Wednesday, March 14, 2018

Piece of front tooth broke off

Piece of front tooth broke off? or Piece of front tooth fell off?

Piece of front tooth broke off?  Well you are not alone and we hear this story from time to time, “A tiny piece of my front tooth chipped off.” during a phone call. Or worse, someone calls very upset and anxious yelling a piece of front tooth broke off!” We can fix it!

Whether a piece of front tooth broke off or a piece of front tooth fell off we can fix it!

When a piece of front tooth breaks off it can be quiet alarming. We often get a frantic phone call from a mother that their child has broken a front tooth. This is not as bad as when a front tooth gets knocked out but it is still a very alarming event. The good news is that we can easily fix the broken tooth.

Piece of front tooth fell off?

How do we fix the tooth when a piece of front tooth broke off?

If you bring us the piece of tooth AND it was actually your tooth and not just a piece of filling then we can rebond it. You can see this in both of the before and after pictures of patients the broke their front tooth. There are two stipulations where this is not possible. First of all this needs to be broken off from trauma and not broken because there is decay. Secondly it must actually be your tooth and not some old bonding composite.

Piece of front tooth broke off

Here you can see us fitting the piece of tooth back together.

  • We etch the tooth and the broken piece of tooth.
  • We place bonding agent on both the tooth and the broken piece of tooth.
  • Next we might add a small layer of composite and then reposition the pieces like a puzzle.
  • Finally the dentist cures the entire area.

So how do we fix the tooth when a piece of front tooth fell off and you do not have it?

We simply do a composite filling in the area, as long the chip is not too large, requiring a crown. If it is more like the entire tooth that breaks away then we may do something like SET.

A small piece of front tooth chipped off – what is the cost to fix?

Fortunately it is fairly cheap, for dentistry anyway, as long as the piece is not so big that it requires a crown or dental veneer. The fee will vary from office to office but you can find the approximate cost on fair health consumer.

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Sunday, March 11, 2018

All on 4 framework options

All on x and All on 4 framework options

All on 4 framework or all on x framework choices are no longer just a choice between what kind of metal. Advances in material science now allow the use of many new materials and manufacturing techniques are also changing.

All on x or all on 4 framework options

All on x or all on 4 framework options can be broken into three general categories. The first is metal and has been around the longest, the second is porcelain, the final consists of several materials that I am grouping together.

#1 Metal all on 4 or all on x frameworks

  • Gold alloy or other noble metal alloy
  • Titanium
  • Chromium Cobalt

Advantages of metal all on 4 framework

  • Long history or use in dentistry and many dental labs and dentists are familiar with the product.
  • Very strong and difficult to break when made properly.
  • If the all on 4 metal framework breaks, we can be laser weld it back together. This is not easy and maybe impossible if there is porcelain on the metal.

Disadvantages of metal all on 4 frameworks

  • Metal costs more than other frames and the noble metal frameworks in particular are far to expensive to be practical.
  • Heavy and if need to have a large frame the individual may notice the weight.

#2 Porcelain all on x framework

  • Zirconia
Xray of zirconia all on 4 framework

On an X-ray the zirconia will look just like metal.

Advantages of zirconia all on 4 framework

  • It is white and is very strong.
  • Zirconia is a very tissue friendly material.
  • If want strong teeth that are hard to break and do not wear down then you can make the framework and teeth one piece and this cuts way down on cost.

Disadvantages of a zirconia all on x framework

  • Technique sensitive so not all labs or doctors will know how to work well with it. This is mostly out of the doctors hands.
  • Need to ensure using high quality zirconia
  • If the lab does not treat the zirconia right or if they use an inferior zirconia product, zirconia frameworks can break and there is NO fixing it.

Image of zirconia all on x framework

#3 Polymer, resin, fiberglass all on 4 framework

  • Pekkton is the strongest material in the high performance polymer family.
  • Trilor is a glass fiber reinforced resin
  • Trinia seems to be the same or very similar to Trilor.
  • Juvora is a PEEK product and I feel the other polymer materials make more sense for frameworks.
Image of a polymer all on x framework

Very unique case which is why I went with a polymer framework, in particular Pekkton.

