Fun Fun Fun! Single-visit porcelain crowns with CEREC 3D!
OK, I know that most people don’t think that going to the dentist is fun, but it sure can be a lot more interesting than it used to be for sure. The advent of digital dentistry, particularly CAD/CAM dentistry that allows us to make all-porcelain crowns in just 1 visit, is just pretty darn cool, and that’s even according to my patients who’ve benefited from it. We brought the CEREC 3D system into our office at the end of December 2007, and in that time we’re approaching our 200th CEREC crown. In the beginning, I didn’t take many pictures because I was really concentrating on learning how to make the crowns beautiful, fit well, and happen smoothly and quickly. Now that we’ve become more comfortable with the technology, I’m taking the time to really take quality photos to show off just what we can do, and yesterday just was the perfect opportunity.
This gentleman had these porcelain-to-metal crowns placed about 4-5 years ago, but he is a major grinder and started breaking the porcelain off within a year. That’s one of the potential problems of adding porcelain on to metal like that. They obviously needed to be replaced, and he drove all the way from Asheville, NC for us to do this in 1 appointment; since we clearly needed very strong porcelain, we chose EMAX, which has truly remarkable strength. Take a look and see the results for yourself after the crowns were glazed in our oven:
Yet ANOTHER cracked tooth due to bruxism (grinding/clenching)
I just can’t say it enough – if you grind your teeth, you need a properly made and professionally adjusted nightguard!
Perfect situation this morning: a young lady of only 29 years age came in for a root canal and crown on a lower molar because of a badly cracked tooth. It didn’t look all that bad on the outside, and seeing how small the previous filling was, you’d really think that the chances of this are practically non-existent……..but you’d be wrong. Take a look:
A Badly Cracked Tooth From Grinding/Clenching
And let me tell you – it is NOT a coincidence that this young lady has suffered from chronic migraines for years, but we haven’t addressed that for her quite yet. First we had to get her out of the terrible pain she had every time she bit down.
If you grind or clench your teeth (and notice that this tooth doesn’t even look worn down or flattened), please be willing to spend a little money, even if your insurance doesn’t cover it. It could literally save you THOUSANDS of dollars in dental treatment, lots of time in the dentist’s chair, and even pain.
A great news story by NPR on Sleep Apnea in children
NPR aired a story this morning (March 5th, 2009) that has to do with snoring, sleep apnea, and the wide-ranging effects that they can have on behaviour, brain function, etc. This is something I”ve been studying and talking to patients about for several years now, but it’s gaining wider acceptance in the medical fields. On the most basic level, sleep disorders cause a decrease in oxygen levels to the brain, which results in various decreases in function and can have significant effects on your overall health.
Please take some time to listen to the reports and read the articles – wonderful information!
Philosophy of Dental Care
We could also perhaps name this…..”How do I know if my dentist and I are on the same page?”
While there are an infinite number of variations on this theme, you can break it down into 2 basic groups of dentists. While both can serve you well, given how important the doctor-patient trust relationship is, I recommend you be willing to ask questions of your dentist and his/her team to make sure that you have the same goals for your mouth and dental health. Here are the 2 basic breakdowns:
(1) “If it ain’t broke, don’t fix it.” Dentists who subscribe to this theory generally don’t recommend any treatment until something actually hurts or breaks or is obviously decayed. In other words, let’s say you have a tooth with a crack in it, such as the ones I showed in this post from January ’09: Cracks in Teeth. This group of dentists generally won’t say anything about these teeth unless it actually starts hurting you or the tooth breaks. Given that it is impossible to actually predict when a tooth like that will break or hurt, you may go for many years with teeth in that condition, so the ADVANTAGE of this philosophy is that you don’t spend any money until it actually happens. The DISADVANTAGE is that – when the tooth finally breaks and/or hurts, it is generally in much worse condition than if treated earlier, which means that it will probably be more expensive to fix. Plus, of course, you might have to deal with the pain, and for some reason, these things always happen on nights or weekends when the dentist isn’t available.
