Thousands of Dental Photos have been created by Dr. Jeffrey Dorfman, Director of The Center for Special Dentistry®.
Cosmetic dental and Tooth Extraction. Total treatment time was about nine hours in two visits during one business week: Monday (four hours) and Friday (five hours). This patient hid his dental condition for over a decade by never smiling.
In the first row of photos, note that the bite was over-closed due to a prior history of an eating disorder, now controlled, and a current tooth grinding habit.
An Oral Surgery consultation with panoramic x-ray (second row) was performed prior to treatment to evaluate opening the bite.
The third row shows x-rays taken after the Endodontist completed eight root canals on the first day on tooth #'s: 6 - 11 and 14, 15.
The fourth row shows the lab-processed 11 unit (11 tooth) temporary bridge and the cast gold post/cores (with Kaitlyn loops) for the root canal treated teeth.
The fifth row shows the cast gold post/cores cemented.
The sixth row shows the lab-processed temporary bridge in place after teeth extractions - the oral surgeon extracted tooth #'s: 3 - 5 and 12, crown lengthening gum surgery was performed on tooth #'s: 6 - 11, and a distal wedge was performed on #15.
The patient will have a final porcelain-metal bridge made after the gums heal. Implants may also be placed in the upper right posterior. A bite plate is also necessary to try to mitigate the force of tooth grinding. Referral for pharmacological management of anxiety is also worthwhile.
Single tooth dental implant placement after Tooth Extraction of a fractured (and non-infected) lower left first premolar. How to Pictures. The lower left second premolar position already has a dental implant as well. 1) - 2). Pre-op pictures showing the fractured tooth, clinically and x-ray. 3) The tooth socket is exposed and ready for implantation of the dental implant . 4) The extracted tooth. 5) A Replace titanium threaded dental implant ready for insertion.
6) The dental implant was inserted into mandible using a slow speed handpiece.
7) Implant covered and surrounding tissue sutured using 3-0 chromic gut dissolvable sutures. 8) Post-op x-ray.
Tooth Extraction of the root of a hopeless tooth #26 and splinting the coronal portion to the adjacent teeth. 1) - 3) Initial images. 4) The wire used for the teeth splint next to a periodontal probe. The wire splint is doubled to prevent the tooth from rotating around it after placement. 5) The splint bonded to the lingual surfaces of teeth #'s 25 and 27. 6) Initial preparation - drilling - through the mid-length of the tooth. 7) Following extraction of the tooth root. 8) The extracted tooth root. This patient has already been through two rounds of scaling and root planing. After healing of this tooth extraction site she will then have an apically positioned flap periodontal gum surgery and then possibly a bone graft to build up this area. It is expected that some other method for tooth replacement will be utilized following this periodontal gum therapy.
Technique for tooth root extraction - resection - from under a porcelain fused to metal dental bridge. 1) Labial photo of an abutment tooth with an endo-perio lesion iinfection. 2) & 3) Initial preparation into porcelain with a diamond bur. 4) Labial photo showing preparation. The metal portion of the dental bridge is prepared - drilled - with a steel bur. 5) Palatal photo showing preparation. 6) Labial photo showing the tooth root under the porcelain (gutta percha is visible in the tooth root). 7) Tooth root being extracted. The occlusal height of this root must first be reduced to allow it to exit. 8) The extracted tooth root.
Cosmetic dentistry treatment of upper and lower right canines by dental extraction. The patient declined orthodontics tooth braces. The upper and lower canine teeth were extracted and the distal of the laterals and the mesial of the first premolars received teeth bonding to close the gap. The second photo is one week following tooth extraction. The dental bonding was placed before the teeth were extracted so the patient never had to show the space between her teeth. Refer to other pictures in this series.
Tooth root extraction resection from under a porcelain fused to metal teeth bridge. 1) X-ray radiograph showing the distal tooth abutment with a combined root canal and gum infection (endo-perio lesion). 2) Labial photo of the same tooth. 3) Radiograph following tooth root resection (the metal chad in the area of the extracted abutment was later removed). 4) Labial picture following teeth extraction. This area could be filled in with dental bonding after healing. The teeth bite - occlusion - on the distal cantilever was reduced. It opposed a lower full arch dental bridge so that supraeruption was not a concern. Treatment options include: i) sectioning and removal of the distal cantilever, ii) dental implants, or iii) reevaluate over time with the patient informed to reduce function in this area.
Esthetic dentistry with teeth extraction for a patient who declined dental braces orthodontics. The upper and lower canine teeth were extracted and the distal of the lateral incisor teeth and the mesial of the first premolar teeth received teeth bonding to close the space. The second photo is one week following teeth extraction. The teeth bonding was placed before the teeth were extracted so the patient never had to show the gap between her teeth. Refer to other photos in this series.
