Porcelain Inlays and Onlays

Porcelain

When a tooth has been moderately to extensively destroyed by decay, previous drilling, or fracture but there is still sufficient enamel remaining, one innovative way it can be restored is with a porcelain inlay or onlay. An inlay is a restoration in which a portion of occlusal (biting) surface is replaced with porcelain. An onlay will restore a larger portion of the biting surface of the tooth. These are considered very conservative restorations. The porcelain allows an excellent esthetic result. It is attached to the tooth using a bonding procedure, allowing it to become very strong. It can be used with wonderful results in small, medium, and even with large restorations lasting more than 12 years, relatively trouble free.

A dental laboratory is involved in the construction of the restoration. There is a 2- to 3-week delay while the inlay or onlay is being made, so the tooth must have a temporary restoration in place during that time.

They have some disadvantages. They are moderately to very expensive to make and place. They take two appointments to complete. They must be adjusted and polished well or they can cause wear of the opposing enamel, similar to a porcelain fused to metal crown. Of course, we make sure they are adjusted and polished to begin with. Porcelain biting surfaces cause more rapid wear of opposing natural teeth, especially in the posterior areas where a metal biting surface may be advised.

Advantages include the excellent esthetics, high strength, predicted longevity, and conservative preparation, 

that is, less drilling than a crown. If the porcelain does chip, it can be repaired. However, you should not chew ice cubes, “jaw breakers”, or any other hard candy with these or any other type of restoration.

For those who want the strongest, longest-lasting, conservative restoration that very closely matches a tooth, porcelain is possibly the best choice. Once it is finished, the tooth, if cared for properly, should not have to be restored again for years. It does allow the conservation of most of the natural tooth.

Resin

Resin inlays and onlays are used in the same areas as the porcelain inlays and onlays. They are very natural in appearance and, like porcelain, are bonded into place. They are considered an extremely conservative restoration. Two appointments, approximately 2 weeks apart, are required to fabricate the inlay/onlay. The tooth will be protected with a temporary filling while the final restoration is being made. The wear of the resin is similar to that of enamel. So unlike porcelain, it will not have a tendency to wear the opposing natural tooth structure.

The resin may be considered slightly “weaker” than the porcelain. However, porcelain is more brittle and more difficult to repair. The difference in strengths is not significant. The resin is more forgiving and is more easily finished or repaired and resin is easier to work on.

With both types of materials, porcelain or resin, you can develop decay on unrestored surfaces, so excellent oral self-care is required. Neither material is advised for patients who have a bruxing (grinding) or clenching habit unless a protective mouthguard is constructed for you.

Unless you have a preference, we will select the most appropriate material for your dental needs. Cost of each is comparable. Both types are excellent choices and are considered highly conservative in the amount of drilling needed.

If you have any questions about porcelain or resin inlays and onlays, please feel free to ask us at any of our office locations:

Hymeadow: (512) 250-5012

Jollyville: (512) 346-8424

West William Cannon: (512) 445-5721

Implants, Crowns, and Bridges vs. Natural Teeth

Nothing can replace the natural teeth you were born with for chewing and function. However, very few people go through life without having teeth filled, crowns (caps) placed, or bridges and implants used to replace missing teeth. Crowns, bridges, and implants are the best answer and closest to your natural teeth, but they are not the same as healthy, natural teeth.

Crowns

Crowns are used to reconstruct a single tooth broken down by dental decay. Crowns are made of ceramic, resin, porcelain, porcelain plus metal, or resin plus metal materials. They are bonded or cemented onto the prepared tooth and cannot easily be removed from the tooth once placed. If the tooth was in good alignment before the crown was prepared, the crown will be in good alignment. If the tooth was misaligned before the crown, sometimes the crown may be made to obtain a more ideal shape and position. It is cleaned and flossed just like a natural tooth and is most like real teeth.

Bridges

Bridges are crowns that are attached together, suspending the crown portion of a false tooth in or over the space left by the missing tooth. A bridge can be used to replace one or several teeth. Sometimes a bridge is used to splint loose teeth together in order to make the teeth more stable. Bridges are usually made of metal covered with either porcelain or resin. Some of the newer bridges are made of all resin or all ceramic materials. They are cemented or bonded onto the existing prepared teeth and are not easily removed once placed. The bridge teeth can be brushed the same as natural teeth, but since they are attached together, must be flossed differently by using a floss threader or other device.

