Why does bonding chip?

There are a number of reasons that bonding can chip and not all of them are in the control of a patient. All things being equal anterior bonding commonly chips due to point stress on the edges of anterior teeth. This can occur when patient places their teeth in an edge to edge position. This stress happens when a patient is using their anterior teeth to cut their food with their anterior teeth. When doing so they can place their teeth in an edge to edge position. Biting into something stiff(a pencil, a frozen milky way, a finger nail,a crusty french baguette) or even using your teeth to tear open a plastic bag can cause bonding to chip.

Another frequent cause for anterior bonding failures is bruxuing during the night. Patients sometimes brux by placing their teeth edge and placing repeated grinding pressure on their anterior teeth. Patients with worn anterior teeth, often are suspected anterior bruxers, and this habit can pose a problem for anterior bonding. I carefully check anterior excursions when I repair the edges of anterior teeth, but even so often patient can go into excursions at night that can cause bonding to break. To protect bonded teeth I frequently recommend having a patient wear a night guard or even a retainer that covers the edges of their anterior teeth since it has been my observation that night appliances do tend to protect bonding from the forces generated by bruxing.

Did you take any good dental continuing seminars this year?

I am currently attending a three day seminar at the Spear Institute in Scottsdale Arizona. The course is called "Demystifying Occlusion" and Dr. Spear is an excellent speaker and his presentation on this subject is thoughtful. I believe the information presented would be helpful to most dentists, regardless of their level of experience.

I have traveled here with members of my New York based Study Club and I find the conversations with my colleagues to be extremely stimulating and helpful to my continued practice of dentistry. My colleagues freely share their experiences and expertise with me and I try and do the same with them. Having time off from our regular work routine can help us focus on new material and ideas and most of us return to our practices with renewed enthusiasm for practicing dentistry.

Why do my front teeth keep chipping and getting worn?

One theory that I have heard (at a Spear Seminar on worn teeth) is that people at night place their jaws in and edge to edge position that they normally would go to during normal day time function. Often with patients with abnormal wear patterns you can get them to manipulate their jaws to a position where the lower and upper jaws fit together almost like pieces in a puzzle and it only makes sense that their own para functional night time habits are causing this pattern of wear.

The simplest solution to this problem is for patients to commit to wearing a night guard each and every night that will not allow this wear to continue. I have attempted to bond edges that are showing this type of wear, but eventually if no night guard is worn the bonding will chipp off, just like their original teeth experinece wear and chipping.

Wnen I have paitnets who do wear their night guards religiously, their bonded repairs work much better and can last a long time.

What is cone beam dental imaging?

This is a three dimensional radiographic image of the head that dentists have been making use of for treatment planning purposes. These images are similar to cat scan images but require less radiation to produce its images.
In my dental practice these scans are routinely used in order to properly treatment plan implant placements. Using a 2-D panoramic image is not as reliable as using a cone beam generated image. Maxillary and mandibular jaws may have sufficient horizontal bone to place an implant but often exhibit undercuts that will impact what size implant can be used. Also it is important to evaluate the thickness and density of the bone available for implant placement.

Endodontists are also making use of this technology to help with diagnosing failing root canals, since they allow the dentist to see cracks and perforations that might not be visible on a normal two dimensional radiograph.