(2) “Here’s a potential problem; let’s go ahead and fix it now before it breaks and hurts.”
In this philosphy of care, the dentist will evaluate you for all current and potential problems, inform you, and give you the option of choosing to have the treatment done before the tooth breaks and/or hurts. Of course, the dentist should NEVER try to force you into anything – always remember that you are the ultimate decider of when to have your treatment done. But if you have some trouble brewing in your mouth, wouldn’t you prefer to get it fixed before it gets really bad? Before it gets more expensive? Before you have to suffer?
It’s probably pretty obvious which philosophy we choose at Smiles by Payet Dentistry – #2. We will inform you of any and all problems that we see. We’ll give your our recommendations based on the years of experience and advanced training and available research. We’ll tell you what treatment options you can choose. And then we will sit back and let you decide how much to do, when to do it, and how you want to do it. Please ask us questions until you feel completely comfortable, and don’t worry that you’re hurting our feelings if you decide to wait.
We understand that you will be ready when you’re ready, and we are here to help you when you are. Our goal is simply to make sure that you are fully informed so that you can make the best choice for yourself. Call us for an appointment, or request one through our website by clicking here: Request an Appointment.
So I grind my teeth, Doc – what’s the big deal?
Many people grind their teeth. Many people clench their teeth. Many do both. The worst part is, though, that many have no idea that they do it, or how much damage they’re doing to their teeth — or how much it could cost to fix. Sadly, too, many dentists don’t do anything about it either. Here are 2 examples of just how badly one can damage teeth by grinding/clenching.
.Teeth damaged by grinding & clenching become short, chipped, worn, jagged, sharp, and ugly
How teeth can look after years of grinding and clenching.
Look how uneven the teeth are as they’ve been ground down. See the gum recession and the deep “notches” in the teeth? These things are NOT caused just by growing older and our mouths aging. It takes incredible force to wear down enamel, which is the hardest substance in your body. But once you wear through enamel into the second tooth layer – dentin – that wears down much faster and the damage accelerates.
Both of these gentleman wanted better-looking smiles. The first one was completed over 4 years ago; we are still in the process of completely rebuilding the mouth of the second gentleman. Needless to say, it is very expensive to rebuild teeth like this. Sadly, it could have been almost completely avoided if they had known about and used a nightguard years ago.
So if you think you grind your teeth – call us today! Sure, your nightguard might cost several hundred dollars………but what is that compared to thousands and thousands of dollars in treatment and many hours of time in the dentist’s chair. You’re investing in the future health of your mouth.
Don’t wait like these gentlemen did. Call us at 704-364-7069 and make your appointment to have a nightguard made and protect your teeth!
Visit our Smiles by Payet Dentistry page on this for more information on the NTI-tss nightguard.
Are Amalgam/Mercury/Silver Fillings Safe?
While silver/amalgam fillings are not requested very often in our practice, as most prefer to have fillings that blend in with their natural teeth, they are something that we do when situations warrant, as I discussed in an earlier post.
However, when it comes to the general topic of silver fillings, there are a lot of misconceptions, myths, and outright falsehoods out there. There are groups that CLAIM to have proof of a vast conspiracy by dentists to poison our population by using silver fillings (these are probably the same groups who believe that fluoride is a Russion attempt at mind-control of US citizens so they can take us over – hasn’t happened yet, and the conspiracy has been around for decades.); these groups CLAIM to have scientific proof that the mercury in silver fillings is poison that will lead to an absolutely amazing range of diseases, and that the simple removal of those amalgam fillings will almost magically cure those diseases. And it gets even wilder than that, but unless you’re specifically looking for a good laugh at how crazy these conspiracy theories get, I won’t bore you with all of them.
Let me be perfectly clear about my stance on this issue:
To date, there is absolutely NO, repeat NO CREDIBLE EVIDENCE that the small amounts of mercury present in amalgam/silver fillings causes any disease or disorder whatsoever.