Aesthetic dentistry for a patient who refused teeth braces orthodontics and instead chose teeth extraction. These pictures focus on the lower jaw. The upper and lower canine teeth were extracted and the distal of the laterals and the mesial of the first premolars were bonded to close the tooth gap. The second photo is one week following teeth extraction. The cosmetic teeth bonding was placed before the teeth were extracted so the patient never had to show the space between her teeth. Refer to other photos in this series.
Extraction of an upper molar with severe dental caries - tooth decay cavity. 1) Initial x-ray. 2) X-ray following tooth extraction of #15 and root canal therapy on tooth #14. Note the gingival extent of the tooth decay below the gum. 3) Tooth preparation following root canal and the removal of the distal tooth decay. 4) Final tooth preparation of the composite dental crown buildup. Note how the distal tooth preparation extends gingivally beyond the composite to solid tooth.
Before and after pictures of cosmetic dental treatment and teeth extraction. The patient declined orthodontics dental braces. The upper and lower canine teeth were extracted and the distal of the laterals and the mesial of the first premolars were bonded to close the space. The second photo is one week following extraction. The teeth bonding was placed before the teeth were extracted so the patient never had to show the space between her teeth. Refer to other images in this series.
Before and after pictures showing cosmetic dentistry treatment for a patient who declined dental braces. The upper and lower fang teeth were extracted and the distal of the lateral teeth and the mesial of the first premolars were bonded to close the gap. The second photo is one week following extraction. The tooth bonding was placed before the teeth were extracted so the patient never had to show the space between her teeth. Refer to other pictures in this series.
How to build an occlusal rest in a dental crown and avoid removing a dental crown after tooth extraction. This two tooth dental bridge has an occlusal rest seat seated onto the rest preparation in the mesial of the second molar dental crown. This eliminates the need for removing the second molar dental crown. The premolar tooth did receive root canal therapy following healing of the tooth extraction site.
Extraction of a mandibular premolar tooth and tooth root resection of a molar with furcation involvement following an accident. 1) The initial x-ray showing the three teeth bridge and severe damage to the second premolar tooth. 2) The second molar tooth showing a furcation involvement - advanced gum disease - and thickening of the periodontal ligament space around the mesial tooth root. The second premolar tooth and the mesial root of the second molar tooth were extracted. 3) Intra oral photo following extraction healing. The patient was informed regarding the long span and declined dental implants. He wanted a new fixed dental bridge anyway. 4) Radiographic healing of the distal root of the second molar after six weeks. The lesson here is the value of salvaging individual tooth roots of molars.
How to pictures show wisdom tooth extraction -a lower right partial bony impacted wisdom tooth. 1) Soft tissue reflection. 2) & 3) Sectioning of the molar tooth. 4) An elevator is being used to split the molar. 5) & 6) Lower forceps and an elevator are used to extract the split tooth roots. 7) The extracted tooth in two sections. 8) Closure of the surgical site.
Surgical tooth extraction of a hopeless upper first molar. 1) Tooth #14 with extensive subgingival decay - tooth decay cavity below the gum. 2) Soft tissue elevation. 3) The tooth extraction socket. 4) The wound is sutured.
X-rays of severe periapical pathology - root canal infection abscess - around the mesial and distal roots of tooth #30 leading to extraction.
Pictures show tooth extraction of a mandibular molar tooth #30 with severe periapical pathology - tooth abscess infection around the tooth roots. 1) This x-ray shows severe periapical pathology - root canal infection - around both the mesial and distal tooth roots. 2) Buccal fenestration around the mesial root following a vertical surgical incision and flap. 3) The extracted mesial tooth root with the noted oral pathology. 4) The tooth extraction site.
Extraction of tooth #30 due to severe periapical - endodontic - oral pathology. 1) Sectioning of the mesial and distal tooth roots. 2) Removal of the mesial root. 3) & 4) The tooth extraction site.
X-rays of a failing distal tooth abutment in a one year old reconstruction. 1) Pre operative xray. 2) Following root canal, periodontal scaling and open debridement. 3) Gutta percha placed into a periodontal gum abscess one year later. 4) Following scaling, targeted antibiotics and tooth extraction. The roots of this extracted tooth were fused. This patient was scheduled for a three month recall; she did not return for eight months following her first three month recall visit. The periodontal gum abscess was readily apparent at this time. It is suggested that reconstruction patients are treated, not cured, and that they must be closely supervised. Patients need to be acutely aware of the need for frequent recall visits. It is possible that earlier diagnosis and intervention might have prevented the loss of this tooth.
