August 19, 2018

Q: How long would it take to open a gap between my canine and central incisors? (missing lateral incisors)

Now, I also have baby pre-molars that are adjacent to my canines. I wanted to know how long it would take to open a gap between my canines and central incisors in order to place an implant that would replace my lateral incisors? Also, would transplantation of my canines be possible? Or would it be better to get a veneer or crown to shape my canine like a lateral incisor and then extract my pre-molars and replace them with implants that look like a canines?

Dr. Huefner’s answer:
Based on the photo you sent, you have very little space, and as such it would be difficult (but not impossible) to orthodontically open the space large enough to place a dental implant.  Not only is the small space a problem, but the canine teeth (the ones you want to move backwards) have the longest roots, and as such are more difficult to move.  There is another problem as well, is that even if the space were opened you would most likely have to have bone augmentation (grafting) to have enough bone to place the implants into.
I do not believe tooth transplantation is possible to correct your problem.
I agree with the concept of porcelain veneers, as this is a very predictable way of correcting your problem.  Braces and implants, even if they could be done would take many years.  Porcelain veneer treatment can be completed in less than a month.
I refer you to the web link below, that shows a great example of spacing and missing lateral incisors treated with porcelain veneers.

Web reference:

Q: What dental work is suggested and what is a rough estimate for cost?

Hello, I am a 40 year old with known dental work. I need 2 implants on my upper left and right 2nd molars with crowns, as well 7 additional crowns, upper right 1st molar and both bicuspids, 2 upper bicuspids on the the left and 1 on each right and left lower bicuspids. In the last 10 years, my teeth have extensively changed, they are shorter, thinner, yellow and more transparent. Bite looks different. Does the above change facial features and expressions???

Dr. Huefner’s answer:
I’m sorry, but it isn’t that easy to give an estimate based on the information you’re giving.  You are speaking of partial or full mouth reconstruction with dental implants.  “Average costs for crowns and implants” may not at all apply to your particular situation.  Dental implant fees vary considerably between dentists, and you may also need some kind of bone augmentation and custom abutments, both which also add to the fees.
So, I highly advise you have consultations with SEVERAL dentists, and I can assure you that you will get different fees from each.  Also, I would strongly recommend that you not choose your dentist solely based on the lowest fees.  Case in point, not too long ago I had a patient come to see me after a bad experience at a dental implant clinic that she chose based on “the lowest fee”, and of the seven implants she had, two had come out, three were not done properly and also needed to be redone, and only the remaining two implants were OK.
As a restorative cosmetic dentist working as a team with an implantologist (the dentist who actually places the dental implants, while I do the actual crowns or bridges on the dental implants), the experience I’ve seen this past decade is that dental implants have over a 95% success rate!  The only two patients I’ve seen with problems were diabetics or SMOKERS!!!!  Thus, if you are either a diabetic or smoker, your chances of success with dental implants is considerably less than patients who don’t smoke or don’t have diabetes.
Regarding whether or not your teeth have changed your facial features I cannot say, except it oftentimes does, especially with people who have missing or severely worn teeth or have lost all their teeth and are wearing dentures.  Generally speaking, properly done dentistry will improve your facial features and make both your teeth and face look younger.

Q: Post and Core Crown and tongue thrusting…Am I in danger of fracturing root?

I had a root canal on my left front tooth 9 years ago with no crown. Last week my tooth broke and my dentist put in temp crown which lasted a week when the rest of tooth broke off at the gum line. I then first realized that I push my tongue into that one tooth when I swallow and sleep. The dentist then did a post and core and I’ve noticed that I’ve already pushed the crown forward by about a mm and I’m terrified that this will cause a fractured root. What can be done and is my fear justified?

Dr. Huefner’s answer:
Although your tongue habit may continue to push your tooth outward, the forces on your teeth by your tongue are less likely to fracture your teeth than biting into hard food, or in people without “tongue trust behaviors” who grind or clench their teeth frequently and very hard.
Tongue trust therapy is not very successful, thus it is doubtful that this habit of yours will ever discontinue even if your saw a speech therapist to address it.
My advice is not to dwell or worry about it.  Give things time to settle down.
If you did loose your teeth due to fracture you should consider a dental implant.  The great thing about dental implants with crowns is that they won’t move with your tongue thrust habit, as they are solidly joined to bone.

