Early diagnosis… early intervention… minimally invasive dental care!
Micro dentistry is a combination of technologies which enables early detection of dental diseases and early, non-invasive treatment. Just imagine this: During your routine check up we discover a cavity so small that no major tooth damage has yet occurred. Without shots or drills we remove decay using air abrasion and place a tooth colored filling. This is possible using micro dentistry technologies. Or, imagine this: At the same appointment, we discover a filling which has fractured due to bite disease or undetectable tooth decay. This fracture is too small to see with the naked eye, and decay can not be detected by x-rays. Only by magnification can this problem be detected. Early intervention is possible, non-invasive dental care is completed. Magnification, binocular and intra-oral microscope technologies and tooth decay detection dyes have prevented the need for a crown or root canal. This is a common occurrence! Micro dentistry can also prevent pre-mature loss of teeth!
Magnification: We use binocular microscopes (16-18X), intra-oral microscopes (40X) and telescopic loupes (“binocular scopes mounted on safety glasses with fiberoptic light sources). We use these technologies before, during and after procedures.
More Accurate Than X-Rays: Micro dentistry uses magnification, lasers, fiber optics and tooth decay detection dyes to detect tooth decay. These technologies are more accurate than x-rays. Research demonstrates that x-rays and traditional instruments detect only 24% of early tooth decay.
Lasers are also used to treat gum disease. Laser energy passes through the soft tissues penetrating into areas inaccessible to traditional instruments. Lasers kill more bacteria microscopically than traditional instruments, and they do it with no damage to surrounding healthy gums.
Air abrasion technology uses a 27 micron particle beam to remove cavities without shots and without drills. Decay is “air brushed” away before it gets big enough to drill out. Air abrasion removes the least amount of tooth possible, making the smallest, most invisible fillings possible to achieve the longest lasting fillings possible. Microscopes, lasers, fiber optics and tooth decay detection dyes, detect this kind of tooth decay. X-rays cannot reveal these early stage cavities.
Intra-Oral Microscopes: Video camera and microscope technologies have combined as “intra oral cameras”. The camera is about the size of a pen. Our microscope can zoom in 18- 40X +, sending color pictures to a chair side monitor. Now you can see what the doctor sees! Microscopes reveal what the naked eye cannot see. Fillings develop micro-fractures and gaps which cause tooth decay. Only a microscope can reveal this early stage of failure. Early detection means smaller, longer lasting restorations….and teeth!
Early detection and treatment can prevent premature loss of teeth,root canals and larger, more costly restorations . Micro dentistry allows patients to see and understand what’s going on in their own mouth. Now, you can make better decisions in planning for your dental health care.
Here are some photos of what restorative micro dentistry can do for you:
*Vertical stress fractures discovered microscopically, enabling restorative care before any complications of tooth fracture occur (including tooth loss from fracture). I find fractures like this 70-80% of the time in teeth with silver fillings in them.
*To your far left and right are vertical stress fractures, and one diagonal fracture in the middle. Cracks like these are common in patients with “Bite” disease. These fracture lines are easily missed without a microscope. This tooth is at risk of fracture.
Failure to treat the underlying cause of tooth fractures (“bite” disease) may result in crown therapy or premature loss of teeth. Bite problems need to be resolved so the the crowns will not fracture as well. There is no escape from “Bite” disease. If your natural teeth fracture under stress, so will any man-made restoration.
*When this silver filling fails and is removed, a microscope can show you and your dentist how significant the crack actually is. A large number of cases like this demonstrate fracture lines that travel across the tooth beneath the filling, only visible after the filling is removed.
*To the upper right where you see the silver filling : Look at the triangular shaped “hole” in this tooth. This is a point of failure and bacterial entrance into the tooth. You can also see a hairline fracture in the silver filling (next to the “hole”). That tells me that decay is going to be found under the filling.
Check also for the tooth crack in the middle of this picture. That’s another tooth fracture which may have been missed without a microscope.The blue “dots” in the middle, reveal bite marks in the areas of fracture.
*Observe the “hairline” fracture line to your right, in the middle of this picture. Notice how the appearance of the crack is wider at the top, “spreading” in a “Y”-shape toward the top. See that? This tooth demonstrated significant internal fractures after the filling was removed. The microscope makes diagnosis and treatment simple and prevents tooth loss by early intervention. Most of the time, there are no symptoms in a case like this! By the time symptoms are present (jolts of pain to chewing pressure, often accompanied by profound, momentary cold hypersensitivity)….treatment outlook may be compromised. Early diagnosis and appropriate treatment is always highly recommended.