How to pictures method for extracting a failing distal tooth abutment from under a porcelain fused to metal dental bridge reconstruction. 1) Upper first premolar tooth with periodontal probing to the tooth root apex. 2) Horizontal sectioning through tooth to separate it from the dental bridge. You need to reduce enough of the remaining tooth root to elevate it while under the dental bridge. 3) Tooth socket after tooth removal. 4) Extracted tooth root. The gingival surface of the newly created pontic could receive dental bonding after primary healing has occurred.
These pictures show an extracted primary canine tooth. Acute periodontal gum abscess infection around an over-retained primary baby canine tooth.
How to pictures show surgical extraction of an impacted lower wisdom tooth. Technique.
Full Mouth Oral Reconstruction - Smile Makeover:
Diagnosis: dental phobia fear anxiety
Treatment: 7 teeth extractions, 8 root canals and composite cores, full mouth scaling and then gum periodontal surgery, 19 teeth of dental bridgework over 8 teeth abutments.
When to extract a tooth. This patient presented with an old dental crown that had broken off a molar that had previously received root canal. Preparation - drilling - into the pulp chamber revealed extensive subgingival tooth decay cavity - dental caries - and furcation involvement.
One reason wisdom teeth should be extracted. In these xrays an impacted wisdom tooth damages the healthy adjacent second molar tooth. A large tooth cavity was created by the wisdom tooth growing into it. The patient did not feel tooth pain.
Treatment: Root canal and crown (the crown covers the site where decay was removed.
Before and after pictures of Full Mouth Oral Reconstruction involving teeth extractions.
Treatment: 7 extractions, 8 root canals and composite cores, full mouth scaling and root planing and then periodontal surgery, 19 teeth of dental bridgework over 8 teeth abutments.
Full Mouth Oral Rehabilitation involving Teeth Extractions on a Dental Fear patient. 20 temporary dental crowns, 14 teeth receiving root canal and 6 teeth extractions. Treatment time: one visit
Cosmetic Dental with Extraction of a Supernumerary Tooth and Dental Bonding.
Treatment time: one visit!
The supernumerary tooth was first prepared to open the interproximal area between the remaining teeth. Teeth Bonding was then placed interproximally on both teeth as if the supernumerary was already gone (this gives a clean field). Then the supernumerary tooth was then extracted.
Extracting Wisdom Teeth. The wisdom tooth is growing at an angle directly into the adjacent tooth causing a dental cavity - tooth decay.
Extract this tooth. In the xray the tooth decay can be seen extending well below the level of the bone around the tooth. This tooth decay - dental caries - can also be seen in the photo.
Multiple Teeth Extractions in a cosmetic dental sedation patient. 1) Working models and bite made right after the teeth extractions. This will serve for the fabrication of the immediate denture. 2) Intra oral picture of bite rims and bite material. 3) Extra oral photo of bite rims and bite material. The patient did not want any wire clasps to be used to retain the dental prosthesis. 4) Intra oral image view of the immediate dentures. A soft reline material was used on the gingival side of these dentures. This soft reline material was allowed to flow into the circular openings in the acrylic denture as it was seated. This soft reline material provided retention instead of using clasps. 5) & 6) Views of the upper denture with soft reline material visible. 7) & 8) Views of the lower denture with soft reline material visible. Photo #4 of 4.
Multiple Teeth Extractions in a cosmetic dental sedation patient. It is easier for a patient to emotionally adjust to a temporary prosthesis that has at least some amount of retention provided by natural tooth abutments. The teeth chosen were #6, 11, 22 and 28. The decision to fabricate a removable immediate partial denture, rather than a fixed lab-processed temporary bridge, was determined by the particular weakness of tooth #28. 1) Initial. 2) Following teeth extractions of all but the four remaining tooth abutments. 3) Working models and bite made right after the dental extractions. This will serve for the fabrication of the immediate denture. 4) Three days following the teeth extractions. 5) Intra oral photo of bite rims and bite material. 6) Extra oral photo of bite rims and bite material. The patient did not want any wire clasps to be used to retain the prosthesis. 7) Extra oral image of the immediate dentures. 8) Intra oral image of the immediate dentures. A soft reline material was used on the gingival side of these dentures. This soft reline material was allowed to flow into the circular openings (see photo #6) in the acrylic denture as it was seated. This soft reline material provided retention instead of using denture clasps. This took two visits over three days. Photo #3 of 4.
Cosmetic dental before and after pictures of a dental phobia patient that involved teeth extractions. Initial result: two visits. Photo #1 of 4.
Extraction of two impacted teeth: the upper right third molar - the wisdom tooth - and the second molar. 1) Xray shows the double teeth impaction. 2) - 6) Different views showing the large osseous defect in bone and the significant exposure of the distal furcation of the first molar. 7) - 8) Packing the defect with freeze-dried bone and gelfoam.