The teeth are generally the same shape as natural teeth. However, if the existing teeth (abutments) that are used to anchor the bridge have moved from their original position because a tooth or teeth have been missing for years, the added tooth (pontic) may be longer or shorter than the tooth that it is replacing. With a bridge, the false tooth will most often butt up against the soft tissue ridge where the removed tooth was.

The shape of the tongue side of the false tooth varies. It is usually smaller on the tongue side and completely fills the space. Food will have more of a tendency to collect in this area, so you must be prepared to clean it. If the missing tooth has been gone a long time, the ridge may have shrunk considerably, and the pontic tooth will be longer that the teeth on either side. If this is the case, there are several periodontal procedures that can be done prior to the construction of the bridge. These procedures will build up the tissue to its former height. The more your mouth has changed from its normal state, the harder it is to make new teeth look and feel natural.

Implant Crowns

Implant crowns are used to replace single or multiple missing teeth. They are either cemented or screwed-retained onto an implant fixture. The crowns are made of porcelain or resin and metal. But they have some significant differences from the natural teeth they replace. Teeth are supported by a root or roots that are irregular in shape. Implants are round. The cross-sectional of the implant will never match that of the tooth it is replacing. A multirooted tooth may be replaced by a single implant, so the manner in which an implant crown comes out of the soft tissue ridge will appear different from a natural tooth. There will be more space between the implant root and the adjacent teeth. Implant crowns are often cemented with temporary cement. This allows the dentist to easily take off the crown and evaluate how the implant is doing. Crowns on teeth are usually cemented with a final cement. Implant-supported crowns are wonderful, but not the same as natural teeth with crowns. Be prepared for some differences. Expect more maintenance on your part and in the dental office with crowns, bridges, and implants.

Smokers take note: There is a heightened risk of dental implant failures among smokers—as much as 20% greater failure rate!

Make Eyes at Your Dentist- It's Normal!

Few people come as close to the average face as a dentist does. Ophthalmologists hide behind those steampunk-y binocular machines; makeup artists have long-handled brushes; and dermatologists get to worry about other parts of the body for hours at a time. But dentists and dental hygienists have no way around it: They spend most of their days inside the faces of people who aren’t their sexual or romantic partners. Lying helpless in a reclining chair, the best a patient can do to make the too-intimate experience less awkward is close her eyes until it’s over. Shutting your lids until the rinse-and-spit command is the normal thing to do.

Or is it? Some dentists make active small talk, and it seems rude to zone out or avoid eye contact when you’re meant to grunt in assent or smize at a joke. Dentists who install iPads or TVs overhead seem to invite an open-eyed approach to their open-mouthed examinations. Then again, unprotected eyes may get flecked with water, spit, and whatever particles the dentist’s tools dislodge. How are we supposed to know which way our eyelids should go?

An unscientific anonymous poll of 114 of my friends and acquaintances suggests that nobody knows. “It literally never occurred to me to close my eyes,” one person responded. “It's weird to look into the dentist's eyes! It feels like I'm seeking intimacy, when really I just want my teeth cleaned,” wrote another. There were many strong opinions in the responses, but no clear consensus on right and wrong. When it comes to eyes at the mouth office, it’s “I feel awkward AF looking into my dentist’s face” versus “Closed feels weird, right? I feel like closed is the weird one here.”

I’d never thought to be concerned about my behavior in the dentist’s chair until my last dental cleaning. Halfway through the appointment, I realized that my eyes weren’t just closed—they were clenched shut, with quivering eyelashes and a furrowed brow to boot. I relaxed my face, not wanting my dentist to think I was in pain or stressed out about a simple cleaning. Then, a horrifying thought entered my mind: What if my eyes aren’t supposed to be closed at all? I’ve never seen anyone else get their teeth cleaned—it’s totally possible that everyone else watches the entire procedure, and my dentist thinks I either have an intense phobia of flossing assistance (I don’t) or an intense fetish for latex gloves, closing my eyes to fully savor the experience of her hands in my mouth (not true).

So it gives me great pleasure and relief to report that there seems to be no weird way to get your teeth cleaned. My poll responses show a healthy split: About 56 percent keep their eyes open, 37 percent close them, and 7 percent do a little of both.

But what do the professionals think? Eileen Danaher, a Rhode Island dentist who’s been practicing for three years, says about 60 percent of her patients keep their eyes open for cleanings, though she attributes that majority in part to her talkative chairside manner. Pennsylvania-based dentist Gulia Omene thinks most of her patients keep them open, especially during cleanings—that’s when they’re looking for “feedback on their gum tissue” and are more receptive to chatter, she says—though her assistant thinks it’s closer to 50-50. For more involved procedures, the ratio flips. Danaher estimates that 95 of her patients shut their eyes for an injection in their mouths; about 53 percent of my poll participants said they close their eyes for anything more complex than a simple cleaning.