A) *Tongue-side view of the tooth.
This crack is obvious. Its next to a silver filling (like so many are). The crack in the middle of the picture, above the silver filling is very dark and reddish looking. The reddish color comes from dye. The crack is advanced enough and wide enough to fill up with dye!
Look at the two white arrows at the top. Can you see the faint white line? The arrows are pointing to it . This tooth is in the final stages of cusp fracture.
What that means is this: The tooth may have absolutely no pain or other symptoms
but I know it could be days or weeks away from at least 1/4 of the tooth to break off.
This information is exteremely important. That little white is the difference between a strong
treatment recommedation (because of the large dark line) and a “critical mass” urgent recommendation for anyone who wants to keep this tooth.
B) *Top view of the same tooth above.
The arrow on the top left is pointing to a subltle dark coloration (corrosion byproduct from the silver filling or tooth decay). The arrow on the upper right is pointing to another unexpected fracture line.
Note: This tooth was painful. This patient was frustrated with her dentist, who could not find anything wrong with the tooth. Thank goodness her dentist was canscientious and ethical. He/she did not perform procedures without a definitive diagnosis!
However, diagnosis was easily made using techniques of microdentistry, microscopes, dyes, fiberoptic light and transillumination, in addition to clinical tests.
*Another tooth with a vertical stress fracture (from “bite” disease)
This fracture is wide enouth to be filled with very fine debris. Cracks like this are easy to see without a microscope, but have you noticed the “Y” shaped lines at the top of this crack? Can you also see a “dark” halo around the fracture lines from the middle of this picture to the top area of the tooth? It looks like the crack is centered in a faint, dark halo in the middle of this photo (caused by tooth decay from micro leakage through the crack).
Look what happens (below) when the tooth is prepared for a crown !
*All of the enamel (the white part of teeth) has been shaved away for the crown prepatation:
The horrizontal lines are grooves made by the dental drill. The dark , black, vertical line as well as the “Y” shaped black lines at the top and botton of the vertical line, are from the crack we saw in the picture above. This crack, like most of them, was deep into the tooth. Treatment at this stage of fracture has prevented root canal therapy or extraction.
*To your left is a gold crown (thats why its shiny and yellow.)
To the right of the gold crown is a tooth with a silver filling. Both the tooth and the silver filling are cracked. The tooth crack is advanced, even more so than the silver filling.See how dark and wide the tooth crack is? Its also in the middle of a dark “halo”. An x-ray may not reveal any decay in this crack. An X-ray will not show the tooth crack either, even though its at advanced stages of fracture. Immediate treatment is indicated for this presentation.
* Early Stage Tooth Fractures
Above we have examples of how teeth frequently fracture. On the left, is a vertical fracture. Most of the time, I find these above the gumline where the microscope can zooom in. However, if the crack is starting like this one (this would be beneath a filling, in between two teeth, where visualization is not possible)…it will not be identified without symptoms, or unless the filling is removed because it has failed.
To your right is an example of an oblique fracture. This crack is going to cause the cusp to break off as soon as it gets large enough. Unless its located in a clearly visible area, even a microscope will fail to catch it early.
“Bite” disease causes these types of fractures. Silver fillings make the cracks even worse. The silver fillings are like lead fishing weights: When you hit them with a hammer, the lead weights spread out and do not pull back to the original form.
Silver fillings do the same thing. On average, humans pound their teeth together 2,000 times a day. Hitting silver fillings over time will make cracks grow larger with each impact of the bite.
If “bite” disease is treated appropriately, damage is significantly decreased whether a tooth has a filling or not!
Your teeth touch during eating, about 8 minutes a day. This is NOT what cracks teeth. Its night time clenching and grinding, generating up to 500Lbs of force, while you are asleep…..
That’s what cracks teeth!
Your dentist can treat that problem with an appropriate night time dental appliance. And by the way, you may not believe you are grinding or clenching your teeth. I hear that all the time. But your mouth tells us a lot more than you know!
Not only can I look at your teeth to realize that you grind and clench; Not only can I look at your teeth with a microscope and make that diagnosis; But I can tell whether or not you are currently and actively grinding and/or clenching teeth by looking your tongue.