Advantages of the polymer all on 4 framework

  • They easy to mill and furthermore the milling pucks are cheaper to buy.
  • All the polymers and resins are lightweight in comparison to the other categories and therefore are easy for patients to adapt to.
  • They act as a shock absorber since they have some give. This is the best attribute of the material as it likely will help take some of the stress of off other important parts of the system.

Disadvantages of the polymer all on x frameworks

  • Can not be repaired if breaks.
  • New product so not many labs will know the material well and there is not a lot or research behind it.

How do we make the different all on 4 framework options?

Today nearly everyone is milling their implant frameworks but there are other ways to achieve an accurate high quality all on x framework.

Milling the all on x framework

The most common method of making all on x frameworks. We can mill a commercially pure block of material to very precise specifications. We can mill every material available today and for many materials the only way to make them is to mill them. Materials typically come in a block that we call a puck because it looks like a hockey puck. The design for the framework is made on the computer or we scan the design into the computer. This CAD/CAM technology drastically increases accuracy and decreases labor costs. s intrinsically homogeneous

3D printing the all on 4 framework

I am sure there are some places 3D printing all on 4 frameworks but it is not common. This additive manufacturing technology could replace the milling in popularity at some point but for several reasons is just not there yet. If using a metal it is currently easier to print resin or wax and then use lost wax according to Dawood.

Lost wax technique for an implant framework.

Traditionally metal was the only option and we made it the same way we made everything else in metal for dentistry. We hand create the framework in wax and use the lost wax technique to cast it into metal. However, frameworks are much larger and the more volume the metal product has the more error is built in. The cooling of the metal results in shrinkage and misfits, which for small things like crowns is acceptable but for large volume fall on x frameworks create serious misfits. To do this right often requires sectioning and laser welding the parts back together on the model. This is labor intensive, expensive due to metal costs, and inaccurate, therefore it is rarely done today.

What is our preference for an all on x framework?

Finally, my ideal all on x prosthesis is titanium or CrCo framework with some sort of porcelain teeth on one arch and nanocomposite teeth on the other arch. This allows the teeth to be the shock absorber instead of the frame. I do have some instances where I think the polymer frameworks are a better choice, but since the products are new I worry about long term durability. Since you have an interest in framework choices you likely have an interest in tooth selection too, therefore our all on 4 teeth selection page may be of interest.

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Saturday, March 10, 2018

Metal free partial denture

Looking for a metal free partial denture?

Metal free partial denture is a patient removable dental prosthesis that we use to replace missing teeth. The use of new products allow dentists to finally offer something with confidence that patients will like! The main reason people have an interest in metal free partial dentures is esthetics but some people have a concern about metal sensitivity.

What is a metal free partial denture?

Metal free partial dentures are just that, they are partial dentures that do not contain any metal. The lack of metal is main reason people chose these partial dentures, whether it is esthetic reasons or metal sensitivity reasons. A partial denture, if you don’t know, is a removable appliance that replaces one or more missing teeth. You can eat and talk with it in but should remove at night to keep your tissue under it healthy. Patients usually like partials, much more so than full dentures.

What are the metal free partial denture options?

The main options are the high strength polymers and resins and the flexible thermoplastic resins. The high strength polymers and resins act a lot like a metal partial. The flexible partials obviously do not act like metal, since they flex.

High strength polymer and resin partial dentures

These are still more of an experimental phase. What I hear is that Zirlux needs more undercut than Ultaire for strength. Also neither of these can have much in the way of clasps that dentists use with traditional metal partials. They can use short akers and that is about it, which means no I-bar or double akers.

Flexible partial dentures lack a framework

  • Duraflex
  • ReSure transparent
  • Valplast
  • tcs

Of these Duraflex and possibly ReSure are the best and I can not think of any reason to use anything other than those for your flexible partial denture.

Images of a metal free partial denture

Image of a metal free partial denture

The one on the left has a framework and is rigid and the one on the right is flexible.


Advantages and disadvantages of a metal free partial denture.