I hope that was clear enough. 🙂
If silver fillings were as bad as the conspiracy theorists claim, then pretty much the whole world would be crazy, as amalgam fillings have been placed by the billions over the last 100+ years. My parents, for example, would have been beset by a myriad of illnesses, as both of them had a mouthful of silver fillings for many decades, and only recently have they been replaced as they’ve slowly worn out. Any strange illnesses in either of them? Nope. Nothing changed after they were taken out 1-by-1 either.
As a rather interesting side note: during my dental school years at the University of North Carolina at Chapel Hill School of Dentistry, I did a 2-month summer exchange at the dental school in Munich, Germany. While there, I was approached by several professors to proof-read some studies that they had translated prior to publishing them in English-language dental journals. Please bear in mind that Germany has pretty much banned amalgam fillings for many years, so it’s not like they are fans of the material. These professors had carried out a study that attempted to find a link between the presence of amalgam filings and a wide range of diseases and disorders; the study had lasted 5-6 years. And what were the results? Simply this:
They were unable to find any positive evidence of a connection between the amalgam fillings and ANY of the list of diseases and disorders that they had listed. Not one.
Kind of interesting coming from professors in a country that has practically banned the material for as long as they have, don’t you think?
A Smile Makeover with Porcelain Veneers and Short-Term Braces
This will be the last cosmetic dentistry/Smile Makeover video that I will post for a little while, as I next want to devote some time to showing how destructive “Grinding” of the teeth can be and why it is NOT something that you should take lightly. Bruxism/Parafunction (the general term for both grinding and clenching, which are 2 separate things) can cause major problems for patients, and often in ways not easily visible because it takes time to develop or they’re under the surface. I believe this is an area of dentistry that is often neglected, and it only makes things worse for patients.
With that said, I do hope you enjoy the way we combined different kinds of treatments to achieve a dramatic Smile Makeover for Daniel, as visible in this video.
Don’t forget – if you want to see all of the videos for our practice, check out our YouTube channel: SmilesbyPayet.
Combination Porcelain Veneers and Short-Term Braces
An exciting future for digital dentistry
Tonight was the first meeting of 2009 for the Charlotte, NC area CEREC Study Club, which I founded shortly after I took possession of my CEREC 3D CAD/CAM system on December 31st, 2007. (If you’re unfamiliar with the terms, CAD/CAM means “Computer-Aided Design/Computer-Aided Milling.”) It was really a very exciting meeting (ok, most people probably wouldn’t find it really exciting, but we’re a bunch of dentists, after all, who happen to be kind of geeky and like hi-tech tools in our office which happen to provide really awesome results for our patients), as the manufacturer (Sirona USA) just recently released a tremendous new upgrade, the CEREC AC Bluecam, which uses a range of improvements in both hardware and software to drastically increase the system’s speed.
Given the cost of the new unit, and since my CEREC 3D is only 13 months old, I’m not going to be introducing this new version to our office this year. The one we have, the CEREC 3D, is still an excellent system, and we regularly enjoy giving our patients the great experience of single-visit all-ceramic crowns and onlays with it. This means no temporary restorations, no second visit getting numb, no metal, practically no sensitivity afterwards……there’s really no downside.
Along with the new system, Sirona USA is launching another terrific innovation that will also benefit patients, and it’s called CerecConnect. The difference is this: with CEREC, we can create 1-4 units of crowns and/or onlays in a row fairly easily, and even do all of them in 1 visit. However, doing a full arch (all the top or all the bottom teeth) is extremely difficult and typically requires great expertise and advanced training, and it will still usually take 2 visits. In addition, the regular CEREC can’t do things like bridges. With CerecConnect, however, we will still be able to completely eliminate using those gunky impressions that NOONE likes, because we’ll take a digital image of the teeth and then just email it to the lab. How cool is that!?!?
I have a number of recent cases that I plan on posting here in the near future once I get the patient education videos completed. You’ll love what CAD/CAM can do in dentistry, for YOU! The digitization of dentistry is proceeding full-speed ahead, and the benefits are simply tremendous.
New Patient Education videos now in the office!
