Zak Kara, BDS, DPDS

It happens much more commonly than you think - your doctor probably (!) won't need it and you should pass it as normal. The sooner you can visit your dentist to protect the tooth from which the crown came off, the better. Best wishes!

Hi AC,

So long as your Periodontist has eliminated all other medical health changes which may be relevant to your gum health, inflamed gums are typically caused by plaque accumulation. This happens just slightly beneath the gum-line, which is a 'pocket' like a trough around the tooth. In your case this is along the veneer 'margin' (which glues against the tooth at the gum line).

If the veneer has cracked, there is any excess cement/ resin in the gum pocket, or plaque/ calculus has built up in that same zone, gum inflammation will be constantly present and accumulating. No matter how good your home hygiene is, that might not be enough. Professional hygiene visits are essential.

Ultimately, if the veneer is cracked it may need to be removed regardless. Then a temporary veneer (usually made of composite resin) will protect the tooth for the short term. If that resolves your gum inflammation, voila! Then you can have the a new ceramic veneer constructed.

Best wishes

Hi Joanny,

I can completely understand that you're making a big decision and doing a lot of research into the options available. 

My recommendation is not to focus on the material being used, but more on choosing an experienced dentist who uses high magnification, and can plan your new veneers using photography and (even better) a computer simulation as a blueprint. They should be able to give you 'provisional' veneers which means you can test-drive the shape and of the new ceramic ones before you commit to the manufacture of the veneers by hand.

Bear in mind that if you want the most natural look, the laboratory technician your dentist chooses to work with matters just as much if not more! Feldspathic porcelain is layered by hand and the technician can create natural characterisation, but they aren't as durable in some circumstances. e.Max is very commonly used and is more durable, but can sometimes look more opaque. Then again, I've seen wizardry with e.Max from some ceramists! 

Cerec, Vita Suprinity and Celtra aren't suitable if you want the most durable and most natural.

Ultimately, excellent dentistry is never a quick fix, but it will be worth it. Like most things in life, you'll get what you pay for. Best wishes!

Hi Kevin, I can completely understand that you think it seems 'wrong' and a lot of my patients ask similar things about dentistry which was done in the past.

Placement of implants depends on lots of things. This includes the available bone (including 3-dimensionally which it is not possible to see from a 2D x-ray, avoiding nearby structures such as your sinuses (which are connected with your airways), not to mention the soft tissue nearby and access within your mouth to place it/ space to take the silicone impression for the crown on top.

We can't see enough information from the x-ray you sent I'm afraid, but the 'tulip' shape of the crown connecting to the implant is the normal shape of an implant-crown. It does often mean that it needs more maintenance and cleaning from you - your dental hygienist will advise what to use.

Best wishes!

Hi there,

Don't panic - dentists are judgemental people, we understand. A dentist with magnification will be able to carefully remove the remaining portion of the bracket - it will probably need to be polished using abrasives. Best wishes.

Hi Myaa,

It's hard to say without knowing precisely the movements needed during these last three aligners. Attachments are often needed for some stages of treatment and not for others. Has your straightening has progressed as planned so far? If so, it's likely that teeth are 'tracking' correctly.

Refinements are still likely to be needed after these 16 trays, as for most clear aligner treatments.

Excellent results are always more likely with excellent communication - so if you've got doubts it's best to call your dental practice and arrange a sooner visit. They can likely show you and explain the Clincheck plan. Best wishes!

Having both gives you flexibility that you don't need to wear your Viveras every single night. But if you're a disciplined person and are certain you'll wear your retainers every night of the week, that's an option too. 

Certain types of tooth movements are more prone to relapse - talk to your dentist/ orthodontist and they will guide you.

Best wishes

Zak

Having veneers placed is a huge decision for you towards a confident smile - my clients tell me they feel a spring in their step they never knew existed. So I totally understand you're doing your research and you seem to be the kind of person interested in details.

If that's the case, if I were in your shoes I would research the dentist providing the treatment. Choose a cosmetically-focused dentist who uses magnification, demonstrate their previous results, can be bothered to explain that they're going to preserve as much natural healthy tooth as possible, simulate the outcome using 3D models or computer simulations beforehand, and then give you provisional veneers to 'test drive' for at least a few days.

I assure you - if they do all those things, they will choose you the right ceramic material, prescribe the right thickness so they don't look translucent (e.max is the less translucent of the most common types, by the way!), and they'll also be working with the best technicians in the country/ beyond. The artistic skill in their eyes/hands is MUCH more important than the shade of e.max, I promise you.

Hope that helps. Best wishes for an excellent result

Zak

No need to worry - if you're in the early stages (first few weeks) of braces, tenderness which seems worse on one tooth more than another is completely normal. Chances of losing a tooth through orthodontic treatment is extremely rare and usually to do with a tooth which has been previously injured in some way.

If you're worried, call your Orthodontic team for some advice and meanwhile I recommend Ibuprofen (as long as there's no medical reason you can't take it) as it's an anti-inflammatory.

Best wishes! Zak

Almost always, the answer is orthodontics first. No dentist can 100% predict or guarantee the gum position, thickness and tone around each tooth until tooth straightening has finished.

Particularly if a gum graft has been recommended due to recession (a tooth/ teeth looking longer), this may become slightly worse after orthodontics depending on the specific tooth movements needed. So it usually makes sense to do the graft once... rather than graft, straighten, and possibly have to graft again...

I'd recommend discussing with a dentist skilled in comprehensive care. Look for Kois, Spear or Pankey dentists who understand how all these things fit hand-in-hand.