Congenitally missing teeth treated with very esthetic EMax all-porcelain bridges

all porcelain EMax bridges and two EMax porcelain veneers

Photo above: Teri was congenitally missing both of her upper lateral incisor teeth. For years she had two bonded bridges and six porcelain veneers, but she didn’t like many things about them, especially the color, shape and thickness of the teeth. Photo below: Dr. Huefner replaced her old dentistry with two all-porcelain EMax bridges and two EMax porcelain veneers. Teri got to choose the color, and chose the BL2 shade from the tooth shade guide.

Teri was congenitally missing teeth, both of her upper lateral incisors.  Embarrassed to walk around with two front teeth missing, her parents took her to the family dentist who placed two bonded bridges and six porcelain veneers.   Now having no missing teeth showing Teri was relatively happy with her appearance during high school and early twenties.  But when she graduated from college and entered the work force, she started rethinking how she felt about her two bridges.  She realized they just didn’t look as good as she hoped that they would be.  She liked her old dentist and thought he did the best that he could for her, but couldn’t help but feel that in this day and age, cosmetic dentistry probably offers new technology that could give her a much more attractive looking smile.  It was time for Teri to see a cosmetic dentist to discuss her alternatives.

After hearing Teri’s story, Dr. Huefner asked her specifically what didn’t she like about her old dentistry?  Teri said she wanted whiter teeth, that the bridges were too thick, that there was brown staining between each of her teeth and the edges of her teeth were shorter on her left side compared with her right side.

EMax all porcelain bridges

Upper photo: Notice how Teri’s right central and lateral incisors are shorter that the teeth on her left. Ideally the teeth should be symmetrical, the same length and the edges of the incisors follow the curve of Teri’s lower lip when she smiles. Lower photo: By Dr. Huefner making Teri’s bridges the proper length she had a much more attractive and natural looking smile.

Dr. Huefner was happy to tell Teri that there was an alternative available today that he thought would give her a much more attractive smile.  Rather than do bonded bridges for two teeth replacements, and then porcelain veneers for six teeth, or porcelain fused to metal bridges, Dr. Huefner advised using a new type of all-ceramic bridges called EMax along with two porcelain veneers also fabricated out of the EMax material on her bicuspid (side) teeth.  By doing this she wouldn’t have that unattractive staining line between each of her teethand they wouldn’t be bulky and thick like her present dentistry was.  Also, Dr. Huefner would make the edges of the teeth even and symmetrical in length and follow the curve of her lower lip in a natural way.  But one thing that really excited Teri, Dr. Huefner said that she could actually choose the color of her new dentistry, so she could get the white colored teeth that she had always wanted.  She chose shade BL2 from the Dr. Huefner’s tooth shade guide.

Teri was excited to hear Dr. Huefner’s recommendations and began her treatment almost immediately.  Her entire treatment, EMax bridges and veneers went smoothly and just as Dr. Huefner had planned.  Teri’s new smile makeover with two all porcelain EMax bridges and two EMax porcelain veneers was completed in just under a month’s time.  As you can see from the photos, Teri got a terrific result and her new smile looks much more attractive by using a better design and all porcelain EMax material rather than traditional porcelain fused to metal bridges that dentists have been using for the past three quarters of a century.

For patients not able or willing to have dental implants to treat their congenitally missing teeth, EMax all porcelain bridges should be given much considerations based on its many advantages and superior esthetics.

Dr. Norman Huefner, Laguna Niguel cosmetic dentist serving Orange County and surrounding cities of Rancho Santa Margarita, Mission Viejo, Irvine and Newport Beach

Orange County Dental Implants

Laguna Niguel dental implant

Top photo: Hopeless tooth removed and implant inserted into the space where the root was. Middle photo: After eight weeks of healing the dental implant was ready to accept the zirconia abutment. Bottom photo: An all ceramic crown (no metal) was cemented over the zirconia abutment. The implant crown matched the adjacent teeth in color, but actually looked better!

I  get a lot of requests for information on Orange County dental implants.  How much are dental implants?  How long does it take for the whole process of the dental implant?  What are the steps in making a dental implant?  Will my insurance pay for dental implants?  Renee is a patient I treated who came in with her upper right lateral incisor broken off.  I treated her with a dental implant to replace the broken off tooth.  Let’s go through the steps and answer some of the common questions.

