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File separation is an unfortunate, but normal event to take place when doing a RCT. The best thing is to be straightforward with your patient, explain what happened and your efforts to make iit right. If youre unable to remove the file yourself, you should at least make the effort to have the patient seen by a specialist who will be able to use microscopes and ultrasonics to try to remove the file fragment. &nbsp;

separation of file has occurred insid buccal canal of upper first premolar when doing filing,,i couldn't remove it by different ways,,,patient is unco_operative &amp;limited mouth opening,,,it's stainless steel file...is it problem to leave the file inside canal &amp;obture at the remaining length?

I'm Dentist &amp; Need Advice?

Cosmetic Dentistry

I like how Dr. Jay Neuhaus answered this question referring to trusting a $0.50 parachute.&nbsp; It&#39;s true: you will get what you pay for.&nbsp;

	I highly suggest spending your time researching reputable dentists in your area instead of searching out the ones offering the &quot;best deal.&quot;&nbsp; To do great work, sometimes dentists have to charge higher fees because they are using superior materials, better labs, or are setting aside more time to give you and the case the proper attention and not rush (as some of these &quot;dental factories&quot; do), for example. &nbsp;

	My advice: Get it done the right way once....in the long run, you will absolutely be better for it.&nbsp;

Good morning everyone. I stumbled upon a Groupon where a doctor in my DMV area is offering $400 per porcelein veneer or lumineer. Should I trust this source? Most veneers cost double from research. How is this even possible?

Should I Trust Groupon Veneers for $400?

If the metal fillings (amalgam) that you&#39;re speaking of are on teeth that are treatment planned to have veneers on them, then the answer is yes, you should have the amalgam fillings removed and replaced with a tooth colored material, or incorporated into the prep design of the veneer.&nbsp; The reason for this is two fold, aiming to achieve the best result in the long run.&nbsp; #1: shade match.&nbsp; The metal will show through the veneer and even the tooth (if the filling is behind the tooth) causing an undesirable grey shade.&nbsp; #2 The porcelain cannot be bonded to the metal filling.&nbsp;&nbsp;

	If the metal fillings are in teeth that are not treatment planned to have veneers, then there is no real indication to have them removed (unless of course there is decay beneath them).&nbsp; If you are seeking to achieve optimal esthetics, (which maybe your dentist is trying to help you lean towards) then taking out the existing metal fillings (if they&#39;re visible when you smile)&nbsp; and replacing them with tooth-colored fillings will help with that.

	Hope this helps!

	&nbsp;

I'm looking improve my smile. My top front teeth are different sizes, shades and have different angles. My dentist has recommended porcelin veneers. A nice before/after picture was produced. I am motivated to move forwards.  My dentist is strongly recommending that I have ALL my metal fillings removed, and replaced with appropriately white shaded material. The claim is that if I don't do this, the longevity of my porcelin veneers will be compromised quite a bit. I don't understand why this would be. Could anyone give me a good explanation on the structural issues involved (I do understand the purely cosmetic reason since the fillings are dark) ?? The cost of replacing all the fillings with this new type of material is quoted at several thousand dollars. Before I spend the money, I want to make sure it is of real structural benefit to the high priced veneers. thanks

Veneer Process Preparation Question

Perhaps you should consider asking your dentist or orthodontist to bond an ortho wire behind the teeth on the lower to stabilize them in their position.&nbsp; Its a small wire, precisely adapted to the surface of your lower teeth (on the tongue side) and then bonded into place.&nbsp; This is done quite frequently at the end of treatment since patients so often lose their retainers/don&#39;t wear them etc.&nbsp; Ask your dentist to make sure you are a candidate for this.&nbsp; If you are, then you won&#39;t have to worry with making another Invisalign tray/retainer as this is a more permanent solution. &nbsp;

Invisalign treatment ended 3 yrs ago. Been in the last tray on the bottom since then. Now I need two new crowns on the bottom. Will the tray still fit after I get the new crowns or will I have to get/pay for new retainers? Not, happy this invisilign thing is turning into a MONEY PIT!

Do I Have to Have New Invisalign Retainer Made if I Need 2 New Crowns?

