Cavity on the chewing or occlusal surface of the tooth.
Conservative cavity preparation for composite or tooth colored filling.
Tooth enamel treated with an acidic conditioner called the etchant.
The etchant dissolves some of the mineral content of the enamel creating surface roughness at the microscopic level.
Frosted glass appearance of the treated surface.
Bonding agent applied.
Bonding agent flows into the surface roughness creating resin tags when hardened with a special light.
Resign tags provide micro-mechanical attachment of the bonding agent to the etched enamel surface.
Dental composite added incrementally to build the bulk of the restoration.
Each increment chemically bonds to the previous increment.
Composite filling thus have both a micro-mechanical and chemical bond to the tooth.
Cavity on the proximal surface of the tooth (in between teeth).
Matrix band placed to confine the filling.
Bonding agent flows into the surface roughness creating resin tags when hardened with a special llight.
Micro-mechanical attachment of the bonding agent to the etched enamel surface.
Composite fillings thus have both a micro-mechanical and a chemical bond to the tooth.
Cavity on the proximal surface of the anterior tooth.
Composite filling thus have both micro-mechanical and chemical bond to the tooth.
Fracture or chip of the biting surface of an anterior tooth.
Tooth preparation for composite or tooth colored filling.
Tooth Abrasion - Loss of tooth structure due to aggressive and improper brushing.
Tooth prepared to receive the composite or tooth colored filling.
Class V restoration decreases tooth sensitivity.
Cavity on the chewing surface of the tooth
Tooth prepared to receive the filling
Filling placed and tooth anatomy carved
Normally silver fillings take 8-12 hours to completely harden and be ready for function
Cavity on the proximal surface of teeth (in between teeth).
Tooth preparation to receive a silver filling.
Silver fillings or amalgam fillings as the name implies are an alloy of mercury with silver, tin, copper and zinc
They have the longest track record after gold.
The disadvantages of these fillings are that there are unaesthetic require more tooth structure to be removed for placing them and may weaken the tooth due to the extent of preparation.
Replacing a missing tooth with a dental bridge requires unnecessary preparation of the neighboring teeth to support the bridge.
Bone loss continues below the bridge leading to gum recession.
Plaque accumulation below the bridge causes gum inflammation and decay of the supporting teeth.
Decay may progress unnoticed leading to abscess of the supporting teeth.
A flipper is a removable option for replacing a missing tooth.
Bone loss continues below a flipper leading to gum recession, plaque accumulation and gum inflammation and adjacent teeth decay.
Maryland Bridge is another fixed option to replace a missing tooth.
The winged extension of the Bridge may easily debond requiring repeated bonding.
Bone loss continues. Plaque accumulation may cause gum inflammation and decay of the adjacent teeth.
The standard of care for replacing a missing tooth is a dental implant.
Dental Implant maintains bone and gum levels.
Neighboring teeth are not destroyed.
Dental Implants feels and functions like your own teeth.
Immediate implant placement is an option if there adequate bone width and height
Immediate implant placement after tooth removal
Tooth lost due to periodontal disease may not have adequate bone for implant placement
Tooth socket is grafted with synthetic or cadaveric bone
Implant placement in the grafted site following a healing period of 3-4 months
Patient has a non-gummy smile and hence does not reveal the loss of bone and gum tissue following tooth loss.
Loss of bone and gum tissue recession following tooth loss.
Implant placement in existing bone results in a longer clinical crown.
Final restoration replaces the tooth crown and part of the root.
Low lip line conceals the longer crown.
Patient has a gummy smile and hence the loss of bone and gum tissue is evident following tooth loss.
Implant restoration in such cases can be challenging when bone grafting is not performed.
Your dental surgeon may give you the option of replacing the lost tissue with pink porcelain or a better esthetic outcome.
