436 N Roxbury Drive Suite 100, Beverly Hills, CA 90210 Call Us: (310) 276-2468
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Brian LeSage, DDS, FAGD, FAACD

Imagine yourself with an
exquisitely beautiful smile.

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My tooth is fractured beneath a new crown and needs extraction

I fractured two front teeth in 2010, and my family dentist did root canals and crowns on both teeth. As the crowns aged, I noticed them more and did not like the way my smile looked. Also, a left molar tooth was aching on and off, so I decided to see another dentist for a smile makeover.

I love the look of the smile makeover, but my left front tooth became sensitive a few months ago, and my dentist said the tooth needs extra care. She noticed a pimple on my gums and referred me to a periodontist for an exam.

My dentist prescribed antibiotics, and the periodontist confirmed that I need extraction. My dentist disagrees about the extraction and is now referring me to a periodontist. I do not want to lose my front teeth, especially after all the work and money I spent on a smile makeover. – Eiso from NV

Eiso,

Although your smile makeover looks beautiful, we wonder if your dentist took x-rays before completing it. If she took x-rays, saw the fracture, and put a crown over the tooth anyway, maybe she did not understand the potential results.

Root fracture on your left central incisor

Thank you for sending us a picture of your x-rays. Your fractured tooth does not look good.

  • Root fracture – In the middle of the tooth root, we see an old, horizontal fracture line that is likely from your original accident. The dentist who did your root canal at that time either did not see the fracture or tried to navigate through it. The necrotic (dead) soft tissue is gone, so the dentist must have removed it and hoped the tooth would heal.
  • Above the fracture – The inside of your tooth looks choppy and eaten away. Some of the root canal filling material is missing. If your gum pimple originates from that area, it suggests an infection is eating at your tooth roots. And if that is true, you will lose the tooth.

Your right central incisor

Diagram of a two dental implants - before and after crown placement

If a dentist or specialist cannot save your tooth, a dental implant is the best treatment option

Your right central incisor (front center) does not look stable either.

  • Root canal filling material – It stops several millimeters before the tooth ends. You have a new crown on the tooth, it might be best not bother the tooth unless you experience a flare-up. We do not see any signs of infection on the x-ray.

Although your dentist missed the diagnosis of your cracked tooth, you need to get it corrected. You can decide if you want an endodontist (root canal specialist) to examine your tooth and try to save it or proceed with the extraction and dental implant.

You can negotiate with your dentist on the cost of continued treatment for your left incisor because she missed the fact that it is fractured and problematic.

Best wishes for a thorough resolution.

 

Dr. Brian LeSage, a Fellow of the Academy of General Dentistry, sponsors this post.

Is it too late for an implant denture?

I have worn upper and lower removable dentures since 1998. Is it too late for an implant denture even if I have bone shrinkage? Thank you. Teri

Teri – Thank you for your inquiry. Regardless of how long you have been wearing dentures, you can still receive implant dentures. But we will explain some factors that may affect your treatment plan.

Is It Too Late for an Implant Denture?

You can get an implant denture even if you have worn removable dentures for decades. But the condition of your jawbone can affect your treatment plan.

Long-term denture wearing

Tooth roots stimulate and preserve jawbone, so when all your teeth are missing, your body uses the minerals from your jawbone and uses them elsewhere. Your jawbone will begin to shrink, and within ten to fifteen years without bone support, your facial muscles will sag. It will become challenging and uncomfortable to wear a denture.

Dental implants and bone shrinkage

An implant dentist embeds dental implants in your jawbone for support. But if your bone volume is low due to shrinkage, dental implants will not be stable. Before you receive implants, your dentist or surgeon must build up the bone or use a technique that does not require grafting if you are eligible for it.

Bone grafting for dental implants

Options for bone grafting for dental implants include harvesting bone from your body, possibly from your hip. Artificial and sterilized bone products are also available. Your implant dentist or surgeon will explain your options.

Implant overdenture

Lower implant denture

Implant denture

An implant overdenture is another name for an implant denture. The denture base snaps, clips, or screws onto dental implants. If you receive a traditional overdenture and have bone loss, you will need a graft before implant placement.

All-on-4 implants

All-on-4 uses four to six dental implants and places them at angles so that more of the implant root is in contact with the bone to increase resistance to displacement. This technique can eliminate the need for bone grafting.

Look for a dentist who is experienced in dental implant restoration or implant placement and restoration. Dentists who restore implants only work with an oral surgeon or periodontist to place your implants.

Dr. Brian LeSage, a Fellow of the Academy of General Dentistry, sponsors this post.

My dentist can’t get the color right on my implant crown

My dentist tried to adjust the color of my implant crown, but it still isn’t right. I want a uniform smile. It’s a shame that the shade of my dental flipper was closer to my tooth color than my implant crown. My dentist doesn’t think this is a big deal. What is he doing wrong? Will I damage my implant if I find a new dentist to replace the crown? – Milan from NM

Milan,

We are sorry to hear about your frustrating experience with your implant crown.

You can find an excellent cosmetic dentist to replace your crown, and it won’t damage your implant. It takes artistry, skill, and patients for a dentist to perfectly match a crown to your tooth shade. Dr. LeSage won’t bond crowns unless he achieves a perfect match.

Some cosmetic dentists use these steps to customize crown shade:

  • Send written instruction for a master ceramist that specify a basic shade
  • Draw areas where the ceramist must add specific tints
  • Try in the crown before cementing it to the tooth
  • Take a picture of the try-in if the ceramist needs to adjust the color
Before-and-after porcelain crowns photos

Dr. LeSage placed ceramic crowns on the patient’s front teeth for beautiful results

You’re probably in the wrong dental office to receive crowns that match your natural teeth. Although most dentists aren’t concerned about a high level of aesthetics, your dentist doesn’t seem to be concerned at all.