Renee’s right lateral broken off.  She was devastated!  It was a front tooth and she couldn’t go around “looking like a hillbilly”.  After we assured her that we would make her a tooth replacement that she would have the next day, she relaxed a bit.  I explained that she had several choices to replace her missing tooth:

  • A fixed (permanent) porcelain bridge, which would mean placing new porcelain caps on the teeth on either side of the broken off tooth and a replacement tooth would be joined to those two new porcelain caps
  • A dental implant, which would mean we would just put a permanent crown into the space of the broken off tooth
  • A removable partial denture or a dental “flipper”, both which because they are “removable”, can be taken in and out

After hearing her choices Renee wanted to know more about Orange County dental implants and solutions to her problem.  I told her that I would take an impression to make her a removable temporary tooth replacement, called a flipper.  I would have that ready the next day.  Then the broken off tooth would be removed and an implant placed into the space where the root had been.  It would take about 8-10 weeks for the dental implant to completely heal and join with her jaw bone.  In the meantime, she would be wearing the flipper, so at no time would she be without a front tooth.

After the Orange County dental implant had completely healed I would attach a tooth colored zirconia abutment into the dental implant.  The dental implant is completely below the gums, but the abutment is above the gums and it is the abutment which would then allow me to then place a crown on top of it.   Thus there are three parts to an implant itself, the dental implant that goes into her jaw, the abutment that goes into the dental implant, and the crown that goes over the abutment.  I assured Renee that her new implant tooth would match her other teeth in color.

Her Orange County dental implants treatment went just as I described and was without any complications.  We started by taking a dental impression for Renee’s temporary replacement tooth, the flipper.  Her broken off tooth was removed and a dental implant placed into the space in her gums where her root was.  During the next two months she wore the dental flipper.  Then she returned and I placed the zirconia tooth colored abutment into the dental implant, took an impression of the abutment and then placed a temporary crown on top of the abutment.  From that point on Renee didn’t need to wear her temporary flipper any more.  Two weeks later Renee returned again, the temporary crown was removed and the new permanent all porcelain crown was cemented on top of the zirconia tooth colored abutment.  That completed her dental implant treatment!

To answer the question on how much Orange County dental implants cost?  That depends a number of factors and variables.  Does the tooth have to be extracted, or has that already been done?  Is there enough bone and/or gums to immediately place a dental implant, or do additional procedure(s) have to be done to correct the deficiencies?  Is the tooth in the front of the mouth or in the back?  That might determine whether a custom tooth colored abutment is fabricated or a stock prefabricated metal abutment utilized.  The former has a higher lab fee than the latter.  And finally, what type of crown does the patient choose to have?  Gold, porcelain fused to metal or all porcelain/non metal crown?  Again, the lab fee would vary depending on what type of crown the patient and dentist choose to use.  So the answer is that there is no average fee.  It’s at least a couple thousand dollars for a dental implant on a front tooth.  Compared to the cost of a fixed bridge and implant could be more or less, depending on the above mentioned factors.  To answer more accurately the cost I would have to see the patient for a consultation and evaluate the specific situation.

Will insurance pay for Orange County dental implants?  That depends on what benefits the policy has.  Some plans do cover implants, many don’t.  However, even if there are no dental implant benefits, they usually cover the benefit for the crown the goes onto the dental implant and abutment.

If you have questions on whether or not you are a candidate for Orange County dental implants, and you are living in the Southern California area, I am happy to offer you a complimentary cosmetic dentistry consultation to discuss a dental implant and alternative treatments to solve your missing tooth problem.

Dr. Norman Huefner, Laguna Niguel cosmetic dentist serving Orange County and surrounding cities of Rancho Santa Margarita, Mission Viejo, Irvine and Newport Beach


Dental Implant to Replace Laguna Niguel Man’s Missing Front Tooth

Laguna Niguel dental implant with zirconia abutment and all porcelain crown

Lower photo: After the dental implant had healed a tooth-colored zirconia abutment was attached to the dental implant. Upper photo: On top of the zirconia abutment an all-porcelain crown was placed that matched Mark's adjacent teeth.

