Lower Arch Reconstruction

Today's patient came to us with porcelain and metal crowns on all of their lower teeth. With time, these restorations had become chipped and worn, making it obvious that they were not natural teeth. Additionally, gum recession had revealed the dark metal collars around these crowns, creating an obvious transition from enamel to porcelain. Finally, porcelain and metal crowns are inherently opaque (do not transmit light) to block out the inner metal layer. This contrasts harshly with the natural translucency of dental enamel and makes the teeth look "old" or yellow. 

After considering the many options, Dr. Kari Ann Hong and the patient decided to replace the existing crowns with new Emax lithium disilicate restorations. Emax provides increased durability over porcelain and metal crowns with better esthetics and more design possibilities. The results speak for themselves! The new crowns have a much more natural shape and contouring, while the shade and translucency better matches natural enamel. Additionally, the increased wear resistance will help ensure these teeth for years to come. If you would like to know more about dental crowns, fillings and other cosmetic procedures, please give our office a call! 

Is bleaching safe for your teeth?

Every year, millions of patients worldwide bleach their teeth using various products. Whether prescribed by a dentist or purchased over-the-counter, almost every effective whitening method utilizes some type of peroxide gel. When used correctly, they are all safe and effective ways to lighten the color of your teeth. Read on to catch the full story!

Peroxides (hydrogen peroxide, carbamide peroxide, etc.) whiten teeth by breaking down the pigmented compounds in the tooth's dentin layer (between the enamel and pulp). To reach this space, these products rely on opening up small gaps in the dentin called microtubules. This can cause a temporary sensitivity to air and cold liquids. However, the tubules quickly re-mineralize and close in a matter of hours. For cases of extreme sensitivity, we may recommend extra fluoride applications to dull the ache. 

Research shows that whitening causes no long term negative effects on teeth. However, prescription strength whitening procedures (zoom whitening or custom bleach trays) have the potential to irritate or discolor the gum tissue. This is why it is important to follow the dentist's directions carefully. It is also important to note that over whitening can cause the teeth to have a blue tint that many patients find undesirable. 

When performed correctly, whitening is an easy and convenient way to improve the cosmetics of your smile. If you would like to discuss your tooth whitening options, please give our office a call!

Complete Smile Makeover!

What makes a perfect smile "pop?"

Today's patient came to our office wanting a smile that exuded natural beauty. Their existing teeth had a general "flat" appearance with uneven wear on the edges. Younger/cosmetically desirable teeth tend to have more variance in shape between adjacent teeth and more symmetry across the midline. Each tooth has unique anatomic features, and a great smile captures these subtle differences!

To create this transformation, Dr. Kari Ann Hong prepared the patient's anterior teeth (from canine to canine) for dental crowns. Impressions were taken and sent to Opus One Dental Lab where six crowns were fashioned from Emax lithium disilicate material. Emax allows us to make hyper-realistic crowns that capture the translucency and shading of natural enamel while remaining resistant to fracture. The result is absolutely stunning! If you would like to know more about dental crowns, smile esthetics or cosmetic dentistry, please give our office a call!

Perfecting Incisors using Emax Crowns

One of the most common dental anomalies is underdeveloped lateral incisors. Often referred to as peg laterals, this condition typically presents as two lateral incisors that look smaller and mismatched when compared to the central incisors. For today's patient, Dr. Kari Ann Hong chose to correct the cosmetics of this smile using two beautiful Emax lithium disilicate crowns.

Since the incisors were already undersized, only a minimal amount of tooth structure had to be removed in fitting the crown. By working with Opus One Dental Lab a near perfect match was made to the natural central incisors. Notice the delicate translucency near the edges of the teeth and harmonious shape. We even captured the pronounced developmental grooves (called mamelons) on the central incisors. The result is a beautiful smile that looks more natural than the "before" shot!

If you would like to know more about the cosmetic services we offer at Thousand Oaks Family Dentistry and what we can do for your smile, please give our office a call!

Best Cosmetic Dentist in the Conejo Valley

Check out this new video testimonial from one of our very satisfied patients! Twenty years ago, Jennifer suffered from pain and headaches associated with stress on her temporomandibular joint (TMJ). In solving this, her previous dentist used dental crowns and veneers to improve the way her teeth came together and ease her TMJ pain. Although the procedure was successful, twenty years of wear combined with gum recession had affected the appearance and function of these restorations. 