The first &quot;red flag&quot; in your question is the point that you mentioned that the spacing between your teeth is getting worse.&nbsp; You also mentioned an overbite.&nbsp; With those two clues, I would explore the possibility of your occlusion (the way your teeth come together when biting, chewing etc) being one of, if not the main insulting factor.&nbsp;

	Sometimes, if a patient has a heavy bite, the bottom teeth can put too much force on the back of the upper teeth, causing them to flare out.&nbsp; If this is the cause of your spacing, simply putting veneers on your teeth may&nbsp; work temporarily, but then your teeth will probably flare out once again if the underlying cause hasn&#39;t been addressed. &nbsp;

	Since you are so young and these teeth are &quot;virgin teeth&quot; as we call them (they don&#39;t appear to have any fillings or crowns on them etc) I would recommend that you go with the most conservative treatment plan.&nbsp; Consider seeing an orthodontist or a general dentist licensed in Invisalign (clear braces).&nbsp; By realigning the teeth, you will remove excess force on them, stop the pattern in it&#39;s tracks and perhaps even close all of the gaps between the teeth.&nbsp; After ortho is complete, if there are still some minor areas of excess space that bother you, you can repair this conservatively with bonding or veneers.

	Hope this helps!

hello out there Iv&#39;e Had gaps in my teeth since I was maybe 12 or 13yrs old When I was younger around 8 or 9 and below I had beatiful smile and now when I need it the most I lack it. I also have a overbite. what do you think is the best procedure for me? I want to get rid of all the gaps and just have the confidence and have that pretty smile again,I have not had that in over 10 years im 22 now just plz give your honest opinion.thanks in advance guys

What is the Best Way to Get the Gaps in my Mouth Closed? (photo)

From this picture, it appears that the issue with your small teeth isn&#39;t just due to the tooth structure itself.&nbsp;&nbsp; You have to look at the entire mouth and smile as a whole- the lips and gums are the curtains and scaffolding, the teeth are the actors on stage.&nbsp; All three components--teeth, gums and lips, when in harmony, are what make a beautiful smile.&nbsp;

	With that said, I would recommend you get the opinion of a general or cosmetic dentist who is willing to get a team of specialists involved (expect: periodontist- treats the gums; and an orthodontist) to treat you.&nbsp; This way the dentist and the specialists can formulate a plan for you that is in your best interest now, and in the long run.

	To start, it appears as though you may need gum therapy (removing excess gum tissue to expose more tooth structure) and/or orthodontics to expose more tooth structure.&nbsp; Once there is more tooth structure visible, you may be pleased with the appearance, or may still need to move forward with dental bonding or veneers as the last phase of treatment.&nbsp; 
	&nbsp;

	Hope this helps!

I hate my teeth soooo much, OMG you have no idea. They're so small. I'm 20 years old, and I have baby teeth. It's so embarrassing. It just lowers my self esteem. What should I get to improve my smile?

Should I Get Veneers, Dental Bonding for My Small Teeth? (photo)

I feel that a second opinion never hurts, and often puts your mind at ease.&nbsp; After all, this is your mouth and no one else&#39;s, so it begets you to get another opinion.&nbsp; You should only move forward with treatment once you are completely comfortable with the proposed treatment plan and the dentist him or herself.&nbsp; It is important for patients to have a two-way conversation with their dentist so they are fully informed and understand their treatment and the reasons the dentist chose this route.&nbsp; What is confusing and often discouraging for patients, is that many times, dentistry is not black and white.&nbsp; There is a lot of &quot;grey area&quot; in which different dentists have varying philosophies, often times none of which are absolutely wrong--they&#39;re just different.&nbsp;&nbsp; So, ask your dentist questions, gets answers and explore your options before jumping into treatment. Hope this helps.

I recently got two crown lengthing/crowns. I waited a month between the lengthening and crown. It&#39;s two weeks later and I&#39;m still throbbing in pain. It&#39;s hyper sensitive to cold. Now he says I need a root canal, without even looking in my mouth. I&#39;m suspicious that two teeth suddenly need canals and suspect the process. These new crowns are all ceramic (not metal on ceramic) and I read the cement used might be the issue. I&#39;m leaning towards getting a second opinion.

Two Recently Crowned Teeth Need Root Canals?

Almost any stain we acquire on our teeth from everyday foods, drinks and habits can can be made lighter, whiter and better with the use of professional whitening.&nbsp; I think that this myth was thrown out of perspective, but has some underlying truth to it.&nbsp;

	First truth: The longer our teeth come in contact with dark staining foods and drinks, the more susceptible we are to stain.&nbsp; This is why straws can be a good option to lessen the amount of time a dark staining liquid (coffee or soda for example) has in contact with your teeth.