Dental Implant solves missing front tooth problem for Laguna Niguel man by Dr. Huefner

Mark, a Laguna Niguel businessman in his 40s had injured his front tooth playing football as a youth.  It abscessed and he had to have a root canal treatment to save it.  Over the years it just never “felt right.”  Finally one day he had pain and swelling around the front tooth and after taking an x-ray of the tooth we determined that the tooth had fractured all the way down the root and had to be extracted.  Mark was devastated! “Oh no, I can’t believe it.  All the rest of my teeth are great and now I’m going to lose my front tooth.”  We assured Mark that he is so fortunate to have been able to keep that injured tooth for so many years and now, with modern dental technology, he has two great options to replace his missing front tooth.

x-ray of dental implant and zirconia abutment

This is an x-ray of the dental implant after it had healed and the tooth-colored zirconia abutment was attached to it. The next step was to place the all-porcelain crown onto the abutment.

This was very good news to Mark.  “So what are my options?” asked Mark.  We explained that he could either have a dental implant or and all ceramic bridge.  We explained that if he chose the dental implant then we wouldn’t need to do any treatment to his other teeth and could actually use an all-ceramic crown over a tooth-colored zirconia abutment that fits into the dental implant.  His other alternative was doing a porcelain bridge, either the traditional porcelain-fused-to-metal porcelain bridge or the new all-ceramic non-metal EMax bridge.  However we went on to explain to Mark that by doing a fixed bridge it would also mean that we would have to place crowns on each of the teeth adjacent to the missing tooth.  After fully understanding his options Mark was adamant, he didn’t want to have to have crowns placed on his otherwise good front teeth that would be necessary if he chose to have a porcelain bridge, so a dental implant was definitely the way he wanted to go.

Upper front tooth with dental implant Laguna Niguel

The end result for Mark was a very natural looking smile that didn't even hint that he was missing a front tooth and had a dental implant.

So now that we knew which treatment Mark wanted to solve his missing front tooth dilemma we needed to do two other things.  First, make a temporary replacement tooth so that Mark didn’t have to walk around with a tooth missing in the front of his mouth.  We did this by making a removable appliance for Mark called a “Maxillary flipper”.  Second, we would schedule Mark’s visit with our oral surgeon to remove the infected broken tooth and place the dental implant.

Mark’s treatment went really smooth.  Our oral surgeon extracted the broken front tooth and placed the dental implant and the Maxillary flipper.  Mark left the oral surgeon’s office wearing the temporary replacement tooth (i.e. Maxillary flipper) so it was not apparent to anyone that he was actually missing a front tooth.  After several weeks his infection had gone away and the implant had healed.  Our next step was to place a tooth-colored zirconia abutment into the dental implant.  The abutment would serve the purpose of the natural tooth, allowing us to place the all-ceramic crown over the zirconia abutment.

The end result really pleased Mark!  His infection and pain were gone and he now has a great looking replacement for his  missing tooth and got back his great looking smile.  When looking at Mark the implant and crown matched his other teeth so well that one wouldn’t even imagine that he is actually missing one front tooth.  This Laguna Niguel man is very pleased with his natural looking dental implant and the treatment we provided him at Dr. Huefner’s dental practice.

Dr. Norman Huefner, Orange County Cosmetic Dentist

Missing tooth – dental implant or porcelain bridge for Gary from Laguna Niguel

porcelain bridge laguna niguel drhuefner

Lower photo: Gary lost his lower incisor due to infection. His treatment options were either a dental implant or porcelain bridge. Upper photo: Due to cost and treatment time Gary chose the porcelain bridge as a more expedient treatment to solve his "missing front tooth problem."

Gary from Laguna Niguel had experienced trauma to one of his lower front teeth when he was younger.  Like too many other people today he didn’t go to the dentist and just “toughed it out.”  After a while the pain subsided and he forgot about it.  However his dental problem didn’t go away.  The tooth became infected and eventually a huge abscess developed destroying the bone surrounding the tooth.  Years passed and Gary finally came in for a dental checkup. His main concern was that his front tooth was so loose that he thought he could pull it out himself!