We recommend that you find a cosmetic dentist with extensive training who partners and communicates with a master ceramist to achieve the perfect shade for your crown. Your smile shouldn’t be a source of stress. Look for a dentist with credentials in the American Academy of Esthetic Dentistry or the American Academy of Cosmetic Dentistry.

 

Beverly Hills dentist Brian LeSage, DDS, FAGD, FAACD, sponsors this post. Dr. Lesage achieved fellowship status in both the American Academy of Esthetic Dentistry and the American Academy of Cosmetic Dentistry.

What are my options for a front tooth that’s turning dark?

For the past four years, I’ve seen my left lateral incisor get progressively darker. I’ve been concerned that if the tooth is dying, I’ll need an extraction and dental implant. My endodontist tested the tooth with ice and electric current and said the tooth is still alive. An x-ray shows a faint horizontal fracture. The endodontist said I can get a root canal, but it would weaken the tooth. The other option is to get some cosmetic work done to hide the dark color. What are my options for cosmetic dentistry? Thanks. Justin from Las Vegas

Justin,

Diagram of a two dental implants - before and after crown placement

If your tooth is healthy and can be saved, you won’t need a dental implant

Did the endodontist say your tooth is infected? If it isn’t infected, a root canal treatment is not necessary. Although Dr. LeSage would need to examine your tooth, it’s unlikely that it’s fractured. A fractured tooth would be dead. And root canal treatment would further weaken the tooth and make it susceptible to leaking and root canal failure. Based on what you’ve described, you’re not in danger of requiring extraction and a dental implant.

What’s Causing Your Tooth to Turn Dark?

If you’ve had trauma to your mouth in the past, it can cause a tooth to turn dark. A traumatized tooth builds a defense, or secondary dentin, that shrinks the tooth pulp, darkens the tooth, and makes it less sensitive to cold or other stimuli.

What Are Your Options for Cosmetic Dentistry?

When a tooth is turning dark, a true dental artist can use a porcelain veneer or direct composite to conceal the discoloration. This is artistic work that you shouldn’t entrust to a family or general dentist.

Color matching – Precise color-matching skills are required to match your surrounding teeth.

Conservative treatment – A cosmetic dentist is trained to make your tooth dark tooth look natural and match surrounding teeth. You won’t need bonding or veneers on multiple teeth to accomplish that.

A family or general dentist doesn’t have the training or experience to color match teeth with veneers or dental bonding. Some dentists recommend placing crowns on several front teeth. Avoid that option.

Look for a cosmetic dentist with credentials from the American Academy of Cosmetic Dentistry or the American Academy of Esthetic dentistry. You’ll receive seamless results, and you won’t be able to tell that your tooth was dark.

Brian LeSage, DDS, a cosmetic dentist in Beverly Hills, sponsors this post.

Three out of five dental implants came out on the third day!

I paid $1800 each for six dental implants to support my dentures. After they heal, I’m supposed to get two more implants. The third day after implant surgery, 3 of the 5 implants came out. Should I have to pay for three implants that came out? What should I expect from the dentist? – Samuel from Nevada

Samuel,

Successful dental implants stay in, so you shouldn’t have to pay for unsuccessful treatment. But more than that, your dentist needs to explain why three out of five implants came out. Authority Dental estimates that dental implants have a 5% failure rate that mainly results from poor surgical technique. And they fail within months or years after implant surgery—not days. But you’ve experienced a 60% failure within three days. You deserve an explanation.

Why Do Dental Implants Fail?

Dental implants can fail for a variety of reasons, but six typical culprits include:

  1. Diagnostic shortcuts and failure to accurately assess bone volume to support implants
  2. Incorrect implant placement
  3. Patient’s medical issues (less common)
  4. Poor-fitting fixtures that lead to infection
  5. Prematurely loading implants with dentures or crowns before they fuse with the jawbone
  6. Substandard implant fixtures
Diagram of a two dental implants - before and after crown placement

Dental implants must fuse with the bone to anchor dental crowns or overdentures

A few things to think about:

  • The two remaining implants – If three of five implants failed on the third day, will the remaining two last?
  • The two implants you’ll receive later – If you receive two more from the same dentist, they might be at risk of dislodging.
  • You don’t have overdentures yet – Dental implants usually fail after placing stress on them. But if yours failed without stress on them, it’s unlikely that the remaining implants would support your overdenture.

Unfortunately, you are the victim of a dental implant horror story. But what can you do about it now?

  • Ask your current dentist for copies of your dental records and diagnostic studies. He is ethically obligated to give you copies.
  • Find a dentist with expertise in dental implants who is a distance away from your current dentist to ensure they don’t know one another. Look for a dentist who partners with an oral surgeon to place implants or has fellowship status in an implantology organization.
  • Ask for a second opinion as to why the implants failed.
  • Depending on what the second opinion dentist or oral surgeon tells you, demand a refund for everything you paid your current dentist—not just the three implants that came out. If you have any difficulty from your dentist about issuing a refund, the state dental board would be interested in knowing it.
  • Don’t allow your current dentist to do any further work in your mouth. Find another trustworthy dentist to correct and complete your treatment. And be patient with the process of getting your implant overdentures done right.

 

Brian LeSage, DDS, of the Beverly Hills Institute of Dental Esthetics sponsors this post.

Three out of five dental implants came out on the third day!

“Because of your smile, you make life more beautiful.”
– Thích Nhất Hạnh

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