We Now Offer Exparel for Oral Surgery

We are pleased to announce that we are offering Exparel for non-opioid pain relief after oral surgical procedures such as wisdom teeth extractions. We are one of only a handful of dental offices across Connecticut publicly offering this solution. Dr. Nick Calcaterra personally administers Exparel himself in our Orange, CT office.

What is Exparel?

Exparel is a medication used to provide long lasting pain relief after invasive surgical procedures such as wisdom teeth removal with IV sedation. It is a liquid medication that comes in vials. Dr. Calcaterra administers the medication directly into the surgical sites immediately upon completion of the procedure. Once administered, Exparel acts as a long lasting numbing agent, providing pain relief for up to 4 days.

Exparel non-opioid pain reliever seen in Orange, Connecticut

A box of Exparel medication that Dr. Nick Calcaterra administers after wisdom teeth surgery in our office in Orange, CT

When used along with traditional pain medications such as high dose Motrin (a.k.a. ibuprofen), our patients need reduced amounts of opioids, or in many cases do not need opioids at all.

Why Exparel?

Vicodin prescribed after oral surgery in Orange, CT

Vicodin – called hydrocodone – is typically prescribed after oral surgery

As you are likely aware, the use of opioids (a.k.a. narcotics such as Vicodin and Percocet) in the United States has created a crisis. There are many factors behind the crisis, but the end result for certain users of opioids is addiction, disability, and sometimes even death.

There is a wealth of research which shows that for many patients – typically older teenagers and young adults – their first exposure to opioids is after third molar extractions. Generally speaking, research has shown that those individuals who received narcotic prescriptions for wisdom teeth were more likely to develop addiction problems later on in life.

Given the risks associated with opioids and the crisis, Exparel was developed. Exparel has been proven in clinical studies to reduce the need for opioids following wisdom teeth removal.

Are Opioids Still Necessary for Wisdom Teeth Extractions?

Sometimes (in our opinion and experience).

Pain affects people differently. Wisdom teeth cases vary significantly in their surgical complexity and invasiveness. Our patients’ medical histories, age, and other factors also impact how much pain they will experience and what type of medications they will require afterwards.

Dr. Nick Calcaterra with Exparel for wisdom teeth extractions in Orange, Connecticut

Dr. Nick Calcaterra with Exparel he is about to administer after a wisdom teeth removal case in Orange, CT

Given the dynamic and unpredictable nature of post-surgical pain, we will re-phrase the question:

Do we still prescribe opioids after tough surgical cases? Sometimes

But we feel comfortable stating the following:

Based on our own use of Exparel on patients requiring wisdom teeth extractions, we’ve witnessed firsthand a reduction and sometimes elimination of the need for opioids.

Can Exparel Help?

The short answer is: probably.

Talk to your dentist or oral surgeon. See if they offer Exparel. See what their experiences have been. Use the internet. Learn more on our Exparel page. Read about Exparel on Reddit.

Appointment request for wisdom teeth surgery with exparel

Do you need your wisdom teeth out and want Exparel to reduce the pain afterwards? Are you looking to avoid opioids after oral surgery? Do you need IV sedation? Then you’ve come to the right place. Call us at (203) 799 – 2929 or visit this page to request an appointment.

Can a Chipped or Fractured Porcelain Crown be Repaired?

As a busy dental office, we see some variation of this quite often:

“Doc, the porcelain on my front tooth veneer chipped. Can you fix it?”

The answer is yes, but there are some limitations. But let’s first look at a successful porcelain repair case we completed in our office.

Before and After Photos of Porcelain Bridge Repair

The photo below shows a patient of ours. He had a 7 unit dental bridge that he loved – and that had been in his mouth for over twenty years. An unfortunate slip in the bathroom led to him banging his tooth on a porcelain sink (notice the irony?) which led him to fracture off a huge chunk of the ceramic on his front tooth.

The porcelain chip was large, unsightly, and very noticeable. His greatest fear was that we would have to do a brand new bridge.

Before and After photo showing porcelain repair of a chipped dental bridge

In Round 1, in Dental Bridge vs. Sink, the Sink won. In Round 2, Dr. Nick emerges victoriously over the Sink and saves his patient’s bridge! Photos and dentistry by Dr. Nicholas Calcaterra.

We utilized the highest rated porcelain repair kit on the market. Leveraging this product, along with our expertise, we produced a phenomenal result. It took us approximately 1 hour. And the best part is that our patient did not need a new bridge.

The Details on Repairing Porcelain

If you noticed from the beginning of this post, we said that we could repair porcelain, but there were exceptions.

Cosmetic porcelain crowns, bridges, and veneers are made in a variety of ways. But nearly every method requires the porcelain to go to extremely high temperatures – like over 1,000 degrees Fahrenheit! So to add porcelain to a crown in a predictable manner, you would need to put the crown into the firing oven. But that’s not possible given that there’s a person connected to the tooth!