After taking an x-ray and examining his tooth it was obvious that Gary had waited too long, his tooth couldn’t be saved.  The tooth required extraction to stop the infection from spreading to his adjacent teeth.  “Oh no,” Gary exclaimed.  “This is the front of my mouth, everyone will see that I’m missing a tooth!  I can’t let my customers see me with a missing tooth.  What can we do?”

Luckily we have a treatment that will allow the removal of Gary’s infected tooth and for him to immediately have a temporary replacement.  It’s called a “removable flipper“.  It would enable Gary not to go around toothless.   However the “flipper” is only a short term solution, as soon as the extraction area healed up and the infection cures he would be able to get either a dental implant or porcelain bridge.  Gary’s main concerns were cost and expediting the treatment, which both favored the porcelain bridge solution over a dental implant.

Thus, we proceeded with his treatment, extracted his tooth, cleaned out the infection and placed a flipper as a temporary solution.  After the extraction site had completely healed, which was about six weeks later, we fabricated a permanent porcelain bridge for Gary from Laguna Niguel.

Dr. Norman Huefner, Orange County Cosmetic Dentist

Dental Implant or Porcelain Bridge When Missing a Front Tooth?

missing tooth dental implant

John broke his canine tooth and had to have it removed. Into the space where the root was a dental implant was placed. During this time John wore a "flipper" as a temporary so that he wouldn't have to face the world missing a front tooth.

John from Irvine had to have his canine (eye tooth) removed because the root had broken below the gum line and there wasn’t enough tooth to place a new crown. Very frustrated because he didn’t want to go around missing one of his front teeth, John came to Dr. Huefner’s cosmetic and general dental practice in Laguna Niguel wanting to know what his options were?

He basically had four choices:

  • dental implant
  • 3-unit fixed (meaning not removable) porcelain bridge
  • removable partial denture
  • or nothing

“Nothing is not an option, ” John said.  I have to have a tooth there.  Which of the other three is the cheapest solution?

dental implant abutment

After the dental implant healed and fussed to the bone an implant abutment was attached to it. This will now enable a porcelain crown to be placed over the abutment.

We explained to John that the least costly alternative would be a removable partial denture, either an extremely inexpensive temporary all-plastic “flipper” or a better fitting, stronger and more comfortable removable partial denture with a cast metal substructure.  When John learned that either of those options meant that the replacement tooth is something that he has to take in and out and was the least comfortable and least esthetic of all the treatment options he decided that the “cheapest solution” was not for him.

“Well, I guess it’s between an implant or a bridge.  What is the difference in cost between those two choices?” John asked.

“These two options cost about the same,” Dr. Huefner explained.”The 3-unit porcelain bridge would mean placing porcelain crowns (caps) on the two teeth adjacent to the space of the missing tooth and then the new false tooth (called a pontic) would be attached to the those two porcelain crowns, making a total of three teeth all joined together, thus the name 3 unit bridge.”

John said that he understood the concept of a 3-unit porcelain bridge, as years ago he had a missing lower back tooth that was treated that way.  He also said that he had already had a very nice crown that was recently placed on his lateral incisor (the tooth directly in front of the missing canine tooth) that he didn’t “want to mess with.”

dental implant irvine

John was fully restored when Dr. Huefner placed a porcelain crown over his implant abutment.

Thus it was starting to appear that by process of elimination John would want to have his replacement tooth done with a dental implant, so Dr. Huefner went on to explain the process:
After the root of the fractured tooth is removed a dental implant will be placed into the space where your root was.  You won’t see the actual dental implant, as it will be below the gums.  We need to wait a couple months for the dental implant to fully attach to the bone and the gum area around it heals up.  Then, into and on top of the dental implant I will place an “implant abutment“, which is attached to the dental implant below by means of a specialized dental implant screw.  The dental implant abutment will be either gold, silver, gray or white (zirconia), but that isn’t really any important consideration because I will make you a porcelain crown will cover the implant abutment and complete the process.

After understanding the entire process of how the dental implant treatment is done and comparing it to the other choices John chose the dental implant.  It took a couple months to complete the treatment, and in that interim we made John a temporary flipper so that he would have a replacement tooth and not to go around as he had feared, missing a front tooth.  The final results of the dental implant treatment were great and John from Irvine was very pleased with how we restored his smile!

