Patient with New Smile

Sartain Temps (1 of 1)

Post op photo of new crowns by Dr. Guldbek

Sartain Temps (1 of 1)-2

Pre-op photo of patient with previous crowns

 

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CAPT Brian Guldbek Assumes Command of the 4th Dental Battalion

On Dec 8, 2013 CAPT Brian Guldbek assumed command of the 4th Dental Battalion, 4th Marine Logistics Group, Marine Force Reserve.  The primary mission of Marine Corps dentistry is to ensure the dental readiness and optimize the dental health of Marine forces.  In an operational environment, dental will provide emergency dental care and, when the mission allows, provide essential non-emergency care to include:  providing dental treatment as far forward as required to eliminate or reduce the effect of dental disease and injury on mission accomplishment, preventing oral disease, and promoting dental heath.  The field dental care system maintains the dental readiness of the deployed force by preventing and treating dental disease and injury.  To accomplish this, dental support is based on a task-organized, flexible structure that responds to rapidly changing conditions across the continuum of missions to provide the required level of dental care.  This task-organized support is based on the size of the unit supported, length of deployment, mission (MOOTW, low intensity conflict, war), and other dental support requirements.

 

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Not All Impressions Are Created Equal

Take a look at the following video of a dental impression for a three unit bridge sent to a prominent national dental lab by another dentist.

 Click on link below to start video…(takes a few seconds to start)

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Still photo from video of bad impression

 

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Another still photo from video of bad impression

 

 

As I have said many times before, attention to detail is critical in dentistry. This  is never more true than with final impressions for a crown or bridge.

Brian Guldbek DDS  Impression

Single Tooth Impression By Brian R. Guldbek, D.D.S.

This is a photo of one of my  impressions for a single crown.   Notice that the flow material discussed in the video completely covers the entire arch. The cuff around the prep is fully distinguishable and continuous.

Taking extra steps to ensure we capture a perfect impression to assure success in the case. From previous blogs you know that I never take impressions the same day I prep the teeth. I spend time fabricating a provisional restoration at the prep appointment  which allows the tissue to heal so when we impress the preps the tissue is healthy, doesnt bleed and I am in control of the entire process. I always take full arch impressions and opposing full arch impressions to provide the lab all the information they need to guarantee success.

 

 

 

 

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Congratulations to Dr. Guldbek on his promotion to Navy Captain

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Captain Guldbek, Captain Miller and Admiral Harr

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Captain guldbek, Kathy Guldbek and Admiral Select Coe

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Marine Coprs Museum, Quantico, VA

 

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Kathys’ 60th Surprise Birthday Party

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Surprise!!!!!!

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Good Friends and Family

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Brian and Kathy

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Good Crowns Vs Bad Crowns …..What to Look For

 

Dentistry is both a science and an art.  A good dentist must have the skills and attention to details in order to deliver a quality restoration. This is never more true than when it comes to crowns and bridges. Here are some guidelines as to what makes a good crown vs a bad crown.

 Qualities of a Good Crown:

  • Perfect fit at the margins and to the adjacent teeth
  • Proper emergence profile of the crown from the gum line
  • Excellent contact between the neighboring teeth
  • Excellent occlusion, i.e the fir of the crown to the opposing teeth
  • Excellent color to match natural teeth

Qualities of a Bad Crown:

  • Poor fit- this results in recurrent decay, sensitivity and ultimate failure of the crown
  • Over contoured crown- this results in inflammation of the gum tissue, gum disease and movement of the crown by muscle forces
  • No contact between the adjacent teeth-results in movement and tipping of the crown
  • Poor color and not natural looking

  Examples of Good Crowns

Good Crown

Excellent Esthetics

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Proper Shape and Contour

 

 

Proper Contact and Contour

Excellent Crown Interior

 

Examples of Bad Crowns

Bad Crown

Overcontoured Tooth

Bad Crown

Unnatural Contours and Occlusion

      

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Poor Esthetics

   

 

 

 

 

 

Bad Crown

Poor Color and Contour

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Now you know what a good crown should look like and how it should fit to the tooth.   A good crown requires a high degree of skill and attention to details which creates the correct outcome.

 

 

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Happy Anniversary

Happy Anniversary to Dr. and Mrs Guldbek…9 Years!

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Fleet Marine Force Oral Board

Dr. Guldbek  will be serving as a board examiner on the Marine Forces Reserve Surgeons  FMFQO Oral Board this Thursday in New Orleans. CDR Guldbek earned his FMFQO in October 2011.

The Fleet Marine Force (FMF) Qualified Officer Insignia is earned by Navy officers assigned to the Fleet Marine Forces of the U.S. Marine Corps who have successfully completed the necessary requirements including serving for one year in a Marine Corps command, completing a written test, passing the Marine PFT, and an oral board conducted by FMF qualified officers. The FMF Qualified Officer Insignia is most commonly earned by staff officers in the medical fields.