The retention of your lower denture can be dramatically increased by placing two implants
Ball attachments placed to retain the denture
Ball attachments snap into the female component secured in the denture
Ask your dental surgeon if this is an optoion for you
The retention and resistance of your denture to masticatory forces can be significantly improved by placing 3-5 implants connected by a bar and clip attachment.
5-8 implants are placed for a fixed denture option.
Existing denture altered and lined with a soft reline material during the healing period.
Following a healing period of 4-6 months new denture fabricated and permanently screwed in place.
6-8 implants placed for a fixed denture option in the upper jaw.
Following a healing period of 6-8 months new denture fabricated and
retained with a bar and clip attachment or can be permanently screwed in place.
Large fractured silver filling with recurrent decay
Tooth prepared to recive the Inlay
An impression taken for precise lab fabrication of the inlay
Porcelain Inlay treated prior to bonding
Tooth is also traeted to recive the Inlay
The bonding agent is then applied
The Inlay cemented with specialized light sensitive cement
Tooth polished to restore to restore form and function
Large fractured silver filling with recurrent decay and compromised tooth cusps.
Tooth prepared to receive the Onlay.
Impression taken for precise lab fabrication of the porcelain Onlay.
Porcelain Onlay treated prior to bonding.
Tooth surface treated to receive the Porcelain Onlay.
Porcelain Onlay cemented with light sensitive specialized cement.
Tooth polished to restore form and function.
Porcelain Onlays protect teeth similar to crowns but conserve more natural tooth structure
Tooth with a large deteriorated silver filling requiring a crown to protect tooth integrity
Filling and decay removed and replaced with a strong buildup material
Tooth prepared for receiving the final crown
Placement of retraction cord helps obtain an accurate impression
Impression taken for precise lab fabrication of the crown
Ask your dentist about the different crown options
Crown protects and restores form and function of the tooth
Tooth decay is mostly asymptomatic until it reaches the pulp (nerve tissue) inside the tooth.
When tooth decay spreads to the pulp (nerve tissue) within the tooth, One may experience spontaneous throbbing pain that aggravates with cold and sweet foods.
Dental pain increases at night while lying down.
If the tooth is left untreated, the infected nerve tissue becomes abscessed causing a swelling.
Root canal treatment as the name implies, is cleaning and treating the canal system within the tooth.
Following profound anesthesia, the canal system of the tooth is accessed by drilling into the tooth.
The canals are cleaned by using sequential files.
The canals are dried and then filled with a bio-inert material called gutta percha.
Extensive tooth decay and mechanical instrumentation during treatment leaves the tooth fragile and prone to fracture.
To protect the tooth from fracture your dentist will advise a crown.
Sometimes depending on the amount of tooth structure that is lost, a post (a metal or a glass fiber pin) is placed for added retention of the crown.
Lost tooth structure is replaced with a strong filling material.
Tooth is prepared to receive the crown.
Retraction cord placed to obtain an accurate impression.
Impression taken for precise lab fabrication of the crown.
Crown restores form and function of your tooth.
Tooth loss causes adjacent and opposing teeth to drift into the space leading to food lodgment, gum inflammation and tooth decay
Preparation of anchor teeth to support the bridge
Impression taken for precise lab fabrication of the bridge
3 unit procelain bridge
Bridge restores function
When multiple teeth are missing in either jaw, partial dentures may be suggested by your dentist.
It usually takes 4 - 5 visits to fabricate your partial denture.
During the first visit small depressions called rest seats are prepared on the teeth that support your partial denture.
Upper and lower dental arch impressions are taken.
Lab fabricates the metal framework with wax blocks.
During the second visit the metal framework is checked for fit and comfort.
Bite registration (the way your teeth come together) is then recorded.
During the third visit, the waxed partial denture is tried in.
Your dentist evaluates the waxed partial denture for fit, function and speech.
After your approval for tooth shade and fit the waxed partial denture is sent to the lab for final processing.
During the final visit, the processed partial denture is checked again for fit, function and speech.
Additional appointments for necessary adjustments may be required.