*Advanced Stage Tooth Fractures
If your teeth are like this, they are at high risk of complications such as:
- A sudden, unexpected piece of tooth breaks off
- Gum infection may begin to start along the fracture lines deeper into the gums
- The teeth may become infected or the fracture may expose the nerve endings of teeth. That means either root canal and crown, or extraction and implant.
Regular microscopic examinations and early, non-invasive treatment will significantly prevent complications and sustain long term dental health.
Examinations and treatment without microdentistry techhnologies can not achieve this level of health.
*This is an example of what restorative microdentistry can do:
- On the left is a typical, but very conservative cavity preparation done by a dental drill. An early to moderate sized decay would be treated in this way .
- The red arrow is a special “micro-cavity” preparation done with a fissurotomy drill tip. An early stage decay would be appropriately prepared this way.
- The black arrows at the top of the tooth picture may look like stains. Don’t be fooled. Since 1998, I’ve been using micro-airabrasion to remove the surface organic “plugs” and then using tooth decay dye, in combination with a diagnostic laser (and fiber optic transillumination – whenever possible) to test for stain vs decay.
- Over 95% of the time this presentation is decay and requires a micro-airabrasion filling.
Sealants will absolutely not work here for this presentation. On the contrary, sealants in areas like this can eventually lead to complications, like root canal therapy!
A micro-abrasion filling as treatment for decay as pictured above (top area with black arrows):
- will remain about the same size as the brown color you seen in the photo.
- It can be done without a dental drill
- it is most commonly done without the need for local anesthetics (no injections!)
- Its comfortable, non-anxiety provoking, “air brush” silent , soft,“swishing” noise with zero vibrations and zero smell
With Restorative Microdentistry Techniques, you could have three separate, minimally invasive fillings in this tooth (above), instead of one large, invasive filling typical of traditional restorative techniques.
*A “virgin” tooth fractured through and through
(using blue dye for reveal)
I’ve seen several teeth like this in my career. A tooth which has never had a filling of any kind. A vertical stress fracture that never had symptoms until, suddenly, deep and sudden “stabbing” , “lascinating” jolts of pain occured (first and only sign of a problen).
“Bite” disease causes this, and extraction is the only treatment option.
At magnifications of 14-18X+, enamel opens up to incredible color changes within fracture lines, indicating early stage decay, microleakage (un- wanted), and deep structural damage to tooth form.
Its the only way to identify and provide meaningful early stage intervention, longevity and health for the teeth.
Its the only way to prevent traditional losses from nerve damage and breakdown of the gums and bone that support teeth. Root fractures attract pathogenic (disease causing) bacteria. Those colonies are the culprits that destroy supporting structures of the teeth.
Good diagnosis using microdentistry technique always includes traditional assessment of other signs of pathology, like:
- age of the patient
- evidence of wear facets (patterns of tooth wear)
- other signs and symptoms of clenching or grinding
- “hot spots”, bite marks located on the tooth or restoration cracks
Type one fractures LOW RISK: straight, vertical fracture lines that do NOT open up or widen toward biting surfaces (occlusal surfaces). No restorations associated with findings. ff
Treatment: No treatment. Ongoing surveillance. Localized bite adjustments to remove or lighten bite forces. Protective splints (normally, night time orthotics or mouth guards)
Treatment: Preventive measures, same as type one fractures. Restore any defective restorations possibly associated with fractured locations.
Type three fractures HIGH RISK: Underlying pathology is expected. Diagonal “Y” shaped or horrizontal cracks, branching off from vertical fracture lines or corners and edges of restorations. Cracks that narrow as the approach the gingiva. Cracks harboring debris. Pairs of cracks that outline an area are “hot beds” for structural or bacterial damage. Fracture lines in the center of brown, gray, white or dark halos.
Treatment: Remove restorations associated with any fracture lines. Remove any caries. Protect incomplete fractures from bite forces. Restore as needed to stabilize.
Dr Thomas Tinney 916-683-7222 7915 Laguna Blvd. Suite 105 Elk Grove, CA 95758
* Photos from, “Definitive Diagnosis of Early Enamel and Dentinal Cracks Based on Microscopic Evaluation”, by David J Clark, DDS, Cherilyn G. Sheets,DDS, Jacinthe M. Paquette, DDS