In this section we compare metal partial dentures to the metal free partial dentures.

Advantages of metal free partial dentures

  • The real advantage is that they are metal free therefore they are more esthetic.
  • The cost of some of the metal free partials is lower.
  • The time and number of dental visits it takes to make some of these partials is less.

Disadvantages of a metal free partial denture

  • You can not add teeth to a metal free partial dentures, well at least not very well. The ability to add teeth to a metal partial instead of remaking something new every time a tooth is lost is a HUGE money saver for many people.
  • They are likely not as durable and we certainly don’t have the decades worth of research and experience with them as we do with metal partials.

What does a metal free partial denture cost?

The cost of a metal free partial denture is roughly the same as a metal partial denture. However, if you get a flexible partial denture then the cost is often lower. The flexible dentures include things like Duraflex and Valplast. Our fees for the polymer metal free partial denture is $2400 and the flexible partial denture is $1500.

You can find the average cost of a metal free partial denture in your area by looking at the fair health consumer website. The dental code for the non flexible partial dentures that you need to type in is D5213 or D5214. This will give you the accurate fee but is not the accurate code for anything non-metal. To the best of my knowledge there is no accurate code for the high strength polymer partial dentures so the use of the metal code will give you the most accurate cost. However, technically the resin code would likely be the “right” code to use. The flexible partial denture code is D5225 or D5226.


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Tuesday, March 6, 2018

White stainless steel crown alternative

What is the white stainless steel crown alternative?

White stainless steel crown alternative treatments do exist! If you are a parent looking for something that looks white for your child there is one excellent option available! The pediatric white dental crown is the answer and many more details can be found on the previous link!

What are the white stainless steel crown alternatives?

The only real alternative to the white stainless steel crown is a pediatric zirconia crown. Dr. Briney, our Board certified pediatric dentist, provides our patients with these crowns routinely. She sees patients from across the Midwest for her expertise in white pediatric dental crowns.

Image of the white stainless steel crown alternative

What is the process of the white stainless steel crown alternative?

The process to receive a white dental crown instead of the stainless steel crown is essentially the same.

  1. We numb the area after using topical numbing gel so that your child does not feel anything. Nitrous oxide is available if we feel it is necessary and for very young children with very extensive dental needs we have access to hospital sedation.
  2. We remove all decay and reshape the tooth so that we can place the white crown on the tooth.
  3. After fitting the crown we cement it with a bioactive cement that helps ensure no decay recurs underneath it.
  4. We verify the bite is accurate, although this is not entirely necessary on children as their bite is constantly changing anyway.
White stainless steel crown alternative on both jaws.

The 3 teeth with arrows all have white pediatric dental crowns.


How much does this white stainless steel crown alternative cost?

The fee for our kids dental crown is $440 in 2018, however, if you have dental insurance then it will cover a portion of that. There is almost certainly going to be other things that we also charge for with the crown, since many of these teeth also need baby root canals or pulpotomies. Our fee is close to the national average but yours may differ due to where you live. To find the actual cost by your zip code we recommend using this consumer fee website.


Finally, if you would like more information on the white pediatric dental crown click the link.

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Thursday, March 1, 2018

freckle on lip removal

Looking for a freckle on lip removal procedure?

Freckle on lip removal procedure is simple and quick with our state of the art Solea CO2 laser. Although treatment is the same, the venous lake is very similar to a freckle. We remove a lot of venous lakes from lips as well.

How do we do a freckle lip removal?

We will start with a topical numbing agent that helps ensure the injection of local anesthetic is as gentle as possible. Next, we give a small amount of local anesthetic into the area. Once numb we hit the freckle with our laser. This kills all the cells that make up the freckle. We disinfect the area and place Vitamin E oil. Finally we go over home care instructions. The total time of this appointment including consultation is less than 30 minutes. The procedure itself only takes a minute or two.

What are the home care instructions for a freckle on lip removal procedure?

We give you everything you need to care for the area. This includes one small syringe of hydrogen peroxide to disinfect the area twice daily and one small syringe of Vitamin E oil to help in the healing process. In 2-3 weeks the small scab that forms will fall off and you will be freckle free!