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Danaher believes her patients decide what to do with their eyes based on their least favorite part of the dental experience: Those most bothered by the sight of sharp instruments or the bright light overhead close their eyes, and those unnerved by the sounds of drills and whirring brushes keep them open to have some sensory distraction. Meditators and deep breathers close their eyes; people who distrust dental professionals—like my survey participant who prefers an open-eyed exam “to make sure no funny business is going down while a stranger's hands are in my mouth”—watch the whole procedure as it happens.

Dental workers have come up with all sorts of visual stimuli to make the time go by for open-eyed patients. I used to visit a dental office with comic strips taped to the ceiling; a colleague’s dentist has decorative panel that look like calm, puffy clouds on the fluorescent overhead lights. Bougier locales have mounted televisions or iPads within view of the chair, and some offer dark glasses to shield a patient’s eyes from flying debris and the exam light. Danaher’s dream is to get a giant “Where’s Waldo?” panel for her ceiling if she ever opens her own practice.

If so many dentists provide so many forms of in-chair entertainment, open eyes must be the norm—right? For some, taking the hint still feels inconsiderate. “I feel [like closing my eyes is] polite to the dentist/technician. If I were in their shoes, I'd be able to focus better if I didn't have a pair of scared eyes in my face,” wrote one poll participant. Another guessed that open eyes would seem “creepy-like” to a dentist at work. The dentists I spoke with roundly dismissed that fear. “It’s never awkward if your eyes are open,” Danaher told me. “You’d think being in that close proximity to somebody, it would be—but we’re two feet away from people all day long, so that doesn’t bother me. Now, if somebody was staring me dead in the eyes and not blinking, that might be a different story.” Danaher’s father, Gerald, a Syracuse-based dentist who’s been in the field for 30 years, says about 70 percent of his patients keep their eyes open, which helps him keep tabs on their experience. “Usually the eyes will tell me how they’re doing,” Gerald told me. “The look in their eye—if they’re darting back and forth, I’ll ask, ‘Are you feeling something?’”

Usually, dental patients in pain or the throes of anxiety will close their eyes. That’s not a problem, dentists say, unless they’re tensing up the rest of their faces, too. Jack Greenspan, a Connecticut dentist (and my partner’s dad) who’s had his hands in people’s mouths for 49 years and counting, says the only strict command he ever gave as a captain and dentist in the Air Force was to a terrified lieutenant who’d scrunched up his eyes and cheeks too tight to accommodate dental instruments. “This is a direct order, lieutenant,” Greenspan said. “Relax your face now.”
But for a lucky few, closed eyes mean the ultimate form of relaxation: a nap. Yes, reader! Some people—some magical, super-Zen, rubber-jawed people—actually conk out while a stranger takes a drill to their molars. Dentists say they love it when their patients fall asleep in the chair. “People will sometimes walk in and say, ‘Oh my God, I’m so nervous,’” Danaher says. “When those people fall asleep, it’s a giant win. It’s the biggest compliment you can give your dentist.” This perception can work in a nervous patient’s favor. One of my survey respondents wrote that, at the dentist’s, “I pretend I am taking a nap since it's weird to be in a room with someone for half an hour and not speak to them.
Faking sleep is extreme; most people who close their eyes at the dentist’s are just relaxing or spiriting their minds away from the physical discomfort and forced intimacy of a dental exam. They are also not normal. Open is the favored eye position of a small majority of dental patients, and dentists seem to be molding their exam rooms, with their fancy TVs and elaborate ceiling decorations, to that norm. Keeping your eyes open will put you in the company of the majority of your peers, so dentists will be ever so slightly less likely to consider you abnormal. Whether normalcy is worth the occasional fleck of plaque to the eyeball is your call.

By: Christina Cauterucci
http://www.slate.com/blogs/normal/2016/10/05/at_the_dentist_should_eyes_be_open_or_closed.html

 

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

6 Ways to Ease Your Child’s Anxiety at The Dentist

"It's time to go to the dentist," are seven words no adult or child wants to hear. While these are not words most people like to hear they are words you need to hear if you care about your smile. Sadly, many children are terrified by even the thought of going to the dentist. May officials have often encouraged the use of sedation dentistry even amongst small kids to help them deal with the nerves associated with visiting the dentist which has led to a widespread debate on if children should be allowed to take in such drug. Despite the debate one thing remains in order to keep healthy teeth your children must go to the dentist here are just a few ways you can help calm your toddler when it's time to go to the dentist:

Speak Positive Words

When it comes to going to the dentist it is terrifying for both children and adults. In order to eliminate anxiety before going to the dentist it is important that you let your child know that the visit will be an exciting one versus telling them they should be afraid.

