Fixing White Spots after Braces with Bonding

We see many patients in our office who did not take care of their teeth when braces were on. Before the braces went on, their teeth were fine. Two years later, the braces come off, and everyone collectively winces and says “Oh my!”

White spots, brown spots, and decay can all result from a lack of proper hygiene during orthodontic treatment. Many cases need to be fixed with dental bonding.

Before and After Photos of White Spot Correction

Below are photos showing how we fixed a rather severe case:

Before and After photos showing fixing white spots with bonding

This young woman from Orange did not take care of her teeth when her braces were on.  We fixed it with bonding. Note the orange tongue ring – which we told her not to wear. Photos and dentistry Dr. Nicholas Calcaterra.

In the above photo, you can see both banded white spots as well as brown spots. All are characteristic of poor hygiene during orthodontic treatment. Her case was so severe that correction with MI Paste was not an option. This was completed over two visits with dental bonding and she was ecstatic!

Note the orange tongue ring… which we told her not to wear. Oh well… we can’t win every battle!

White Spots and Decay Already Forming

We thought we would post this photo to show what poor hygiene can look like:

Not brushing with braces on leads to white spots

His teeth were perfectly white before the braces went on. We counseled him and his parents immediately. His orthodontist was aware of this.

Notice the white spots, the brown areas, the inflamed gums, and the actual cavity forming? With a lot of hard work, we were able to turn the ship around. But his teeth were perfect before the braces went on.

We’d Love to do Bonding… Not!

We are always up for the challenge of fixing a patient’s smile after braces. We have dozens of before and after photos we could post. But what we love even more is watching the braces come off and not having to do a darn thing!

So, let’s avoid the need for bonding, correction with MI Paste, and veneers… just take care of your teeth when the braces are on and you’ll be all set!

Bye Bye Peg Lateral!

Every so often, we see peg laterals in our office in Orange. A peg lateral is an upper lateral incisor (the teeth directly next to your two front teeth) that has a peg shape. Since these teeth are very visible when you smile, our patients frequently want us to fix the appearance. Let’s look at a recent case we did using bonding:

Before and after photo fixing peg laterail incisor with bonding

Before and after photo showing how we fixed a right peg lateral incisor with bonding. Dentistry and photos by Dr. Nicholas Calcaterra

The above patient is a 17 year old Amity High School junior who just completed orthodontics. We coordinated the efforts with his orthodontist (Dr. Phil Caporusso) so that when the braces came off, we got to work. We used bonding and gave him a new look in a little less than an hour!

How Peg Laterals can be Fixed

The appearance of a peg lateral can be addressed in two basic ways.

  1. Porcelain Veneers – with veneers, a thin piece of cosmetic porcelain is placed over the front surface of the tooth. Veneers last longer than bonding and will always look better. The downside is that they are much more expensive and require 2 visits to complete.
  2. Bonding – in bonding, white filling material is placed over the tooth and then polished. Bonding is done in one visit and is less expensive than veeners. The downside is that bonding will not last as long and typically does not look quite as good (although with expertise you can get a very natural result as seen above).

We always discuss your particular case with you prior to making a recommendation for which option (veneers vs. bonding).

Peg Lateral Trivia

Some interesting tidbits we’ve learned from fixing dozens of these teeth over the years:

  • The overall prevalence in the general population is 1.8%. That may seem high. But then again, most patients have these repaired so you can’t tell. If the above patient smiled at you do you think you could tell? We didn’t think so.
  • In cases of single peg laterals, the left side is twice as common as the right. So our patient was a unique one!
  • Women are 1.35 times more likely than men to have one or both teeth affected.

The above data were compiled from this research study.

Do you have a peg lateral that you would like us to evaluate? If so call us at (203) 799 – 2929 or visit this page. And remember, don’t try fit these pegs into a round hole!


Hockey Pucks Don’t Scare Us

It was just a routine day at the office for us. But not for our patient John. A senior at Amity High School in Woodbridge, John took a hockey puck to his front tooth! At first glance, it looked like a case of “man vs. hockey puck with the puck winning!” When John showed up at our office in Orange nearly 1 hour later, we collectively said “Not so fast Mr. Puck!”

Hockey Puck damage to front tooth before and after photos of dental work

Our patient John was cheerful but obviously distressed when he came in. We ultimately got him back to normal!

The photo above shows before and after shots of John. How did we do it? Did we mention that it was the Senior Prom in 36 hours?

Due to the extent of the fracture and the pain, we had to do an immediate root canal. Upon completion of that procedure, we did bonding to give John something to smile for the Prom. It worked.

For a fracture of this size, bonding is not the best long term solution. Cases like these require crowns. So, we prepared the tooth for an all ceramic crown. We did custom shading of the porcelain so it would match his other tooth completely. We were also able to close the gap slightly between his two front teeth. See a closeup below:

Before and after photo front teeth and hockey puck dentist with crown

Before and after photos. We did an all porcelain crown. Even at this closeup, there is no way you can tell it is a crown! Photos and dentistry by Dr. Nicholas Calcaterra.

John is now a student at UConn in Storrs and is very happy with his new tooth! And he is careful of hockey pucks. See you at your next cleaning John!

Beat the Black Triangle with Bonding!

Many of our patients come to us with the dreaded black triangle! Our experience in our Orange, CT dental office is consistent with the published research: approximately one third of all adults have unaesthetic black triangles. Before we discuss the details of this, let’s look at before and after photos of a case we just completed:

Before and After Photos of Black Triangle Correction

Before and after photo of dental black triangle being fixed with bonding

Black Triangle correction using dental bonding. The results speak for themselves! Case and photos by Dr. Nicholas Calcaterra. Clicking on the photo will show an even larger version.

The patient above is a middle aged female in our practice. She was very self-conscious about her smile. She stated that for family photos, she would put her tongue behind her front teeth so that the black hole would not be visible.

We discussed her options at length. While porcelain veneers could have achieved an even better result, we collectively felt that option was overkill (too invasive and too costly). So we decided on bonding. We were able to achieve the above result in one hour and she left a changed woman!

Here is a photo from farther away:

Before and after picture of dental bonding to eliminate black triangle

Another view. Photo Dr. Nicholas Calcaterra

About Black Triangles

The term black triangle is more slang than anything else. The technical term is an open gingival embrasure. An open gingival embrasure can lead to multiple issues, including:

  • Esthetic concerns.
  • Greater likelihood of decay – because food is more likely to be chronically trapped there.
  • Speech issues – air can escape through the gap(s) while speaking which can affect the pronunciation of certain sounds.
  • Ejection of saliva while speaking – we’ve seen this happen on a couple of times but several patients have asked us to fix their embrasures over this very issue.
  • And others.

Remember that not all open embrasures need treatment. And if you don’t want to treat them, that’s fine too! We’re very low key and we do not push treatment. However, we have helped many patients address these with either bonding, porcelain veneers, or all ceramic crowns with great results. Just ask our patient above! Contact us if you would like a consultation.