Tuesday, November 14, 2017

Need crown after root canal?

Do you always need crown after root canal?

Need crown after root canal from your dentist? Are you being told that you have to have a dental crown after completing a root canal? Find out when you do need one and when you may not. Also find out what your crown options are.

Which teeth need dental crowns after a root canal?

Typically the easiest way to think about whether you need a crown after a root canal is to determine where the tooth is in the mouth. Back grinding teeth, molars and premolars, typically need a dental crown after a root canal. Front teeth that we use for tearing, canines and incisors, may not need a dental crown.

What are some of the factors that determine whether you need a dental crown after a root canal?

As I mentioned above, whether the tooth is a front tooth or back tooth is one of the most important factors. However, there are several other factors to consider as well.

  1. Is the tooth a front or back tooth?
  2. Do you clench or grind your teeth?
  3. What is your history? Have you broken teeth in the past?
  4. How bad is the crack, break or decay that is causing you to have a root canal?
  5. How much of your tooth is actually left? This one is very similar to the one above.
  6. Is there a tooth opposite, above or below, the tooth getting a root canal.

How do these factors impact the need for a crown after a root canal?

If you clench or grind your teeth you are far more likely to need the protection that a dental crown will provide you. If you have broken teeth in the past then you need the dental crown. Teeth that get root canals because they are badly decayed or broken have less tooth structure and therefore need a dental crown. Basically unless the tooth died of trauma, like a hit to the face, and does not have any fillings you likely need a crown.

Is a dental crown after a root canal necessary?

Studies show that a dental crown after a root canal increases the chance of the tooth surviving. There was a 6x higher survival rate in this study. Another study shows that only about 1/3 of the molars survive without a crown at 5 years.

Is a dental crown after root canal necessary?

The vast majority of back teeth with a root canal need a crown, just like this one will.

Back tooth = Need crown after root canal almost always.

Front tooth with lots of decay or broken = Need crown after root canal.

Front tooth with very little decay and not broken = Does not need crown after root canal.

Do I need a crown on front tooth after a root canal?

This is the one place that you typically do not need a crown after a root canal. However, if the tooth has a lot of decay or is missing a large portion then you do need a crown.

Tooth already has a dental crown, does it need a new dental crown after the root canal?

That is a very good question and can be hard if not impossible to give you a great answer even if the same doctor did all the work on you. If there is decay around the edge or margin of the crown then yes you need a new crown. An example of that type of situation is right below this paragraph.  However, many cases there is not decay apparent and this causes a problem. The problem is the dentist will not know what is under the crown. In fact, no one knows how much of your actual tooth is left. Therefore recommending a new crown can be a bit of a guessing game.

Ultimately you will probably hear whatever the dentists prefers instead of what you actually need because no one can tell you that. The “best” option is to get a new crown. However, a dental crown is an expensive procedure. Add that to the fact that most people do not need a new crown and you can see why we rarely offer this best option.

Do you need crown after root canal

Decay under the margin or edge of the crown. This tooth will need both a root canal AND a new dental crown.

Personally, I never replace the crown when doing this unless I see tons of decay under the edge of a crown. One can make the argument that my protocol is under-treating, but I am comfortable with my method.

What are your options for dental crowns after a root canal?

Dental crowns come in a variety of materials today. Gold crowns are still available but are more expensive and wear down more. They are excellent for gum tissue and we can slightly modify gold in the mouth to have an excellent fit. However, we make very few gold crowns today. Porcelain fused to metal crowns were once very popular and are still in use today by some dentists but their use is disappearing and may not be around in a few more decades due to better options.

Ceramic crowns are what many doctors are going to and what future crowns will likely be made of. Emax and zirconia crowns are the two most popular. Both are strong and white in color. They both have some minor pluses and minuses and what you get is highly dependent on the dentist who does it. Emax on average is better looking but weaker, however, zirconia is caching up in the esthetics department.

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Friday, November 10, 2017

Dental veneer cracked

If your dental veneer cracked what can you do?

Dental veneer cracked? What are your options?

A cracked dental veneer can be an esthetic emergency so how do we fix it?

If caught early, we can repair a crack with bonded white composite filling material. This is a patch, not a fix, but it often lasts for a long time if done properly. If the piece has cracked off we can bond it back on the same way we bond dental veneers from the start. Some cracks we can not do much other than replace the veneer, your dentist will have to decide what the best course of action is.

Dental veneer cracked naturally and then repaired.

Step buy step for repairing a cracked dental veneer

  • Mechanically roughen and bevel the porcelain in the area with diamond bur with copious water spray and gentle touch
  • Optional – microetch for more mechanical retention and better cleaning of the biofilm.
  • Porcelain etch per manufacturprs’ recommendations
  • Silane agent
  • Bonding agent preferably with no HEMA
  • Composite

Why did the dental veneer crack?