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FMFQO Device

The FMFQO insignia is a metal device depicting the eagle, globe and anchor (EGA) atop two crossed rifles on a background of ocean swells breaking on a sandy beach atop a scroll with the words “Fleet Marine Force.”

The EGA makes a clear statement that the wearer is a member of the Navy/Marine Corps team. The crossed rifles symbolize the rifleman ethic of the Marine Corps; every Marine is a rifleman, just as every Sailor is a firefighter and damagecontrolman aboard ship and submarine. The surf and sand represent the “littoral zone,” the coastal regions where Sailors have served alongside Marines as they earned their reputation and world’s respect — “the shores of Tripoli” and the “sands of Iwo Jima.

 

By: Brian R Guldbek D.D.S.

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“Would You Want This In Your Mouth”

 

If you remember in an earlier blog I stated that 80% of all dental impressions sent to labs are inferior and/or inadequate. In a continuing series I will be presenting real cases sent to dental labs by other dentists to help educate patients so they can make informed decisions concerning their dental health.

I have talked about why I don’t take impressions the same day I prep teeth because I want to be in control when I take the impression. I also take full arch impressions even for single crowns because I can properly articulate the opposing model and capture function. Unfortunately to save time and money, most dentists use “Triple Trays” which capture only 1/3 to 1/2 of the dental arch, are very flimsy and provide no functional movements. These Triple Trays in my opinion are sub optimal for quality dentistry and are only convienent and less costly for the dentist using them.  Most crown fees within a geographic area are very similar regardless of the dentist, materials and lab that they use. Why wouldnt you go to a dentist that pays attention to the details, uses the best materials and lab?

CASE 1 

Impression 2 orange

Triple Tray Impression

This was a triple tray impression sent to a lab for a single crown. The light body syringable material is not even properly set.  Margins of the prepared tooth are indistinguishable.

 Here is the impression poured in dental stone that the lab will use to fabricate the crown.

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Model of Prep

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Close up of Model

Notice the orange unset impression material  and bubbles on the model. I cant see one margin that the lab needs to finish the new crown.

Would you want your crown made from this impression?

 

 

By: Brian R. Guldbek, D.D.S.

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Extraction and Bone Graft #9

Part IV contd of My Dental Journey

Yesterday I spent two hours with Dr. David McClenahan at North Shore Periodontics in Libertyville (http://www.northsuburbanperio.com) to remove #9 and place a bone graft in preparation for an implant.

All I can say is WOW. Despite the fact that I was loosing my front tooth, Dr. Mclenahan and his assistant made me feel comfortable and put me at ease from beginning to end. I can honestly say that I felt absolutely nothing, even Dr. McClenahans shot technique was remakable. As the procedure progressed Dr. McClenahan explained everything and the final result was more than I could have hoped for. I have had zero post op pain and I mean zero!

I truly believe that personal relationships between a doctor and patient are the cornerstone in the healthcare setting. This sets the stage for the patient to be comfortable and feel well cared for which leads to the best outcome. I said at the beginning of these blogs that “I wish I could go to me because I wanted to feel comfortable and cared for but now I can honestly say that “I’m glad I went to Dr. McClenahan”.

Thank you  Dr. McClenahan and his entire staff for taking such good care of me.

 

 

By: Brian R. Guldbek, D.D.S.

 

 

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My Upcoming Extraction…..

Part IV of My Dental Journey

Wednesday May 8 I will have my front tooth extracted and a bone graft placed by Dr. David McClenahan in Libertyville.  There will be an eight week healing period of the graft before the implant can be placed. The plan is to  temporarily bond the extracted crown of #9 by Dr. Mclenahan in the extraction site to serve as an ovate pontic to shape the bone and tissue during the healing process. I will have a flipper with a denture tooth made just in case the bonding does’nt hold for the full eight weeks. Cant be seeing patients with no front tooth!!

Keep you posted on how the appointment goes!

 

 

By: Brian R. Guldbek, D.D.S.

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2100 Year Old Egyptian Mummy..And You Thought You Had Dental Problems

Researchers using Computerized Tomography Scans on the head of a 2100 year old Egyptian Mummy were stunned to see the level of dental problems as well as unique treatment for a seriously decayed molar.  The scans show evidence of  severe wear ( due to diet), severe cavities and a sinus infection due to multiple abscessed teeth.

Dentistry was common in ancient Egypt but the use of medicated linen in this case has led researchers to believe there was the existence of Dental Specialists practicing interventional medicine.

They determined that this was a wealthy young man in his 20s or early 30′s but could not determine a cause of death. Experts say the pain the man suffered would have been excruciating and would have posed a serious health risk. There is another account of a mummified Pharaoh whose cause of death was determined to be from a septicemia caused by a seriously infected molar.

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Panorex showing severe decay

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CT Scan

 

By Brian R. Guldbek, D.D.S.