Bone loss below a partial denture continues following the loss of teeth.
Teeth supporting the partial may fracture due to the excess loads of chewing brought to bear on them.
In situations where there is no posterior back of the tooth to support the partial, the partial may rock making chewing difficult.
Failure to wear the partial causes drifting of teeth.
Drifting of teeth may lead to ill - fitting of the partial.
When teeth cannot be saved due to gross decay or periodontal disease known as (gum disease) your dentist may recommend immediate dentures.
Impressions are taken prior to removal of teeth.
Immediate dentures as the name implies allow patients to have their dentures on the same day their teeth are removed.
This prevents the embarrassment of being without teeth.
It also serves as a bandage for the extraction sites and help healing.
The lab removes the teeth from the model and fabricates the immediate dentures.
Teeth are removed and the dentures are delivered.
As the extraction sites heal and the bone remodels, the denture will require adjustments and relining to make it fit better.
At the end of six months to a year when the healing is complete, your dentist may advise you t get a new denture.
Proper tooth brushing is essential for maintaining the health of your teeth and gums.
Use a toothbrush with soft, nylon, round -ended bristles to prevent damage to the gums and teeth.
Place the bristles at a 45-degree angulation at the long axis of the teeth along the gum line.
Gently brush the outer tooth surfaces of 2 to 3 teeth at a time using a back and forth motion.
Place the brush against the biting surface of the teeth and use a gentle back and forth scrubbing motion to clean the pits and grooves of the teeth.
Tilt the brush vertically behind the front teeth to brush the inner surfaces.
Maintaining a 45- degree angle brush all the inner tooth surfaces using a back and forth motion.
Replace your toothbrush every 3-4 months as bristles fray and will not clean effectively.
Flossing helps to remove plaque from between teeth where the toothbrush bristles cannot reach.
Flossing is essential for healthy gums and to help prevent tooth decay between teeth.
Wind 12-18 inch floss around the middle fingers of each hand.
Keeping 1-2 inch length of the floss taut between index fingers and the thumbs guide the floss gently between teeth.
Contour the floss around the side of each tooth and using an up and down motion clean the side of the tooth and under the gumline.
Floss each tooth with a clean section of the floss.
There is an old adage – “Floss only the teeth you want to keep”.
Flossing below a bridge requires a floss threader that is passed below the bridge to pull the floss through.
Interdental cleaning aids such as toothpicks and miniature bottle brushes are used when there is spacing between teeth.
Interdental cleaning aids also help to clean effectively under braces.
Antibacterial mouth rinses help to reduce the microbial count in the mouth.
Plaque accumulation causes gum inflammation leading to gingivitis.
Regular professional cleaning helps prevent progression of gum disease.
Cleaning is followed by polishing to remove surface roughness.
Gingivitis if left untreated progresses to initial Periodontitis
Periodontitis invloves the tissues surrounding the tooth – gum, bone and periodontal ligament
Destruction of the periodontal ligament and bone loss leads to deeper pockets
Cleaning below the gums with specialized instruments helps control the disease progression
Localised delivery of anti-microbial agents to aid in the healing process
Initial periodontitis if left untreated progresses to advanced periodontitis.
Resistant micro-organisms cause deeper pockets and advanced bone loss which requires surgical intervention to control the disease.
Gum tissue reflected to aid cleaning in deep pockets.
Sharp bony spicules smoothened.
Gum tissue is sutured.
A periodontal pack placed after surgery for speedy recovery.
Bone Grafting immediately following removal of teeth helps socket preservation and implant placement inadequate bone.
Grossly decayed teeth are extracted.
Bone Graft is placed in the tooth sockets following extraction of the teeth.
Graft covered with a specialized protective membrane.
Gum tissue sutured over the graft.
Site prepared for implant placement.
Implants placed and covered with healing screws.
Following a healing period of 4- 6 months, the implants are exposed and titanium posts called abutments which secure the crowns are screwed in.
