Are 3D printed restorations up to standard?

Any technology that enhances accuracy and convenience improves standard of care. Let’s face it: regardless of how much we may enjoy seeing out dentist, dental treatments are not fun. As anyone who has had any dental work such as crown, veneers or orthodontics has experienced having a mouth full of gag-inducing, messy impression material is unpleasant.

In my practice we have used intra-oral scans since 2016 for orthodontic treatment. They provide unparalleled accuracy which essentially translates into more comfortable and predictable treatments. The scan process takes a few minutes and immediately provides a 3D interactive computer model which can help me generate a simulation of teeth movement and even provide a design.

In 2017 we experimented with using 3D scanners for providing restorative solutionsm but even though patients much preferred the comfort of an intr-oral scanner to traditional impression technique, I was not happy with the restorations.

This year, the new improved scanning technology prompted me to retry restorative solutions such as onlays. I have been pleasantly surprised at the improved fit, accuracy and overall aesthetics of the 3D printed onlays. In fact so much so that we are introducing 3D printed veneers. I will follow with some before/after results and keep you posted.

The Understated Beauty Of Lower Anterior Teeth

One of the most gratifying practices in cosmetic dentistry is delivering perfect lower laminates. They are an exercise in minutiae: lower anterior teeth are the smallest teeth in the mouth and generally at least 50% smaller than upper anterior teeth, therefore everything from preparation, to fabrication and delivery of these tiny little ceramic sculptures is more challenging, not to mention the fact that lower anterior teeth-from an occlusal and periodontal perspective- are very vulnerable; therefore, more often than not, they come with a whole lot of other baggage like missing teeth, receding gums, crowding and periodontal bone loss.

The job of a great design is to give the appearance that none of those problems ever existed.

Here are two such cases from this past week. Above is a patient who has missing laterals (so she has 4 anterior teeth, as opposed to 6) and below for a patient with crowding and attrition. The latter is actually pretty straight forward from a design perspective. The former is more challenging to camouflage and make perfect. But I always love a good challenge. There’s a lot more to these cases but that’s a discussion for a future post.

Let's Talk About Clenching

Meghan Markle’s smile is highly coveted. So let’s talk about stress😉 and modern strategies for keeping teeth perfect forever.

Problem

Stress induced clenching/ grinding is the leading risk factor for preservation of enamel, and porcelain restorations (such as veneers).

If not managed well, clenching/grinding can cause irreversible structural damage by shortening or cracking teeth, not to mention TMJ discomfort marked by pain in jaw, neck and shoulders.

Solution

Night guard, Botox therapy and/or enamel restoration with porcelain, depending on stage of intervention. This is one situation that early intervention is key to long term success as most of associated damage to teeth and bone is irreversible but restorable.

Contact us to schedule a consultation.

International Women's Day 2019

March 8th is International Women’s Day. So Let’s talk about women’s oral health.

Fact: Women are more proactive than men in taking care of their oral health, yet they have higher incident of periodontal disease. Why is that? Periodontal condition is directly influenced by reproductive hormones. In other words, for a woman’s body to favor reproduction, her immune system becomes less proficient at fighting harmful bacteria in the mouth. So it’s fair to say the main differentiation between men and women’s oral health is women’s baby-making hormones.

Here is a rundown of the different stages of women’s reproductive life, their impact on oral health and what can be done about it:

Puberty (~8-14) is when girls are first exposed to estrogen and progesterone. Estrogen’s basic reactionary end-game is inflammation; hence gum bleeding and sensitivity starts showing up around puberty and in response to plaque.
Adulthood(~15-50) is when, in additional to hormonal fluctuations, adult responsibilities kick in. Adding pregnancy to the mix makes women prime for periodontal disease.The combination of hormonal fluctuations around period, pregnancy and lactation cause gum inflammation and increased sensitivity to plaque. This is notably one of the most crucial times/stages in terms of women’s health because moms share their microbiome with their babies in more ways than one. 
Menopause(~51+) is when estrogen levels drop and bodily fluids like salivary flow decrease. Not only that, women’s risk of Osteoporosis increases, which can cause an added risk of bone and therefore tooth loss. This combination primes post-menopausal women prime for having oral health issue.

So enough already! What’s one to do?!
Non-negotiable pillars of healthy mouth for women:
1. Meticulous oral hygiene to decrease the prevalence of bad bacterial which thrive in plaque ridden environments.
2. Good Nutrition to boost body’s ability to heal and repair
3. Avoidance of Sugary and acidic foods as much as possible or; if you do cheat -which we all do- follow it with an antidote like a re-mineralizing powder or rinse.
4. Ensure you have adequate Calcium and Vitamin D in your diet to strengthen teeth and bones. 
5. Avoid dental visits the week before menstruation to minimize sensitivity due to gingivitis. Schedule a dental check-up during the second trimester of pregnancy. 

STANDARD OF CARE IN COSMETIC DENTISTRY

Cosmetic Dentistry Is Aesthetic Judgement Applied To Restoring Teeth

It's a simple formula yet hard to deliver.  WHY? Because there is no standard for a perfect smile. All the rules for designing smiles are at the end formulaic, which for the most part result in predictable and plastic results. 

I would say the #1 reason patients hesitate to initiate a cosmetic dental procedure, aside from cost, is absence of a guarantee that they will like the final results.

In my practice I overcome this by making multiple trial temporaries and the agreement that a short term delay is better than living a life-time with less than perfect results. So when in doubt, I make yet another trial run of the final result, have my patient live with them for a week or two, before making a commitment to the final design.