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita

Why Should I Replace My Old Silver Fillings?

mercury amalgam filling

This patient had a relatively small mercury amalgam filling placed a number of years ago. There was leakage around the filling, causing internal decay. Because of the high content of mercury in the filling the restoration exhibited much expansion and contraction over the years and there are at least five visible fractures in the tooth. If this tooth would have been restored before the fractures developed a simple composite filling could have been utilized. In this case the tooth is so damaged by the fracture and decay that a full crown is necessary to save the tooth.

Question: I had a lot of cavities when I was a kid and my dentist back then filled them with silver amalgam fillings.  My dentist tells me that my fillings are leaking and that teeth are getting cracks in them.  I’ve never had a problem before except a few years ago one tooth broke and I had to get a crown.  The teeth he’s talking about don’t hurt and never bother me.  Why should I do what he recommends and put in new fillings or crowns?  Shouldn’t I just wait until they break or start bothering me?  John, from Orange County

Answer:  A hundred years ago the horse and buggy was one of the best modes of transportation.  But today we have much better ways of getting around.  The automobile and airplanes certainly have many advantages over horseback, right?  The “silver” amalgam fillings were developed around the time of the Civil War and certainly have served their purpose in dentistry for over a hundred years, but today they are not the best way to restore teeth and unquestionably have their own share of problems.  Many dentists like myself haven’t even used them in our dental practice for over fifteen years.

First, you should know that “silver” is actually a misnomer.  They really aren’t “silver”.  When first placed in the tooth the amalgam fillings are “silver colored” because the amalgam filling’s main component is mercury, up to 50%, which is silver colored.  It is the mercury that imparts that color to the amalgam.  Later that silver color often corrodes and discolors and the filling becomes black.  The other 50% of the amalgam ingredients are lead, tin, copper, zinc and a small amount of silver.  From a health standpoint alone, many researchers and physicians would argue that having mercury and lead in the mouth is not healthy.  When we remove the mercury filling material it is legally categorized as “bio-hazard” and dentists are not allowed to throw it into the trash or down the drain.  By law we are required to have a bio-hazard removal service come to our office to take away our “bio-hazard”materials and dispose of them in a way that does not contaminate the environment. It is amazing that the government considers mercury amalgam filling waste bio-hazard and still have not completely outlawed the usage of the material as they have done in many other countries.

When you were younger John do you remember what was in the thermometers used to take your temperature?  It was mercury, right?  But, it’s not longer used today, is it?  There are health reasons for that.  Mercury is toxic.  The reason it was used in thermometers was that mercury is actually a metal that is a liquid.  And the reason it worked as a thermometer is that mercury expands or contracts based on the temperature.  Now imagine a filling in the middle of your tooth that expands and contracts each time you eat or drink something hot or cold.  When it contracts it allows bacteria to go into the tooth in between the interface of the tooth and filling.  When it expands, it places internal pressure on the remaining tooth.  This is what commonly produces the cracks in the enamel of the teeth around the filling.

Now, most dentists are all in agreement that when a tooth has a cavity and the decay is removed that if it was a small cavity the tooth will be 10-25% weaker, if a medium cavity 25-40% weaker, if a large cavity 40-60% or more weaker.  So imagine a tooth that is weaker to begin with, and then having a filling that expands and contracts thousands upon thousands of times over a period of years.  At some point something has to give, and the tooth often develops cracks, and these cracks often lead to fractured teeth.

You might say, doesn’t the mercury amalgam filling strengthen the tooth?  The answer is a resounding no!  It just fills the void of the cavity and actually relies on the strength of the remaining tooth structure.

Today when dentists see teeth with leakage, which leads to decay, or visible fractures in the tooth around the filling most dentists will recommend being proactive.  This means removing the old mercury amalgam filling and replacing it with a restoration that will strengthen the tooth and help keep it from breaking.  The choices the dentist will typically recommend are a bonded composite filling, an onlay (usually porcelain, but many dentists still use gold on back teeth) or a crown (again, usually porcelain but sometimes gold).  Obviously the choice of which of these types of restoration will depend on the size of the original filling, the amount of decay or tooth that is cracked or fractured.  Your dentist should be able to explain to you why he/she makes a particular recommendation.

What will happen if you don’t follow your dentist’s recommendations.  If it’s a small filling and you have a light bite and don’t grind or clench, and if you’re lucky, maybe nothing will happen.  Or on the other hand, maybe nothing will happen for a while.