Embrace Brushing Teeth at Home

It is recommended that you begin brushing your child's teeth once they start growing in. This not only encourages overall healthy teeth but it also helps children get used to having something on their teeth so that they are not paralyzed by fear when their first trip to the dentist arrives.

Start with a Pediatric Dentist

Pediatric dentists specialize in only children's teeth which may be the best bet for your little one as they get used to visiting the dentist. Not only is a pediatric dentist an expert in pediatric tooth care but he is also an expert in making sure your child does not have a full blown while getting take care of.

Play Pretend

Kids love playing pretend and using it as a tactic in overcoming fear will make playing pretend so much better. Set up a play date a few days before your child visits the dentist and have his or her room set up like a dentist office. Pretend to be the dentist and let them be the patient as you explore their teeth and gums. Your child is sure to love this game and most of all you are prepping them for their visits in a few days.

Don't Bribe Your Child

When taking your child to the dentist the last thing you want to do is bribe your child with things such as candy or other sweet treats. Bribing your child with sweets would be counterintuitive to what the dentists does for the teeth. It is best to simply calm your child's nerves. If you must bribe your child bribe them with stickers and or other fun activities.

Avoid Words that Promote Fear

Using the words "pain." "shot" or even "doctor" can be frightening for small children so try not to let your child know that they are going to see a doctor. Instead, share with them that they are going to see someone who cares about how strong their teeth and gums are. Using less fearful words could also help with decreasing anxiety.

By: Stephanie R. Caudle
http://www.huffingtonpost.com/stephanie-r-caudle/6-ways-to-ease-your-child_b_11549086.html

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Crowns: An Overview

Why would I need a crown (cap)?
1. A tooth has been so badly damaged by decay or so heavily restored by fillings that it can only be saved with cast restoration
2. A tooth has been treated endodontically (root canal treatment). These teeth are almost always restored with a cast restoration because they have lost a great deal of tooth structure from fracture, decay, or the drilling process. These teeth are prone to fracture under normal and light chewing forces.
3. The tooth needs to be used as an abutment (anchor) for a bridge to replace missing teeth.
4. Grinding your teeth, an improper bite, age, fillings and tooth decay can all be contributing factors in the wearing down, cracking or breakage of your teeth. 

What are dental crowns?
Dental crowns cover the entire visible surface of your affected tooth and add strength, durability and tooth stability. Click here to learn about the difference between crowns, bridges, and implants.

What kinds of crowns are there?
Expect to pay more for porcelain crowns because they are usually more time-consuming than gold crowns. Porcelain, porcelain over metal and gold crowns average between $600 to $3100 each in total cost. The new reinforced resin or bonded all-porcelain type costs more than other types, require more skill from your dentist and the lab, and may exceed your insurance plan coverage for crowns.

• Resin and Porcelain Crowns

• The new reinforced resin or bonded all-porcelain type of crown as the nicest appearance. This crown can be made from pure ceramic or a new reinforced composite resin, and is almost indistinguishable from natural teeth. Thew new bonding technology involved provides an exceptional bond to your tooth. It is metal-free, and thus satisfies the needs of patients with metal sensitivities. When correcting your back teeth with bonding, the cosmetic dentist will perform a tooth colored onlay. This type of procedure is used to correct only those parts of the tooth that are in need. This is a metal-free procedure. 
• Advantage: Porcelain crowns or new reinforced resin are considered to be the most aesthetically pleasing, as it is so easily matched in color to the surrounding teeth
• Disadvantage: The thickness of the porcelain required for pleasing aesthetics also requires that more tooth structure needs to be removed. It is more difficult for your cosmetic dentist to get an ideal fit where your gum meets the crown. Gingival inflammation appears to be more common with porcelain crowns that gold crowns. All-porcelain crowns require a higher skill level from your dentist and lab.
• Crowns Made of Gold