Permanent crowns are cemented in place.
Loss of teeth causes the outer plate of the bony socket to resorb towards the inner plate reducing the width and finally the height of bone.
Implant placement in inadequate bone requires bone grafting.
Bony bed prepared to receive the block graft.
Block graft shaped to fit the site and secured in place with tiny screws.
Voids filled with particulate bone graft.
Graft protected with a specialized membrane.
Following a healing period of 6 – 9 months the gum tissue is reflected to expose the tiny screws.
Screws removed and site prepared to receive the implants.
Implants covered with healing screws.
Following a healing period of 4- 6 months, the implants are exposed; titanium posts called abutments which secure the crowns are placed.
Most common reasons for gum recession are periodontal disease, improper and aggressive tooth brushing.
One of the treatment options is soft tissue grafting.
Tissue graft is harvested from the palate.
Gum tissue reflected, tissue graft placed and secured with sutures.
Graft is slowly replaced by the recipient tissue.
Gum tissue recession can cause tooth sensitivity due to exposed root surface.
Exposed root surface is prone to root decay.
Gum tissue recession can be treated by soft tissue grafting.
Tissue graft can be harvested from your palate or from a tissue bank.
Gum tissue is reflected; graft is placed and secured with sutures.
Tooth decay extending below the gum line is inaccessible for treatment.
Crown lengthening repositions the gum tissue at a lower level exposing the cavity.
Tooth decay accessed, cleaned and filled.
Tooth fracture below gum line is inaccessible for adequate treatment.
Crown lengthening repositions the gum tissue at a lower level exposing the fracture.
Tooth prepared to receive the crown.
Form and function restored.
Tooth with insufficient clinical crown height (portion of the tooth above the gums).
Restoring the tooth with a crown without crown lengthening will cause frequent loosening of the crown due to inadequate retention.
Crown lengthening repositions the gum tissue at a lower level exposing adequate tooth structure.
Crown lengthening may be the treatment of choice if you have a “gummy smile”.
Repositioning the gum tissue at a higher level cosmetically enhances your smile.
Crown lengthening repositions the gum tissue at a lower level exposing the cavity
Crown lengthening may be the treatment of choice if you have a "gummy smile".
Inadequate oral hygiene during orthodontic treatment causes red puffy gums.
Laser may be used to excise the inflammed tissue and aid in tissue healing.
Periodontal disease causes bone loss leading to deep pockets.
Laser may be used to reduce pocket depths to manageable depths.
Healthy gums have a gingival sulcus depth of 1-3mm
Periodontal disease causes bone loss leading to deeper pocket
Pocket depths of 4mm or greater is considered disease
Gingival hyperplasia causes increase in the thickness of the gums, leading to deeper pockets even without bone loss
Gingival hyperplasia is seen in patients taking medications such as Dilantin, Nifedepine and Cyclosporin etc
Gingival recession can be due to periodontal disease
Gingival recession can also be due to aggressive and improper tooth brushing
Perio- probing is done to determine the stage of periodontal disease by measuring the amount of bone loss
6 measurements are recorded for each tooth during each recare appointment
These measurements also help to determine the success of treatment and home care
Large numbers indicate resistant micro-organisms and the need for more aggressive treatment
Tartar accumulation below gumline causes angular bony defect
Gum tissue reflected to aid cleaning in deep pockets
Bone Graft placed in bony defects
Specialized membrane placed over the graft to prevent gum tissue migration into the grafted site-Guided tissue regeneration
Sinus Cavity accessed through an opening made in the wall of the sinus
Sinus membrane raised, bone graft placed in the sinus cavity and covered with a protective membrane
Following a healing period, implant placed in the grafted site
Ask your dental surgeon if this is an option for you
Professional Chair side whitening systems dramatically whiten your teeth in less than an hour!
Chair side teeth whitening is done by the direct supervision of your dentist.
Lips and Gums are painted with a protective coating.
