True Face of PFM Crown

I started to cut PFM crown which showed leak and open margin.
PFM crown shows inner metal parts. It caused lot of problem like staining or damaging gum. The metal rust and easily deformed in wet oral cavity environment and it cannot last long in wet or moisture environment by its nature.
Once PFM crown is removed, the inner tooth structure always shows damage. You can see the teeth near gum shows black caries or cavity / soft dentin. It is the neck area of teeth, it got damaged the higher chance of tooth fracture is. This patient choose to replace PFM crown by my advice even though it does not have any pain or symptom. I show him gum stain and open margin( leak ) in cervical area of Crown and he accept my advice. Luckily we can save this tooth this time and replace PFM crown with Zirconia Crown which is single material not combined material like PFM, which stands for Porcelain fused metal. I like Zirconia mono block because it is a single material, there is no seam or gap in material it self.
The damage in the tooth was extensive and the Post or inner pin in the tooth he has was not good either. I replaced alll damaged area with composite or build up material. Sometimes we use Calcium based liner or base to protect nerve of teeth from boding chemical damage.

Dental Amalgam Hazard

FDA finally announced new guideline for dental amalgam.

On September 24, 2020, the FDA provided recommendations about the use of dental amalgam, a mercury-containing dental restorative (filling) material, in certain groups of people who may be at greater risk to the potential adverse health effects of mercury exposure. These groups are as follows:

  • Pregnant women and their developing fetuses;
  • Women who are planning to become pregnant;
  • Nursing women and their newborns and infants;
  • Children, especially those younger than six years of age;
  • People with pre-existing neurological disease;
  • People with impaired kidney function; and
  • People with known heightened sensitivity (allergy) to mercury or other components of dental amalgam.

Dental amalgam is mixture of metal alloy including Copper and Mercury. The Mercury is known toxic metal for human. I have grown up in Korea next to Japan. We, Koreans all heard about “minamata disease” from Japan. The minamata disease is a neurological syndrome caused by severe mercury poisoning. Symptoms include ataxia, numbness in the hands and feet, general muscle weakness, narrowing of the field of vision and damage to hearing and speech. It happened as a public disaster in Japan at 1956. If you google it , you will see horrible pictures of it.

I ban amalgam in my practice from start. I am against of any material which I don’t like to use on me and my family, even though it is legally on sale in USA or FDA approved. I have 9 years boy. I treat all of my kid patients as my son. It is my rule from beginning.

Medi-cal allow or encourage us to use dental amalgam on kids because it is cheap to reimburse. I am against of it. I have never used amalgam on kids. If patient refuses my recommendation because of financial issue, I kindly refer them another office. However, I feel sad…. However, I don’t have proof till FDA finally change their Guideline as above.

These shows typical dental amagalm treatment with medi-cal coverage. Too many and too much….. The teeth with amalgams eventually flex and break. Once it is broken, It break so badly .. The option for that tooth is only extraction..

Dental amalgam already banned in Korea and Japan , most of Europe countries. It is a little bit late but I am glad that FDA finally support my philosopy.

Thanks for reading.

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Impacted Canine Extraction

우리 병원에 찾아 온 교정환자입니다. 눈 바로 밑에 상악견치[위송곳니가] 매복되어 있었습니다.[ 잘못나와서 뼈속에 갇혀 있는 상황입니다.] 전에 다니던 교정치과에서 다른 구강외과로 리퍼하여서 뽑으라고 하였습니다. 전에 다니던 교정치과와 여러가지 문제가 있어서 상담끝에 우리 병원으로 옮긴 환자입니다. 일단 CT를 찍어서 뽑지 않고 교정이 가능한지 알아보았습니다.

CT 촬영결과 뽑지 않고는 교정이 어려울 것으로 예상되었습니다. 환자는 전의 교정치과에 이미 상당한 교정치료비를 지불하여서 여러가지로 어려운 상황이었습니다. 저의 교정치과는 제가 치료가능한 치료는 제가 다 하는 편이어서 환자의 상황을 고려하여 그냥 우리 치과에서 뽑기로 하였습니다.

일단 안쪽 잇몸을 열고 치아의 위치를 확인하였습니다. 자 이제 발치에 들어갑니다. 제가 사랑니도 뽑고 임플란트도 심고 어느 정도 수술을 잘 한다고 생각하는 데, 웬걸 이건 꿈적도 안합니다. 할 수 없이 치아를 절단하여 뽑기로 하고 치아의 머리 부분을 절단하여 뽑았습니다.

