers vs dental crowns

How to care for your cosmetic veneers

Benefits of Cosmetic Veneers

Porcelain veneers vs Resin Composite veneers

Read More

Topics

Teeth Whitening

Vital bleaching

1. Non-professional home whitening

2. Professional home bleaching

Home bleaching technique

3. ‘In-office’ bleaching

‘In-office’ bleaching technique

Risk/Complication

Limitation

Read more

Topics

Crown – What is it?

How do we do it?

Picture on cases done in our clinic

Maintenance

Read more

More info on General Dental Treatment

Introductions

Composition of composite resin

Dental composite resin

Restoring Composite Resin

Another case: Replacing old silver (amalgam) restorations with composite restorations

Read more

Clinical cases with white filling

Read more