30-40 % hydrogen peroxide is the active ingredient in most whitening gels.
Hydrogen peroxide can be light activated or chemically activated to release oxygen.
Oxygen enters the enamel and bleaches the colored substances.
Whitening treatments have no effect on the color of bondings, veneers or caps.
Occasional touch ups with a specially designed touch up kits help keep your teeth their brightest.
Midline diastemas can be closed by direct bonding procedure.
The enamel of the adjoining teeth is treated with an acid conditioner.
The acid conditioner dissolves some of the mineral content of the enamel creating surface roughness.
Creates resin tags into the enamel when hardened with a special light.
Thus creating a micro-mechanical attachment to the enamel.
Tooth colored dental composite added incrementally to close the diastema.
Each increment chemically bond to the previous increment.
Ask your dentist if this is an option for you.
Porcelain veneers help fix stained, chipped, crooked or spaced teeth.
It usually takes 2-3 dental visits.
Your dentist uses depth reduction burs to remove only 0.3-0.5 mm of tooth structure.
An impression is taken for precise lab fabrication of the porcelain veneers.
Porcelain veneers are custom designed thin shells of porcelain that are bonded onto the enamel of teeth.
Porcelain veneers prepared prior to bonding.
Teeth prepared to receive the porcelain veneers.
Veneers are bonded to the enamel of teeth with special light sensitive cement.
In just two visits porcelain veneers can help restore your smile!
Teeth with deep pits and grooves are prone to decay.
The pits and grooves are treated with an acid conditioner called the etchant.
The etchant creates surface roughness at the microscopic level.
Sealant is applied and hardened with a special light.
Dental Sealants as the name implies flows into the surface roughness and seals the pits and grooves of teeth from bacteria.
After routine cleaning and polishing topical fluoride is applied to the teeth of children and patients who are at high risk for tooth decay.
Fluoride applied topically either in the gel form or varnish helps prevent tooth decay by strengthening the enamel.
Fluoride promotes remineralization and hence aids in repairing early decay.
Fluoride application also helps to decrease tooth sensitivity by blocking the dentinal tubules.
When primary (baby) teeth are lost due to decay, the adjacent teeth may drift locking the permanent tooth.
The permanent tooth may fail to erupt or may take a deviated path of eruption.
Orthodontic treatment is required to correct it.
This can be prevented by placing a space maintainer.
Space maintainer is an appliance custom made for your child’s mouth to maintain the space intended for the permanent tooth.
If your tooth cannot be salvaged due to gross decay or periodontal disease, your dentist may recommend extraction.
Teeth are suspended in their sockets by the periodontal ligament, which connects the tooth to the bone.
During an extraction the periodontal ligament is severed with elevators, loosening the tooth.
The tooth is then easily removed with forceps.
Sometimes, due to the curved anatomy of roots, a portion of the root might fracture during an extraction.
Root tips can be carefully removed with the help of root tip elevators.
Wisdom teeth become impacted when there's a lack of space in the dental arch and their growth is prevented by overlying gum, bone or adjacent tooth.
When the wisdom tooth is totally impacted the developmental sac that surrounds the tooth becomes filled with fluid and enlarges to form a cyst.
As the cyst grows it may hollow out the jow and permanently damage adjacent teeth, the surrounding bone and nerves.
During development the roots may involve the nerve which may lead to paresthesia (altered sensation or numbness of the lip) if removal is delayed.
The pressure from the erupting wisdom tooth may move other teeth and disrupt the alignment of teeth.
Partially impacted wisdom teeth cause food lodgement in the area.
The overlying gum tissue becomes inflamed and irritated.
Food lodgment may eventually lead to decay of the wisdom tooth and the adjacent tooth.
Failure to remove the wisdom tooth may necessitate root canal treatment of the adjacent tooth.
The area can get infected and the infection can spread to the muscles that help to open and close the mouth leading to restricted opening of the mouth, stiffness and illness.
