The reason the tooth hurts is that it is cracked INSIDE, not just outside. These old silver fillings have been acting like a wedge right up the middle of his poor tooth. Slowly, it has fractured the tooth from the inside out. Now this entire portion has broken. This is what has caused so much recent pain. But…..and this is SO important….the tooth has not had ANY other symptoms before this!
Here’s the problem. This back tooth has been causing a LOT of pain for this poor patient. He can’t bite even lightly without the tooth hurting a lot. Cold bothers it, and hot is starting to, also. This has been for the last week. The crack is evident on the back side of this tooth (near the arrow). But that’s NOT the only crack in the tooth. It’s just the most obvious.
Look at Cleo’s smile before and after she had her teeth fixed. She asked for teeth that were straighter and whiter. We completed this with a bridge and some crowns. What a difference!
You’ll recall the tooth Cleo had to have extracted. The temporary was used to ’shape’ the tissue in this area and aid the healing process. Here’s the original condition of her teeth, and the final results:
It’s difficult to even see where the tooth was extracted! The ‘fake’ tooth looks as if it emerges from under the tissue just like all the others. A beautiful result.
Cleo had the non-restorable tooth taken out. When a tooth is taken out the body immediately starts to take away the bone. Basically the body is saying, “No tooth….no bone.” This is a problem we’ll look into further when we discuss dental implants. But in the esthetic zone of the front teeth this can lead to devastating results. As the bone leaves, the gum tissue goes with it. Soon the area where the tooth came out looks ‘caved in’ and the gum tissue has migrated to a higher level than the teeth near it. It looks horrible.
Here’s an area on a different patient that has had only a moderate loss of tissue after a tooth was removed. This is because a dental implant was placed in the area.
These were the complications we were working with after Cleo agreed to have her teeth crowned. The tooth shown below was not going to be kept. So she needed a bridge to replace and replicate this tooth. It should be straighter, as should all the others. And she wanted whiter teeth, too. She was tired of having dark, discolored teeth.
So Cleo wanted a change. And more importantly, there were functional and structural issues, too. The cavities she had developed were large and, after taking into account the size of the existing fillings, there were no other options than to crown these teeth. Also, she didn’t like to smile because her teeth were not straight and, as she put it, not pretty.
If you’ve read any of my other posts you’ll know I’m not a fan of so called ‘instant’ orthodontics. So often a little ‘real’ orthodontics will dramatically improve not only the final esthetics of the case but the longevity, too. However, there are times that the final solution is to ‘fix’ the teeth, and braces are not required.
Let’s look at Cleo. She had many older fillings in her front teeth and recently began to develop cavities around a number of them. Because of the location of one of these cavities she would also have to lose a tooth. She wanted to improve the overall appearance of her front teeth, too. She had always been unhappy with the way they looked.
Since we agreed on ‘natural’ and not ‘Hollywood’ for the shade of his teeth, Robert decided to proceed. We placed 6 beautiful all-ceramic crowns on his upper front teeth. The gaps were closed, the color was brighter (but not TOO bright!), and the teeth were the right size because the orthodontics were a success. Also, the edges and corners were restored to their ideal position allowing Robert’s new teeth to function better. He was ecstatic! Take a look: 
So Robert had his teeth positioned correctly, and now wanted a cosmetic enhancement. Our conversation revolved around a few things. First, he wanted ‘whiter’ teeth, but not ‘too’ white. He used the term ‘natural’. I was in agreement. Too often people get their teeth fixed with white ‘Chicklette’-looking crowns or veneers. They’re SO white that any characterization is lost. Since Robert is fairly fair-skinned, that would have looked horrible.
The many spaces that existed between his teeth could be filled in with correctly-sized teeth since the orthodontist had moved the teeth into the right general areas. My only other area of concern was the different levels of his gum line around these teeth. They were uneven and could be dramatically improved with a bit of recontouring. After careful consideration, Robert decided to leave them at their current level. He reasoned that he never smiled large enough to see them anyway!