• Gold crowns are appropriate when appearance is not a priority to you. The gold metal is extremely workable, making gold crowns a more precise fit than any other type. While there exists a slight possibility of chipping with porcelain crowns, gold crowns provide no such possibility.
• Advantage: The preparation of a tooth for a gold crown is the simplest and least complicated preparation as there is minimal tooth structure removal with as much as possible of the healthy tooth structure remaining untouched. While porcelain is hard by comparison, it may cause wear on opposing teeth over the years where goal is not as likely to do so. Gold is also easier to fit to the area where the tooth and crown meet for a better fit. Gold is also a healthier environment for the gum tissue.
• Disadvantage: The cosmetic aspect, unless it is being used in the back of your mouth
• Porcelain and Metal Crowns

• For a very natural appearance, porcelain fused to metal crowns are the answer. However, they have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally, a darker line will be visible at the edge of the crown, near to your gum when it recedes with age. 
• Advantage: Porcelain fused-to-metal crowns have a very natural appearance
• Disadvantage: They have a metal substructure and require an opaque below the porcelain. This can make the translucency of natural teeth difficult to replicate. Occasionally a darker line will be visible at the edge of the crown, near to your gum when it recedes with age
• Types of Porcelain
• There are two types of porcelain - felspathic and pressed ceramic porcelains. The felspathic type is the original method that has been around for 20 years. Ceramist in a dental lab bakes porcelain onto tin foil and then heats it in an oven. The Ceramist is able to create tints and opaques inside the porcelain to give the natural look we seek.
• Pressed ceramic is created from a single ingot. The single ingot is milled in one piece to create the desired shape. The stains and opaques are applied only to the surface of the porcelain to give a natural look.

How do I choose a color for the dental crowns - how white should it be?
Whiten your natural teeth to either the level of whiteness you want or to the brightest they can be. Your cosmetic dentist will then have the crowns made to that color. Teeth are of course not monochromatic, so typically more than one color is used to used a very natural look. This color variation is critical in avoiding fake or artificial looking teeth. It is the internal contrast of colors that help create vitality. The internal play of light on the porcelain in the restoration helps to create this vitality. Surface texture is also very important, and helps to break up light reflections and make the crown look more natural.

There is no one standard system in the dental field to measure and determine tooth color. The most often heard about, however, is the Vita shade guide. This guide divides tooth color into four basic shade ranges:

A (reddish brown)
B (reddish yellow)
C (gray)
D (reddish gray)

In the A range, there are five level of darkness. Ranges B, C, and D, each have four levels.

Not all of your teeth are the same natural color. Usually your eye teeth tend to be darker than the others, your front teeth are typically the whitest, and molars tend to be a shade between the two. The goal for everyone is to achieve their individual optimum whiteness while still looking natural.

Most dentists will show you a shade chart for your to pick from. Keep in mind, with a good cosmetic dentist, this is merely a starting point. Other considerations when determining the color of crowns for each patient are your complexion, hair color, the color of your natural teeth and even your eye color.

What is the procedure?
- Preparing (drilling) the tooth in an appropriate fashion for the type of crown chosen
- Making impressions of the prepared tooth, opposing teeth, and the occlusal (bite) relationships
- Selecting a shade for tooth-colored crowns
- Fabricating a provisional restoration that will remain in place while the crown is being constructed
- Cementing or bonding the completed crown into position. If the work to be done is extensive, there may also be several appointments needed for preliminary seating (try-in) of the crowns or castings

What do I need to do BEFORE I get the crown?
It is important for the ultimate success of the crown(s) that you understand and can perform thorough plaque removal. You should immediately begin following the oral self-care instructions that you have been given. It will make the procedure more comfortable and efficient, and the resulting restorations will look better. Final impressions cannot be taken until the gum tissue is healthy. Crown lengthening is an oral surgery treatment that involves removing excess gum tissue around the upper teeth to make them look longer. Your cooperation is appreciated and necessary.

What do I need to do AFTER I get the crown?
As is true with your natural teeth and especially with teeth that have been restored with any dental material, you should avoid chewing on excessively hard or sticky foods after the crowns have been cemented. It is especially important not to bite down on hard foods with just one tooth. The porcelain material can fracture from the metal substructure under extreme forces. Anything you chew that could break a natural tooth could break a crown!

Be sure to brush and floss daily as instructed. We also advise using a fluoride mouthrinse as part of your daily routine. Please be sure to return for your regular examinations and prophylaxis (cleaning) appointments at the time intervals we suggest.

After observing these types of procedures for many years, we note that the gingiva (gums) can recede from the crown margins and the surrounding tooth structure may become visible. This recession usually takes place over a period of several years and may require restoration replacements or a periodontal plastic surgery procedure to correct it.

We expect that you will receive many years of service from the cast restoration.

If you have any questions about crowns and bridges, call our office and ask or set up an appointment. We have 3 convenient locations around Austin.