First one should determine how and why the dental veneer cracked. How long has the dental veneer lasted before the crack? Is the crack a hairline fracture or are we talking about a full break? Another important question, which you can not answer is whether or not the veneer is on enamel or dentin tooth structure?

If the dental veneer is pretty new, less than a year, then your cosmetic dentist will likely just replace it. However, it is important to try and determine why it cracked. It is possible that there was a microscopic fracture in the veneer from fabrication. If so then just replacing it will likely work. Typically there is a bite issue and the individual is either a clencher or a grinder. If this is the case then it can be very difficult for all parties involved to find a workable solution. A nightguard will be mandatory. The lab technician and the cosmetic dentist will have to carefully explore the material selection options and your bite. Some people break things no matter what, especailly they do not use a nightguard religiously.

If the veneer is older than a few years then you can probably chalk it up to bad luck or normal wear and tear.

Dental veneer cracked – What is the cost to repair or fix?

If we can repair the veneer, the cost is significantly less. We charge several hundred dollars depending on the severity of the fracture. However, if the crack is unrepairable and the veneer needs replacement then we charge over $1500. Typically replacing one dental veneer is more costly per tooth than doing several together because it is harder to get just one to match.

My dental veneer cracked and it’s brand new! How long should it last?

This is a great question and the answer varies depending on who did it, what material we use, how hard you are on your teeth, and if you use a night guard. I have a post on the topic of how long dental veneers last. Research does show that bonding a veneer to enamel is important to long term success.

 

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Friday, November 3, 2017

Accidental tooth bud extraction

What to do for an accidental tooth bud extraction during primary tooth removal?

Accidental tooth bud extraction during removal of a primary tooth can occur. When it does it is important to replace the tooth bud into socket quickly.

How do you replace the accidental tooth bud extraction into the socket?

Step one of replacing a tooth bud or immature tooth is the separation of it from the primary tooth. Do this gently and try to avoid touching the tooth bud and immature tooth as much as possible, especially avoid touching the apical portion. Once you have only the tooth bud remaining place it back into the socket. The position is not critical as it will likely develop and erupt just as one does in an auto-transplantation case or surgical extrusion technique case. However, there is definitely a “right” position for the tooth bud.  You should try to put it back exactly where it came from. The piece should fit together like a piece of a puzzle.

How should you monitor a re-implantation of an accidental tooth bud removal during primary tooth extraction?

Follow up with patient at 1 week and 1 month. After that routine follow up at their 6 month recall is fine.

What does an accidental tooth bud removal during primary tooth extraction look like?

The tooth bud may be very small and look similar to an enamel pearl. However, the position of it should be a giveaway.

Image or accidental tooth bud extraction during primary tooth removal

You can see an immature premolar tooth bud that came out with the primary molar.

The tooth bud may also really be more mature and we can consider it an immature tooth. Efrat 2001 shows a case of accidental immature tooth removal during extraction. Tooth #28 was the accidental tooth that was removed. The 2 year follow up looks good other than some coronal pulp calcification.

accidental removal of immature tooth during primary tooth extraction

What determines if the replacement of an immature tooth re-implantation will be successful?

Basically stage of development and time out of socket are the critical factors, with earlier in the development and shorter time being better for survival.

  • Short distance from pulp horn to apical foramen
  • An open apical foramen
  • Short extraoral time, which may be less than 45 min or less than 2 hours depending on source of information
  • What was tooth storage medium for the tooth while it is out? Preferably saliva, saline, milk or HBSS4).

List of some accidental immature tooth removal during primary tooth extraction literature.

The is not much literature on this exact topic but auto-transplantation has a lot of literature and since the procedure is so similar one can consider them a good source of information.

Efrat 2001 describes a case of immature premolar tooth removal during extraction of primary tooth roots in the Dental Trauma journal. Kemp 1977 also describes a case of immature premolar tooth removal during extraction of a primary molar in JOE.

Andreson has a lot of literature on tooth avulsion and auto-transplantation. The recommendation is non-rigid splint for 2 weeks if tooth is erupted.

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Friday, October 20, 2017

Botox Treatment in Dentistry and Orthodontics

Botox Treatment in Dentistry and Orthodontics

When you hear Botox, you most likely think of the many esthetic purposes people use it for. What goes unknown to a lot of people is that it offers a variety of other benefits, especially in the field of Dentistry. Dentists are ideal doctors to deliver Botox because of the training they get with facial anatomy, structure, nerves, and muscles.  It makes sense that they would be the field to administer Botox for pain treatment or esthetics.