저 뿌리 부분은 이제 눈과 아주 가까이 있어서 신중을 기해야 합니다. 차라리 안뽑고 묻는 편이 안전할 수도 있습니다. 이미 수술 전에 환자에게 상황에 따라 뿌리를 안뽑을 수도 있다고 설명했습니다. 뿌리를 조심히 조심히 움직인 결과 다행스럽게도 뽑는데 성공하였습니다. 이 경우 뿌리가 안움직일 경우 안뽑아도 무방합니다. 뿌리는 어차피 시간이 흐르면 뼈와 흡착, 흡수 되기 때문입니다.

뿌리도 다 뽑고 환자를 위해서 뼈이식도 하였습니다. 자 이제 교정만 잘 마무리 하면 됩니다. 교정은 제가 제일 잘하는 분야이니 큰 문제 없을 것 같습니다.

Whole surgery procedure was written in Korean. Here the summary is. I prefer to do all the necessary dental procedures for my orthodontic patients on my own in my clinic. Of course I do things only I am confident. My philosophy is if one doctor can treat patients or cases from start to finish , that is best. It can reduce communication errors or scheduling errors, so many small or big mistake we can face with multiple doctors or bosses. I don’t like to do dentistry or orthodontic treatment like conveyor belt or factory cookie cutter. Most masterpiece in world was made by one painter or sculptor. However I refer procedures that I am not confident. The impacted canine is not easy surgery case, I reviewed 3D x-ray and I offered my orthodontic patient for extraction in my clinic. I extracted teeth successfully.

Gap close

Gap closed with composite

This patient has 2-3mm gap between Upper front teeth. We usually recommended veneer or crown option but it cost more than simple composite fillings. Ceramic veneer and crown looks better but composite fillings can do jobs and it is better to have gap filled than nothing.

We use special matrix system called Bio-Clear to mimic the natural anatomy of teeth. As you see here, we leave some gaps on gingival side to preserve hygiene cleansing out space. If someone fill that all the way to top ; gingiva, inflammatory reaction or gingivitis may happen in the future.

비발치교정- Damon orthodontics

위의 환자는 아래 소구치가 치아 사이에 갇혀 있고 , 위에 치아가 많이 삐뚤삐뚤하였습니다. 아직 환자의 나이가 어리고 X-ray를 찍어 확인한 결과 뼈를 확장시킬 여력이 있음을 확인하였습니다.

X-ray는 환자와 의사에게 많은 정보를 제공합니다. 간혹 X-ray 촬영을 거부 하시는 분들이 있습니다. 이런 경우 저는 그냥 치료,진단을 안하는 쪽을 택합니다. 제대로 알지 못하는 진단과 치료계획을 세우느니 안하는 것이 낫다고 생각하는 쪽입니다.

저희 병원에서 사용하는 Damon 교정장치는 서서히 뼈를 또는 dental arch를 확장시키는데 유리한 장치입니다. 그래서 이 경우도 Damon brace를 사용하여 2년에 걸쳐 교정하여 좋은 결과를 얻었습니다. 처음에는 18개월 정도를 예상하고 시작하였는데 생각보다 시간이 조금 더 걸렸습니다. 위아래 치아가 물리는 정도를 완벽하게 교정하고자 조금 더 시간을 할애하였습니다.

오른쪽 사진은 치료전후의 치아를 중첩한 모습입니다. Digital 모델 두개를 최대한 근사치값을 컴퓨터로 계산하여 중첩한 모습니다. 어금니쪽은 환자의 교합을 유지하기 위하여 많이 움직이지 않은 것을 확인 할 수 있습니다. 앞니도 이동량이 2-3mm로 환자의 치아가 상하지 않는 범위내에서 움직여진 것을 확인 할 수 있습니다.

교정치료는 생각보다 많은 변수가 있고 의사의 정성과 지속적인 모니터링이 필요한 치료입니다. 치료를 결정하실 때 환자의 치아를 자신의 치아처럼 보는 선생님을 택하면 큰 문제는 없을것입니다. 오늘은 이상입니다!

Clear Aligners

Today I have clear aligner case to design. I design every case by myself, no delegating to anyone. I think I am the profession who knows my patient well and can design and fabricate best fit aligner for my patients.

We are also fabrication most of aligners in house to keep best quality.

Some of my patient is staying in South Korea and NYC but their orthodontic treatment is still going because we sent them aligners.

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Implant Surgery

Zygoma Implant

This patient had a implant placement surgery done in Mexico. Short implant may look okay for some people but in my dentist’s view, it is NOT. Sooner or later short implant will fall off and it already lost surrounding bones more than 50%.

Long one is in the SINUS which is air-filled buffer space between your mouth and brain. It is floating around it. It is like you have floating bullet around your heart or Aorta.

I know there are many dentist who is excellent outside of the States but when you plan to have a implant surgery. It is not to nail down shelf to your wall. It is NOT that simple thing. Dr. will do osteotomy to prep you bone exactly as same as implant to sit implant precisely.

I recommended patients you must decide what dentist you will go based on who he or she is, how much he cares you, NOT on price tag.