Before and after of freckle on lip removal.

Image of freckle on lip removal

What is the freckle on lip removal cost?

We charge $750 for consultation, removal and any follow up procedures. If the freckle returns within 5 years we will retreat at no charge to you. Your insurance company considers this an esthetic procedure, therefore insurance does not cover this.

Who is a candidate for freckle on lip removal?

Anyone with a freckle that is not too deep. Your doctor or dentist will have to tell you this and may not know for sure until after the procedure is over.

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Tuesday, February 27, 2018

Gold v titanium dental implant screw

Gold v titanium dental implant screw – Which is better?

Gold v titanium dental implant prosthetic screw is a question dental professionals may ask themselves or be curious as to what is the difference between the two options. Does it impact out dental implants at all?

Image of gold v titanium dental implant screw

What is the cost difference in gold v titanium dental implant prosthetic screws?

The costs of prosthetic screws vary from company to company so I will give a list of some 2018 price differences. All fees are pre-shipping, which if you are only ordering one or two prosthetic screws does make up a decent percentage of the total cost. Companies also have different prices for different types of screws but I will try to compare the basic abutment screws. Furthermore they have different prices for different users so my prices are mine and may not be the same for others, but it should give you a comparison of gold vs titanium screw cost.

Comparison of gold v titanium screws

As you can see the cost seems to be the same for the companies offering these online. There is almost certainly ways to get gold screws for the other systems but one must be careful with off brands screws. It is my opinion when it comes to screws it is always best to use the same manufacturer of the dental implant itself to ensure best fit.

So which is better? Gold vs titanium screw research

The research finds that gold is a better material for a dental implant prosthetic screw. How critical it is or how much it impacts the clinical situation is definitely debatable. Gold screws are hard to even find and may not exist for some companies so clearly few dentists are using them.

Jeong found that gold screws have a more intimate fit than titanium screws. Doolabh found the preload is better with gold screws vs the titanium screws, as did Stuker.

Gold v titanium prosthetic screw options

Implant direct has a very nice list of many of titanium and gold screws we use today in dentistry. This list is from 2018.


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Enameloplasty dental code

What is the enameloplasty code? What is the cost? Before and after?

Enameloplasty code refers to the ADA dental code we use for removal of tooth structure without replacement. The dental code is in the D9971 and we most often use it for minor cosmetic corrections.

Other common names for the enameloplasty code D9971?

The technical name for this procedure is odontoplasty. The ADA dental code states “odontoplasty 1-2 teeth; includes removal of enamel projections”.

Image of enameloplasty code

What does enameloplasty cost?

There are occasions when the dentists do not charge anything, but this is when he or she is doing something else that they are charging you for. In 2018 we charge $220 for this procedure. Typically your insurance will not cover as it is done for esthetic reasons. If you are looking for an enameloplasty cost in your zip-code, please try the website fair health consumer

Enameloplasty before and after photos

The most common reason we do plasty is for cosmetic reasons of front teeth. Usually it is to shorten front teeth that are too long or to fix chips. In this before and after photo we level the front teeth and make them look more uniform, they were initially to long and “rabbit” looking.

Image for enameloplasty before and after

Enameloplasty of front teeth

Odontoplasty is a cosmetic procedure, consequently we do this on front teeth almost exclusively. I personally do not plasty back teeth, however I can image some unusual situation where one would do a plasty on back teeth.

Enameloplasty side effects?

There are no side effects to this procedure other than the change of length of tooth. In addition to the esthetic change your bite could possibly change slightly as well.

Enameloplasty after braces?

This procedure after braces is very common when we take braces off. Your orthodontist will usually do this the day they remove your braces or the day you finish clear aligner therapy (CAT). leveling the teeth through odontoplasty is part of your orthodontic treatment, as a result there is no additional fee for it. Below you can see a patient that did not like her pointy canines. Treatment for a pointy canine is almost always leveling and this can be done either before, during or after braces.

Image of enameloplasty after braces


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