Botox has shown the ability to greatly reduce pain by relaxing the muscles. It was first approved by the FDA in 1989 for the treatment of strabismus and blepharospasm in adults, and later on Botox was approved for cosmetic purposes such as smoothing wrinkles and treating forehead asymmetry.

What do we use Botox Treatment for?

Botox has shown to be effective for a variety of purposes. In the world of Dentistry and Orthodontics, we primarily use it for pain management. Botox can treat pain that originates from muscles and it is beneficial in finding the source of your pain. Botox was approved for treatment of chronic migraines in 2010 and is also used to reduce teeth clenching and grinding, allowing you to avoid What is Botox Treatment in Dentistry and Orthodonticswearing splints. We also use it for a variety of other dental applications such as:

  • Pursed or puckered lips
  • Upside-down smiles
  • Overly recessive lips
  • Blepharospasms
  • Cervical Dystonia
  • Other headache pains due to muscle tension
  • And more

How Does a Botox Treatment Work?

Botox is a safe treatment and it helps relieve pain and reduces wrinkles by blocking nerve activity and it causes your muscles to relax. If we administer Botox in higher doses, it can completely inactivate the muscles. It acts only on nerve endings by blocking the signal for muscle movement.

Your Botox treatment will last 3-4 months and after that your muscles will begin to resume their usual activity. Your activity level and your biochemistry determine how quickly activity returns. The treatment its will take roughly 15 to 20 minutes. Discussing what you want to accomplish with your Botox treatment will take 10 to 15 minutes and 5 minutes to administer the Botox. For the best results we recommend to get treatment every 4 to 6 months.

Side-Effects of Botox

The side-effects that come with a Botox treatment are relatively small. Roughly 3% of patients will experience eyelid drooping and 1% will experience eyelid swelling. Some of the other side-effects may consist of dry-mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, double vision, blurred vision, and possible allergic reactions. There are more side-effects, but you will discuss those with your dentist or orthodontist before your Botox treatment.

Botox Treatment with Bauer Smiles in Wheaton

If you are experiencing the symptoms previously described or are interested in seeing what a Botox treatment can do for you, call today at 630-665-5550.

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Tuesday, September 26, 2017

Biohorizons PEEK abutment seated

Looking to see if your Biohorizons PEEK temporary abutment is seated on your x-ray?

Is your Biohorizons PEEK abutment seated? Biohorizons PEEK temporary abutment is radiolucent thus it does not show on you x-ray.  This makes it tough to know if it is fully down. Unfortunately, there is no website in existence like What Implant is That to identify if components are all the way down.

Why is it hard to know if the Biohorizons PEEK temporary abutment is fully seated?

Is that Biohorizons PEEK abutment seated? I personally struggle with this because the PEEK temporary abutment is often deep, making it impossible to see clinically. I most often use them in immediate placement situations, therefore the surgical site is bloody and the implant tends to be deeper than where I would normally place it. The chances of an abutment not seating increases with depth of placement. This happens because the deeper the dental implant the more likely either bone or tissue will hold it up.

Examples of different PEEK temporary abutment x-rays on Biohorizon dental implants.

This first one is the contour healer and has a shape that creates a more natural emergence for your custom abutment. They are nice but the depth of the dental implant needs to be close to ideal. Furthermore, there can not be very much bone loss or the bone loss must be uniform. Unfortunately, I’m not sure how you could possibly know that you have this fully seated.

Xray image of Biohorizons PEEK contour healer

Is this Biohorizons PEEK abutment seated?

Again another Biohorizons PEEK abutment seated on an immediate case. I like to show this case because the implant is deep. The dental implant is at the buccal bone level, which is lower due to bone loss from a root fracture. I expect some bone loss on this but probably not to the height of the implant. It is tricky to know the correct depth when there is asymmetric bone loss like this and it’s even trickier to know if the PEEK abutment is down. I should have gone with Ti abutment like below as that would have been much easier.

Xray of Biohorizons PEEK abutment seated

 

What does the Biohorizons titanium temporary abutment look like seated?

Well since it is titanium it is a lot easier to see but can still be confusing. Below is an image of a Biohorizons titanium temporary abutment with the patient’s existing PFM as a temporary crown. This is an immediate extraction and immediate temporization situation.

Image of Biohorizons titanium temporary abutment seated on xray

Tricks to seating a PEEK abutment

  1. Don’t use PEEK when you don’t need it. Use titanium temporary dental implant abutments.
  2. Use a Profile drill system, I believe all implant systems have them. A profile drill will help ensure that you are able to fully seat an abutment since it removes excess bone and tissue.
  3. Know your system.
  4. Take an x-ray of the PEEK abutment on a dental implant not in the mouth.
  5. Use a radioopaque PEEK material (or coating), like Glidewell does.
  6. There are some technique sensitive tricks to making your PEEK radioopaque.