If the wisdom teeth make their way through the gum tissue, due to lack of space may erupt towards your cheek causing cheek bite.
Horizontal impaction implies, tooth lies horizontally in the bone.
Gum tissue reflected to expose the impacted tooth.
Bone overlying the tooth crown is removed to expose it.
Crown is sectioned and separated from the root.
The root is elevated from the socket and the gum tissue is sutured in place.
Vertical impaction implies, tooth lies vertically in bone but fails to erupt
Gum tissue reflected to expose the impacted tooth
Bone overlying the tooth crown is removed to expose it
Purchase point prepared and tooth elevated from the socket
Mesio-angular impaction implies, crown of the tooth pointing towards the front of the mouth.
Bone overlying the tooth crown removed to expose it.
Crown is sectioned vertically to divide the tooth into two fragments.
The distal (back) fragment is removed first, making room for the removal of the mesial (front) fragment.
Disto- angular impaction implies, crown of the tooth pointing towards the back of the mouth
Gum tissue is reflected to expose the impacted tooth
Crown is sectioned horizontally and seperated from the root
The root is elevated from the socket and the gum tissue is sutured in place
Overlying bone is removed to expose the tooth
Tooth is elevated from the socket and gum tissue is sutured in place
Grinding or clenching of teeth at night due to stress or bite discrepancies.
Wear facets due to the excessive loads of grinding.
Loss of tooth structure due to stress concentration at the necks of the teeth.
Temporomandibular joint pain and headache upon awakening.
Upper and lower arch impressions.
Fabrication of night guard with hard plastic.
Wearing the night guard protects your teeth and TMJoint.
When tooth decay progresses close to the pulp or nerve tissue within the tooth, you will experience sensitivity to cold, sweet and sour foods.
Acids in cola drinks and sports drinks deplete the calcium in enamel making then sensitive and prone to tooth decay.
Loss of enamel due to clenching or grinding of teeth causes tooth sensitivity due to exposed dentin (sensitive tooth structure).
Enamel loss due to aggressive tooth brushing or stress concentration as a result of clenching or grinding of teeth can cause tooth sensitivity.
Exposed roots can cause tooth sensitivity as they lack the protective enamel coating.
Bone loss due to gum disease leads to deep pockets, exposing roots and causing sensitivity.
Root decay of exposed susceptible roots causes sensitivity.
Cracks on teeth are ingates to the dentin and pulp within the tooth causing sensitivity.
Condition: Initial decay
Treatment options: Filling - Composite or Silver filling.
If left untreated the cavity progresses to a medium size cavity.
Condition: Medium size cavity.
Treatment options: Inlay, Onlay or Crown depending on the cavity extent.
If left untreated the cavity progresses to involve the pulp or nerve tissue within the tooth.
Condition: Large cavity involving the pulp.
Treatment: Root canal treatment and crown.
If left untreated there will be extensive tooth structure damage and abscess.
Condition: Gross decay - Non restorable.
If left untreated, Neighboring teeth will drift leading to food lodgment, Tooth decay and gum disease.
Treatment options: Bridge or Implant
Large deteriorated silver filling with multiple cracks and no symptom.
If left untreated, cracks progress to involve the nerve tissue within the tooth.
Symptoms: Pain on biting into hard foods and hot, cold sensitivity.
If left untreated, cracks may progress to involve the root or area where the roots divide(FURCATION) and the tooth cannot be saved.
Symptoms: Fractured tooth, Loose fragments, abscessed tooth.
Abrasion: Initial lesion
Treatment: Tooth colored filling.
Failure to treat: Progresses to deeper defect closer to the nerve tissue (pulp)
Abrasion: Large lesion (nerve tissue/pulp exposed).
Treatment options: Root canal treatment and Crown.
Failure to treat: Crown fractures and tooth cannot be saved.
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Daniel Castro D.D.S
6901 Helen of Troy, BLDG. C,
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