If your mercury amalgam filling is medium or large in size or if you have a heavy bite and grind or clench your teeth, then at some point your tooth will undoubtedly break.  Broken teeth are the most common emergency I have in my practice.  Sometimes when that happens there is a lot of pain involved.  Sometimes even a root canal might be necessary if the fracture goes into the tooth nerve.  Probably the worst case scenario is that so much of the tooth breaks off that the tooth cannot be restored and has to be removed (extracted).  That would then necessitate needing to replace the missing tooth with a much more involved treatment like a 3 unit porcelain bridge or implant.

John, I can’t tell you much more about your particular situation without seeing you as a patient.  But in general you will be best served by proactive dentistry geared to prevent larger dental problems from occurring.  Certainly replacing old mercury amalgam fillings that are leaking or exhibit cracks in the surrounding tooth structure with state-of-the-art dental restorations (whether composite fillings, porcelain onlays or crowns) is usually the best way to preserve teeth and prevent pain and more expensive dental treatment down the line.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita
Question: I had a lot of cavities when I was a kid and my dentist back then filled them

with silver amalgam fillings.  My dentist tells me that my fillings are leaking and that teeth

are getting cracks in them.  I’ve never had a problem before except a few years ago one

tooth broke and I had to get a crown.  The teeth he’s talking about don’t hurt and never

bother me.  Why should I do what he recommends and put in new fillings or crowns?

Shouldn’t I just wait until they break or start bothering me?

What do you do when you break off a front tooth? Laguna Niguel Dental Implant

broken lateral incisor

Renee fell and broke off her upper lateral incisor at the gum line. She had three choices: 1) a dental implant, 2) a 3-unit porcelain bridge or 3) a removable partial denture.

Renee from Laguna Niguel tripped and fell on her face.  The little bruises on her chin and elbows weren’t the problem.  She broke off her upper later incisor at the gum line.  Ouch!

When she came into our Laguna Niguel cosmetic dental practice she was in tears, hoping we would be able to just “glue the tooth back into place.”  Unfortunately that wasn’t something that could be done.

“Oh no, I have to have a front tooth.  I can’t go around with this gaping hole in the front of my mouth!” were her words of frustration.  We agreed 100% with Renee.

After explaining to Renee that she had three options for us to give her back a front tooth she relaxed a little.  We explained her three choices:

  • a single tooth implant
  • a 3-unit porcelain bridge
  • a removable partial denture
dental implant with abutment

Renee chose to have the dental implant. The broken tooth and root was removed and a dental implant was placed into the area where the root had been. Then the white abutment was attached to the dental implant with a special dental screw that joins the two parts together.

Renee was quick to respond, “I definitely don’t want anything that I would have to take in and out.  The removable partial is not an option for me.”

She wanted more information regarding the difference in treatment between the implant and the 3 unit porcelain bridge. Basically, if she didn’t like the appearance of the teeth on either side of the broken off tooth then a three unit porcelain bridge could be made.  A bridge means putting dental crowns on those teeth on either side of the missing tooth, but those two dental crowns also connect to another dental crown in the middle which will replace the broken tooth.  Dentists call the middle dental crown that replaces a missing tooth on a bridge a “pontic”.  Renee’s answer was that she already had porcelain veneers placed on those teeth several years ago and was very happy with their appearance and didn’t want to redo the two porcelain veneers with dental crowns to make a porcelain bridge.  “Can’t we leave those two teeth alone and just stick a tooth in there?”

That was actually what her third choice was, doing a dental implant. The broken tooth and root would be removed and into the area where the broken root was a dental implant could be placed.  On top of the dental implant another implant part, called an abutment, is attached to the dental implant by means of a special dental screw.  Then on top of the abutment a custom made implant porcelain crown is placed.

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After the abutment was attached to the implant a porcelain implant crown was cemented over it, completing the implant procedure.

After thinking over the three options Renee chose to do the single dental implant to replace her broken off upper lateral incisor.  Her treatment went smooth and to Renee’s delight, the results were very nice.  Her only criticism was that the dental implant looked so good that it actually looked better than her two natural teeth on either side that had previously been treated with porcelain veneers.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita
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