An important component of the dentistry we provide is managing our patients' fears and expectations. Jennifer was understandably very nervous coming into her appointment to have her crowns and veneers replaced. On top of the typical stress of a dental visit, she was concerned if the new restorations would fit as well as the originals. Fortunately, Dr. Kari Ann Hong is an expert in providing dentistry with a compassionate touch. Jennifer put on our noise isolating headphones and relaxed while Dr. Kari finished the appointment in just two and a half hours! She even left our office in custom temporary crowns that mimicked the esthetics and mechanics of the permanent units to come. 

Having your smile rejuvenated can be a stressful and daunting process. However, we pride ourselves in creating a relaxing atmosphere that makes the experience enjoyable! If you would like to know more about dental crowns, veneers or implants, please contact our office at (805) 480-9820 or at staff@thousandoaksfamilydentistry.com.

Case Presentation: Esthetic Crown Lengthening for Veneers

Today's patient came to us with complaints about the shape of their anterior (front) teeth. The teeth appeared too small or "boxy," and a large proportion of the smile was occupied by gum tissue. To correct these concerns, our office decided to utilize cosmetic veneers in conjunction with esthetic crown lengthening. 

Crown lengthening is a procedure performed by a periodontist where the gum tissue is contoured to reveal more tooth structure. Dr. Wilgus at Camarillo Periodontics worked with us to treat this patient and delivered phenomenal results. Even before veneers, the teeth have better proportions and the smile has a less "gummy" appearance. The next step will be to prepare the teeth and design a set of natural and uniform cosmetic veneers. We cant wait to see the final product!

Case presentation: Full Anterior Veneers

Take a look at this beautiful transformation performed at our office! In the before pictures, notice how the biting surfaces of this patient's anterior (front) teeth are worn down and uneven. Flattened and discolored teeth create an older appearing smile, regardless of age. The new veneers allowed Dr. Hong to develop a uniform and well rounded smile, while correcting the tooth shade. The results are absolutely stunning! If you would like to know more about veneers or any other cosmetic services offered at our office, please let us know!

Case Presentation: Acid Erosion Repair

At Thousand Oaks Family Dentistry, we offer an entire range of treatments and services for our patients. From pediatric exams to esthetic reconstructions, we have the knowledge, skill and equipment to handle any dental concerns. Today, we would like to highlight a recent case where we restored the esthetics and functionality of a patient with severe acid erosion.

Acid erosion affects many patients in one form or another. It can be linked to dietary habits such as sucking on lemons or certain types of medications that turn the saliva acidic. Most commonly, it is the result of a gastric disorder, such as acid reflux or bulimia. In rare cases, it can be attributed to genetic conditions that prevent dental enamel from "maturing" and becoming resistant to low pH. No matter what the origin, the results are always the same: decreased enamel thickness and tooth anatomy due to constant bathing in an acidic environment. 

Treatment

 Here, the patient needed their lower arch of teeth rebuilt from years of acid wear. When approaching a case like this, we have to be mindful of both esthetics and function. Close cooperation between our office and the dental lab assures that we deliver a final product that both looks great and respects the patient's jaw and chewing function. 

Pretreatment photograph

Stone modelwork of the patient before treatment

Here, we see the patient's pretreatment condition.  In order to best treatment plan for esthetics and function, stone models of their teeth were sent to our dental lab. The lab used wax on the models to mimic an ideal outcome. We were then able to show the patient what to expect when we treat the teeth. This waxed up model is also used to make temporary acrylic crowns, which hold space while the patient awaits the final crowns. 

Initial waxup of patient’s left side

Initial waxup of patient’s right side

After reviewing the wax models with the patient, we decided to do a combination of minimal preparation composite onlay crowns and lithium disilicate full coverage crowns.  Also, note the gap on the photo left (patient's right). Here, we added a bridge to replace the missing second premolar. After the teeth were readied for crowns, we sent impressions, previously waxed ideal models, pictures and instructions to our dental lab.

Picture of the patient’s teeth, after being prepared for final crowns

Our lab then took all of this information and fabricated crowns for the prepared teeth. This process took two weeks. Special attention was paid in matching color, texture, tooth bulk and biting function to the patient's needs. 

The final crowns on a stone model

The crowns were then sent back to our office, where we checked them for color, fit and size. Once we determined the crowns were a perfect fit for the patient, we permanently adhered them with crown cement.

Results

Overall final product

Closeup of patient’s right side

Closeup of patient’s left side

The finished product!  Not only did we restore the cosmetics of the patient's lower teeth, but we added back functionality and tooth structure. Both our office and the patient are ecstatic with the results!

As mentioned before, this patient represents a small portion of the services offered at our office. Every day, we treat a wide spectrum of dental problems, from fillings and cleaning to implants and full mouth veneers. If you would like to know more about the types of cases we treat and what they involve, please give us a call. We are always ready to meet all of our patient's dental needs!