So, the next best thing is to bond composite material to the fractured porcelain. Composites are the white material used in fillings and bonding. The challenge is that the bond from composite to porcelain is not that strong. Nevertheless, when done correctly, we can still get a good result, as you can see below:

Before and after photo porcelain fracture repair of front dental bridge

Another chipped dental bridge. You can see the underlying gold of the bridge. 45 minutes later, he walked out like the bridge was brand new! Photos and dentistry by Dr. Nicholas Calcaterra

His bridge was cemented in placed. So we bonded composite on there. Two years later, he still looks great!

How to Get a Porcelain Chip Repaired

If you have a chipped front crown, veneer, or bridge, you might just think you can call any dentist and have it taken care of. That is not always accurate for the following reasons:

  • Repairing porcelain is not an every day procedure for most dentists. So, many dentists simply do not know how to do it.
  • A dentist has to keep in stock a very specific (and expensive) porcelain repair kit. Most dentists don’t have this in stock.
  • Some larger fractures can be impossible to repair in a manner that lasts a while. In those cases, you may need to invest in a new crown, bridge, or veneer.

If you believe this is what you need, it never hurts to call and ask the dental office if they are able to do this type of procedure.

Request a consult to repair porcelain on a crown or bridge

Do you have a crown or veneer that is chipped? Interested in seeing if it can be repaired? Call us at (203) 799 – 2929 or visit this page to request an appointment.

 

An Hour and Half for a Crown?

We get lots of new patients of all ages in our office. Many need treatment while others do not. Some need fillings. Some need root canals. And some need crowns.

For those patients needing crowns, we often describe the process, which includes the fact that we sometimes schedule for an hour and a half.

“An hour and a half??

That is the response we sometimes get. Some cannot understand why it would take that long. The irony of this situation is that we are often replacing a poorly done crown that had been done in less than an hour.

A 90 Minute Crown

Let’s look at before and after photos showing a crown that took 90 minutes:

before and after photos showing a single central incisor crown

Before and after photos showing a crown on a single upper central incisor. We think the extra time was worth it. Can you tell it is a crown? Photos and dentistry Dr. Nicholas Calcaterra.

The above photo shows a crown that took 90 minutes. She had two very large fillings in her upper right central incisor that were consistently breaking every 6 months.

Why did it take 90 minutes? Here are some reasons:

  • We had to prepare the tooth very conservatively (which means we went slowly) to prevent her from needing a root canal.
  • We had to create space under the gums for the crown to go. Notice how you can’t detect where the crown meets the tooth!
  • We had to get an ideal shade match.This takes time and expertise! Notice how the shade matches the other teeth perfectly.
  • We had to make a good looking temporary crown.

Needless to say, our patient was very happy with the results. Time well spent!

45 Minute Crowns

We thought we would include photos of crowns that were not visually pleasing.

Ugly dental crowns that took only 45 minutes

We did NOT do these crowns. Both patients recalled being in the chair for less than an hour.

The crowns above are from patients who came to our office seeking treatment. They were unhappy with the appearance of their front teeth. On questioning, they both indicated that they were in the chair for less than an hour. Needless to say, when we treated them, we spent a lot of time getting things right.

Are you unhappy with your smile? Do you have a black line around your crown? Are you unhappy with the shade? We can help. Call us at (203) 799 – 2929 or visit this page to request an appointment.

From a Flipper to a New Front Tooth

One of the most frustrating things for a patient (and challenging for us as dentists) is dealing with the loss of a front tooth.

In many of those cases, our patients have to wear the dreaded flipper for several months or more. No one likes a flipper – they can break easily, you can’t chew hard foods, they don’t look natural, and you can easily lose it.

Below is our patient Kim whom we helped to ditch her flipper:

before and after photo front tooth implant

Due to a fractured tooth root and an infection, she lost her left front tooth. After months with a flipper, this is what we achieved! Photos and dentistry Dr. Nicholas Calcaterra.

Our patient had to wear her flipper for several months while waiting for the infection to resolve and for the dental implant to become stable. On more than one occasion, she misplaced it, and then had to walk around without a front tooth!

A Look at Kim’s Flipper

front tooth dental flipper for missing tooth.

Kim’s flipper – along with the tooth model from which it was made.

This is Kim’s flipper. You can see it is a single tooth attached to denture acrylic. It is fragile and can break easily. She did NOT like wearing it.

Ditching the Flipper with Dental Implants

So how did we help Kim? As we mentioned before, we saved her smile with a dental implant. See these photos for a closeup:

before/after dental implant photo

Restoring a missing a front tooth on Kim with a dental implant and crown. Photos and dentistry Dr. Nicholas Calcaterra.

As you can see above, we gave Kim her smile back using a dental implant. She is now able to talk, smile, and chew normally.

It took significant time and expertise to match the new crown to her existing smile. We think the results speak for themselves.

And what, you may ask, did Kim do with her flipper after she left our office with her new tooth? We don’t know… but the rumor on the street is that somehow a hammer was involved…

Are you missing a front tooth? Walking around with a flipper but hate it? Call us at (203) 799 -2929 or see this page if you want to come in to see how we can help.

Covid-19 Notice: We are open for all types of dental care.

We have been open for all types of dental care since May 20, 2020. Existing and new patients continue to be welcome. As always, our office exceeds the requirements recommended by the CDC, OSHA, and CT Dept of Public Health.