Surgical closure of a buccal dehiscence on an upper lateral incisor. 1) The initial presentation with the lateral incisor root exposed tooth tooth decay up to the tooth root apex. 2) Surgical exposure of the site after extraction of the tooth root. A full thickness mucoperiosteal flap with bucco-lingual vertical releasing incisions was used to obtain primary closure. The tooth socket was curetted and freeze-dried cortical bone chips were placed with Biomend membrane. 3) Primary closure was obtained with 3-0 Vicryl sutures. 4) The final result after fabrication of the porcelain-metal fixed bridge. Pictures.
Removal of a retained primary molar tooth and placement of a dental implant. 1) Intraoral photo of the retained primary molar in the second premolar position. 2) Xray of this tooth. Note that these retained primary teeth can remain in the mouth many years. This tooth was finally getting loose in this 37 year-old female. 3) Primary closure after removal of the tooth and dental implant placement. The dental implant was placed at the same time as the extraction because the extracted tooth was not infected and its removal did not leave a void in bone. 4) Initial location of the first stage dental implant four months later. 5) Occlusal view after removal of the healing screw at four months. 6) Radiograph at four months. 7) The dental implant healing collar in place. 8) X-ray of the dental implant with healing collar in place.
Mistaken tooth extraction of a second molar tooth instead of an impacted wisdom tooth - third molar - and the subsequent eruption of the third molar into the second molar position. This patient is a 27 year-old female who had recently moved to New York from Seattle. She brought prior x-rays and an interesting story involving dentistry in Seattle that I thought was worth relating. 1) In Seattle the patient was referred to an oral surgeon for the tooth extraction of #1 but #2 was mistakenly extracted instead. 2) Radiograph after extraction of #2 showing #1 still present. 3) This new, less clear Panorex was taken a year later (still in Seattle) but the wisdom tooth #1 can be seen moving down into the second molar position on its own. 4) This x-ray was the first of the series taken in our office. The wisdom tooth #1 has almost fully erupted on its own after about two and a half years. PS - the patient was billed for and did pay for the extraction of the wrong tooth.
Remove impacted wisdom teeth - third molar teeth - before they damage adjacent teeth. The lower wisdom tooth is on an angle and leaning against the second molar. This has caused big tooth decay - dental caries - in the second molar that will probably require root canal therapy and a dental crown to repair. The patient did not feel tooth pain.
How to pictures show teeth extraction of a horizontally impacted lower wisdom tooth and a second molar with a lot of tooth decay. The patient was in a lot of dental pain. 1) Pre-op x-ray. 2) Tooth #31 had a temporary dental filling in it. 3) - 4) After removal of the dental crown of #32 showing the residual empty tooth socket. 5) - 6) Minimal flap reflected to show exposure of the tooth roots of #32 with sectioning. 7) Removal of first tooth root. 8) Second tooth root brought forward in the tooth socket and ready for removal.
A hopeless tooth that should be extracted. 1) Picture of tooth #18 shows gum tissue growing into the gap previously occupied by tooth structure. 2) Xray showing extensive tooth decay extending below the level of the gum and jawbone.
A hopeless tooth that needs to be extracted. 1) X-ray shows an upper first molar with gutta percha - root canal filling material - extruded into a large radiolucent area. 2) Palatal photo of the extracted tooth shows the extent of the gutta percha extrusion. The extra fragment shown is also gutta percha. [jm-o]
These x-rays explain the reason for wisdom tooth - third 3rd molar extraction: damage to the adjacent second molar tooth. 1) - 2) Two xrays show a lower wisdom tooth impacted on an angle and pushing into the adjacent second molar causing a large tooth cavity. 3) Xray shows the wisdom tooth was removed and the second molar following root canal with the large distal tooth cavity still present. 4) Cast gold post and core and crown in place. Note the distal crown margin completely covers where the distal tooth cavity was removed.
These pictures explain why wisdom teeth - third 3rd molars - should be extracted: damage to the adjacent second molar tooth. These photos show preparation of the second molar to remove the distal dental caries after root canal was performed on it and the wisdom tooth was removed. 1) - 2) Dental caries is present in the distal area of the second molar tooth. Temporary dental filling material is visible in the occlusal opening following root canal therapy. 3) Tooth decay removed. 4) Temporary filling material removed showing gutta percha in root canal orifices prior to cast post and core preparation.
1) X-ray shows a lower wisdom tooth impacted on an angle and pushing into the adjacent second molar causing dental decay. 2) Dental decay is present in the distal area of the second molar tooth. Temporary tooth filling material is visible in the occlusal opening following root canal therapy.