	Second truth: After whitening (bleaching), teeth become dehydrated temporarily, making them more susceptible to picking up stain.&nbsp; That&#39;s why we advise patients to avoid dark staining things (tobacco, coffee, red wine, etc) for the first 24-48 hours.&nbsp; It&#39;s not that your teeth will all of a sudden become a deep Argentinian Malbec Red if you accidentally have a glass of Malbec, it&#39;s just more likely that the the whitening you just did won&#39;t appear as effective thereby negating the effort you just put in.&nbsp; No worries, you&#39;ll just have to bleach an extra night or two to counter that and achieve the whiteness you desire.

Will coffee cause re-staining after whitening? &nbsp;Is there any way to avoid coffee staining besides drinking coffee through a straw?

Coffee After Professional Whitening?

Veneers can often accomplish what bonding cannot.&nbsp; Over time, bonding can discolor and break down, whereas porcelain, when done properly, does not.&nbsp; What&#39;s involved though to achieve perfection, is more communication between your dentist and the dental laboratory about size, shade, shape, and contour through photographs and provisional temporization (temporaries)&nbsp; Your dentist should complete a diagnostic wax-up to create a visual model which will allow you to perceive the final results.&nbsp; From this model, you will be able to determine if the size and shape of the teeth are right for you.&nbsp;

I wanted to know if it would look normal to get veneers strictly on my canine teeth and first bicuspids? My front four teeth look great, it&#39;s the size and shape of my other teeth that bothers me. I&#39;ve had them bonded but my tooth shade is very white and the bonding seems to look more yellow&#39;ish.

Veneers on Just Canine and First Bicuspids?

Being as young as you are, implant are a serious option for you to consider.&nbsp; When teeth are missing, your bone remodels and the appearance of your face changes.&nbsp; Dental implants help preserve facial structure, preventing bone deterioration that occurs when teeth are missing. &nbsp; Generally speaking, you can absolutely switch from dentures to dental implants.&nbsp; Let me explain this better for you though...

	First of all, you must consult with your dentist who will review your case and refer you to a specialist (either an oral surgeon or a periodontist) who will assess your medical status and the bone quality in your upper and lower jaws to see if you are a candidate for dental implants.&nbsp;

	Assuming you are a candidate, your dentist will discuss options of implant-retained removable dentures and implant-retained fixed prosthesis.&nbsp; The key words here are &quot;removable&quot; and &quot;fixed&quot;.&nbsp;

	With implant-retained removable dentures, the surgeon will place between 4-6 implants in the upper jaw and 2-4 implants in the lower jaw.&nbsp; Once the implants are stable, (about 6-12 weeks) a small locator attachment is gently placed onto the implant itself, allowing&nbsp; your dentist to reline your existing dentures and &quot;pick up&quot; the impression of the locator attachments in your mouth.&nbsp; What is created is an exact fit--kind of like a puzzle piece--and the denture is now able to snap on and off of the implants.&nbsp; As a result, the denture feels much more stable and secure.&nbsp; Your ability to speak, eat and chew are greatly increased as well.&nbsp; You still have to take the dentures out at night and clean them as you would your regular denture.&nbsp; You must also be sure to care for your dental implants and clean your mouth regularly with rinses and cotton wipes.&nbsp;

	If&nbsp; you do not want to have to deal with dentures at all, you may want to consider implant-retained fixed prostheses.&nbsp; This means that more implants must be placed in each jaw (expect about 6-8 implants per jaw). Your dentist will then make individual crowns (one tooth) or bridges (two or more teeth) to create your new smile, ensuring that form, function, comfort and esthetics are in harmony at all times.&nbsp; This prosthesis is &quot;fixed&quot; meaning that it is permanent, and only removable by your dentist.&nbsp;

	Lastly, what&#39;s important to understand, is that you do not need to go directly into &quot;fixed&quot; from conventional dentures. Often times, we will phase a patient from conventional dentures to implant-retained dentures and then finally onto a fully fixed appliance.&nbsp; This allows the finances to be spread out over a greater period of time, and also allows the patient to phase into their new treatment.&nbsp;

For about 3yrs, is it still possible for me to replace them with dental implants and it still look natural and also could bone loss be a problem. I am 34yrs old. Thank you

I Have Had Dentures, Am I A Candidate For Dental Implants?

Tracy Shaw, DMD

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Happy Patient - Miami Beach, FL

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Love Dr Shaw!

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