To learn more about PEEK material check out our PEEK post! If you are unsure about the seating of your dental implant PEEK abutment I recommend posting on DT or a facebook group. Someone will know and be willing to help you. My experience is people on these sites are willing to help but you may need thick skin. If you ask nicely and do not act cocky, people will hep you! No one is perfect and critical comments will only make you better.

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Sunday, September 24, 2017

Advantages of Dental Implants

Advantages of Dental Implants

Advantages of dental implants are fairly well known to dentists but the average patient may not know them. If you lost a tooth years ago, that tooth likely has a bridge or denture. Today, there are other options you can pursue and one of those options, is dental implants. Dental implants are metal screws or frames that we place in your jawbone through surgery. They essentially replace your tooth root and Advantages of dental implantsallow for a tooth or teeth to attach to them, thus replacing your missing tooth.

Implants provide a solid foundation for replacement teeth and can have a very natural look to them. Dental implants also provide functionality similar to your original teeth and they feel almost completely natural. We also expect dental implants to really last. The longevity of a dental bridge and a dental implant may be close to the same in the research but if a dental bridge fails it takes another tooth with it.

Dental implants provide a higher sense of confidence on many levels. They look and feel more natural so it won’t feel or look as if you have something artificial in your mouth. Also those around won’t be able to notice a difference. You don’t have to worry about your implants falling out like bridges or dentures, which can bring on replacement costs and happen at inopportune times. These implants also help maintain the shape of your face by maintaining your current bone levels.

Types of Dental Implant Solutions

There is a wide array of dental implant solutions available. Some of the options even incorporate previously more common methods of replacing missing teeth.

All on 4 This is a dental implant solution that incorporates dentures and only your dentist can remove it. The name All on 4 comes from the fact that the solution utilizes 4 implants, however, we often use more. The name stuck because it is catchy. All on 4 attaches the denture to the implants, but still utilizes am acrylic denture and acrylic teeth.

Single Dental Implant – If you are missing one tooth, this is most likely the best option for you. These implants will help you regain your natural look and you will notice little to no difference when chewing, speaking, and smiling.

Implant Supported Dentures This is the most likely option to pursue if you are missing most of your teeth. There are many sub categories in this option. There are fixed full-arch implant supported bridges, implant supported dentures or All on 4, then there is implant supported overdenture and telescopic prosthesis.

Advantages of dental implants at Bauer Dentistry

If you are interested in knowing more about the advantages of dental implants please call. If you know you need dental implants but still have questions our would like more information about the available options and the details pertaining to each type of implant solution, contact us today at 630-665-5550.

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Wednesday, September 20, 2017

Magic mouthwash

Magic mouthwash or miracle mouthwash

Magic mouthwash is an umbrella term for a compounded mouthwash that doctors use to treat mouth sores.  The term miracle mouthwash is one we commonly use as well. Most often someone will use them during chemo treatment if they develop mouth sores or if they have a medical condition or disease that causes severe mouth sores. If sores are from an ill fitting denture please fix the denture.

What is in magic mouthwash?

There are many formulations for miracle mouthwash, and different will use slightly different formulations. The most common recipe is equal parts of Benadryl, Maalox, and lidocaine. However some versions also include tetracycline (to prevent secondary bacterial infection), a corticosteroid (to reduce inflammation), or nystatin (to treat or prevent fungal infection).

What is in a pediatric version of magic mouthwash?

Since patients do not swallow this the dose for pediatrics and adults is the same. Although, if the 5ml is too much for them to rinse with just lower the amount that they use each time.

How do you use miracle mouthwash?

Swish and spit 5 ml 3-4 times a day is the normal dose. Typically you will rinse for about 1 minute with the solution.

Interested in making homemade Magic Mouthwash or Magic mouthwash OTC?

All you need is equal parts of liquid benadryl and maalox.  If you are trying to make this without a prescription, use ibuprofen in place of lidocaine since you can only get lidocaine by prescription.

What are the alternatives to Magic or miracle mouthwash

We have found some of our patients actually prefer Rincinol over the magic/miracle mouthwash. Rincinol is basically aloe vera extract mouth rinse which comes in small liquid packages or bottles. We have patients use it 2-10 times a day, they will take half the package and swish for 1 minute and spit it out. It is not harmful if someone swallows some on accident. however the idea is to not swallow any.

Magic mouthwash alternative

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