The Golden Proportions: A Case Study

Last month, we posted a blog article on  The Golden Proportion, a set of dimensions based on ideal proportions found in nature. When it comes to the smile, these proportions are only one piece of the aesthetic puzzle. The position of the lips framing the teeth, the angulation of the teeth, and the location of the dental midline are all examples of factors that influence our interpretation of a pleasing smile. However, the golden proportion is an interesting feature to study, as it is so deeply rooted in mathematics.  To better explain how the golden proportion helps define facial esthetics, we assembled a few real-life cases for you to examine!

Case 1

Central tooth width to length ratio: 74% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168

Golden proportion ideal measurements, assuming the central is ideal width:

• Central 7.4
• Lateral 4.6
• Canine 2.8

Comments:

Case 1 has centrals that follow an ideal width to length ratio at 74%.  In evaluating the golden proportion, the laterals and canines are wider than ideal. The frame of the lips is much wider than in Case 2 or 3, so the gum tissue above the gum/tooth margin is very visible.  

Case 2

Central tooth width to length ratio: 96% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D:

• Central 1.618
• Lateral 1
• Canine 0.168

Golden proportion ideal measurements, assuming the central is ideal width would be

• Central 8 
• Lateral 4.9
• Canine 3.0

Comments:

Case 2 has centrals that are nearly 1:1 in the width to length ratio and have a square appearance.  It appears that the centrals have some wear on the biting edge and that they could stand to be 1-2 mm longer.  The laterals and canines are slightly wider than the golden proportion measurement.  The patient's lips frame the overall smile so that hardly any of the biting edge or gum/tooth margin of the teeth show.  Thus, the aesthetic discrepancies are less noticeable.

Case3

Central tooth width to length ration: 90% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168 

Golden proportion ideal measurements, assuming central is ideal width:

• Central 9
• Lateral 5.6
• Canine 3.5 

Comments:

In reviewing the three cases presented here, Case 3 has nearly exact golden proportions.  The central tooth width to length ratio is slightly greater than ideal at 90%, but the upper lip covers enough of the gum/tooth margin of the centrals that this ratio isn't as relevant in evaluating aesthetics.  Also, the upper and lower midlines are slightly off center from one another, but the upper central midline is perpendicular to the floor of the mouth and centered with the patient's nose.  Thus, the midline is aesthetic even though the upper and lower midlines don't match each other.

Facial Esthetics and the Golden Proportion

Have you ever wondered why it is so easy to spot a perfect smile? It’s something almost all of us can do subconsciously. Beyond straight white teeth, there is something that just seems to stand out on someone with a “Hollywood smile.” Believe it or not, mathematics and proportions dictate the esthetics of our teeth and facial characteristics. By following a few basic ratios and the golden proportion, it is easy to see how a great smile comes together!

When we smile, our maxillary (upper jaw) anterior teeth will show the most. Our two central incisors are flanked by slightly smaller lateral incisors and then by the canines. The premolars and molars behind the canines will show as well, which contributes to the “width” of the smile. In an ideal situation, the line between the two front teeth should run perfectly parallel to a line drawn between the eyes or ears. This measurement is of particular concern in patients with head and neck injuries or asymmetrical faces. In addition, the two central incisors should be about 80% as wide as they are is tall. That is, if the tooth is 10mm tall it should be nearly 8mm wide to look the most natural.

The most important principle to follow in facial esthetics is something called the golden proportion. This principle dictates the relative widths of the anterior teeth.  Here, the lateral incisors are used as a reference factor of 1. The central incisors should be 1.618 times the size of the laterals, while the canines should only take up about .618 of the space. These very specific numbers can separate artificial “chicklet” looking teeth from a well rounded and robust natural smile. When performing cosmetic procedures such as crowns and bonding, we always work our hardest to preserve and develop these dimensions.

These ideas and principles dictate how our office works towards creating beautiful and esthetically pleasing smiles. Most people are not born with these ideal dimensions and still have beautiful faces. What these numbers do, however, is establish a guideline for how we approach crowns, dentures, implants and restorations to the anterior teeth. Don’t measure your own smile and become disappointed! These numbers do not take into account a number of other factors that can alter your facial appearance. Everyone has a unique smile and deserves a unique treatment!

At Thousand Oaks Family dentistry, we offer a wide range of services that can create mild to dramatic changes to your smile. As with any procedure, we can only decide what treatment is appropriate for you with a full consultation and exam. If you would like to learn more about facial esthetics and cosmetic dentistry, please contact our office!