Oh, it feels so good to finally be able to announce this, as I’ve been working on it so hard for so many nights after my family has gone to bed, but FINALLY I have begun producing some new Patient Education videos to help explain a number of options that we offer by using pictures of many similar cases.
Over the last 4 years, I have amassed a catalog of about 38,000 digital photographs of the work that we do. You can see my Photography Blog post on the subject of Patient Communication with Digital Photography for more info on how/why we take pictures of our work, but now I’m finally able to turn a lot of those photos into various video formats to highlight problems that many patients have, often without even realizing it, and to let our patients actually see what they can expect once the treatment is completed. It’s really quite exciting! We’re not talking about “stock” photography here, of work that someone else did. EVERY SINGLE ONE of the pictures that you’ll see were taken by Dr. Payet (me), and every completed procedure was performed by Dr. Payet (me) and my Team. (Hope you don’t mind me talking about myself in the 3rd person for a moment there; I was having a Bob Dole flashback after reading some political articles. 🙂
We’ll look forward to showing you these new videos when you come in!
Don’t have any of those videos in Web format quite yet, but keep an eye on our website, Smiles by Payet Dentistry, for them to begin appearing there within the next few weeks. You’ll be able to see and understand so much more easily, I promise!
Migraine and Tension Headache Treatment
One of my favorite therapies to offer patients is the NTI-tss, also known as the Nociceptive Trigeminal Inhibition – tension suppression system. From the name, it’s easy to see why we simply call it the NTI, though. 🙂 Why is it one of my favorite therapies? For a very simple reason: it’s not often that you can literally transform someone’s life for the better in a couple weeks or months with no medications, no surgery, and at a very reasonable fee ……. but that is something that we do regularly with the NTI.
It’s such a simple-looking device, and it’s often difficult for people to understand how such a small nightguard can make such a dramatic difference, and often even more difficult to believe that a dentist can help them, even after they have been to every other kind of doctor and had every kind of test and scan imaginable.
So how does a dentist treat migraines with the NTI-tss?
The essential basis for why the NTI is so effective is this: we now know that many migraines and chronic tension headaches are triggered by either CLENCHING or GRINDING of your teeth.
“WHAT?!?!?!” might be a natural question at this point, so please feel free to express your disbelief at this time. 🙂 Don’t worry – that’s a common reaction. But think about an analogy that I often find effective with patients. Imagine that you decided to work out your biceps every day for 3-5 hours/day with a 2-3 lb. weight. Sure that’s not a lot, but for 3-5 hours per day? For weeks on end? For months on end? Maybe for YEARS on end? How do you think your biceps would feel? Ok, now imagine how all the muscles involved in opening and closing your jaws would feel if you decided to work them out for 3-5 hours every night for days, weeks, months, or years on end? Don’t you think that, in either scenario, the muscles involved would probably hurt like crazy?
I’m not going to get into all the details, as that gets extremely complicated, but if you’ll bear with me a moment and accept that this is a possibility, then wouldn’t it be logical if – by stopping or at least minimizing that clenching or grinding action — you could stop all the incredible muscle fatigue and pain, and the headaches would either go away or be greatly decreased? Well, that is just what the NTI does, and it does it far more effectively than any other type of nightguard I’ve ever prescribed for patients.
The NTI is not just a device to minimize/stop clenching and grinding, though — it can be a very effective tool in diagnosing the problem itself. In fact, it’s a critical part of the use of the NTI; we don’t just make one for you, put it in and say, “Bye – hope it works!” It’s a process – one that can take just a few days to be effective, or one that may take many months of very careful analysis and refinement to figure out precisely what the muscular problem is and how the NTI should be best adjusted for the individual.
Here’s a brief PDF video of how the markings that I see on the NTI help me determine what’s going on; also look carefully to see how different the patterns are to understand how much it varies from one person to another. And in future posts I’ll expand on this whole process more. If you’d like to ask specific questions, please comment!
Subscribe via RSS
Smiles by Payet Dentistry - Beautiful Smiles. Lifetime Care 