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Why I Dont Take Impressions the Same Day I Do a Crown Prep

Many of patients ask me why I dont take the final impression for a crown or bridge the same day as I prepare the tooth or teeth. They invariably say “My previous dentist did everything at the same appointment, why do I have to come back and get numbed again and spend another hour in the dental chair?”

Fair question and here’s my answer:

Its all about control of the process, provisionalization, accuracy and final fit of the restoration. We have already talked out provisionalization and why I feel thats important (Click here for blog on provisionalization) and why I spend more time on the provisional restoration so tooth position is maintained and the gum tissue around the prep heals and is healthy prior to taking the impression. Most dentists who take their impressions the same day as they prep are invariably fighting bleeding and sulcus fluid which compromises the accuracy of the impression.  It has been estimated that 80-85% of all dental impressions sent to dental laboratories are inadequate for various reasons.

I would rather control the process by taking a little extra time and effort to assure that when I take my final impressions the field is dry and the tissue is healthy so when I pack my cord I get  perfect tissue retraction and a subsequent 100% accurate impression and permanent crown back from the lab.

 

By: Brian Guldbek, D.D.S.

 

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Dental Visit with Dr. David Newkirk in Naperville

Part III of My Dental Journey

I had my comprehensive patient visit with Dr. David Newkirk in Naperville yesterday  to discuss the restorative options for my fractured front tooth.  He provided a very thorough exam as well as taking extensive intra and extra-oral photos so that we could sit down and discuss  the case.  His entire staff was very  friendly,  accomodating and made me feel comfortable. 

Treatment planning was complicated because  the periodontist felt an immediate implant was not indicated and that a bone graft was needed , so we needed to decide how we would temporize #9 during the 8 week healing period after the bone graft was placed.  In the end, we decided that we would restore four of my front teeth with two crowns and two veneers  to re-create harmony in my smile.

Next up, Dr. Newkirk will prepare #8 for a crown and fabricate a splinted lab processed provisional restoration for #8 and an ovate pontic for #9  to facilitate bone and tissue contours for the implant. I’m so glad I wont have to wear a flipper with a tooth for 8 weeks!!

Thanks Dr. Newkirk

By: Brian R Guldbek, D.D.S.

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My New Assistant

Am I getting older or are they getting younger?

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Young Vince Lombardo helping me with his Dad, Mark Lombardo

 

 

By: brian R. Guldbek, D.D.S.

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Implant Consultation

Part II Of My Dental Journey

Last week I had my implant consultation with Dr. David McClenahan at North Shore Periodontics in Libertyville. Initial treatment plan was for an immediate implant after extraction of my fractured front tooth. This way I could have a temporary placed the same day as the surgery ( dont want to walk around without a front tooth). However, because the tooth is rotated  the bone is very thin in front and Dr. McClenahan was concerned that there was  insufficient bone to place an immediate implant. He wants to place a bone graft  into the extraction site and let it heal approximately 8 weeks prior to placement of the implant.

This unfortunately complicates the temporization of the missing tooth during the 8 week healing period. So its off to Dr. David Newkirk in Naperville in two weeks to decide our course of action.  Stay tuned!

 

 

By: Brian R. Guldbek, D.D.S.

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I Wish I Could Go to Me!

Even dentists need dental care. Last august, I fell 10 feet from an extension ladder (really, the ladder fell and I went with it) while painting my garage. I know, I’ve heard it a thousand times, you can afford to hire someone, but I was taught by my father that if you can do something for yourself, you should. Enough of that!

I thought it would be beneficial ( both to my patients as well as myself ) to share my dental experience as I go through removing my front tooth and having an implant placed. As you can see from this photo, tooth #9 was completely fractured off.

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Three days after the fall

 

 

 

 

 

 

 

 

Luckily , the day that this picture was taken, my brother in law Don said, lets go and see if we can find your tooth.  We unfolded the beige tarp that I had under the ladder and despite the beige paint all over the tarp I immediately spotted my tooth as if I had a cosmic connection to it.

I saw the dentist , Dr. David Newkirk in Naperville, several days later and he determined that the tooth was non- restorable and that  an implant was indicated. Luckily he was able to temporarily bond my tooth back in place. Thanks Don and Dave!

Next stop, the periodontist. Dr. David McClenahan in Libertyville  for an Implant Consult.

 

By: Brian R. Guldbek, D.D.S.

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ALLERGY TO LATEX

Latex Gloves

Latex Gloves

   Natural rubber latex is a common ingredient found in many consumer products, such as balloons, balls, appliance cords, hoses, hot water bottles, pacifiers, swimwear, toys, tires, condoms, rubber bands and shoes. Latex also can be found in many medical or dental supplies and devices, such as masks, gloves, syringes, catheters, dressings, tape and bandages.??Unlike some consumer goods made from synthetic (manmade) latex, such as house paint, natural rubber latex is derived from a milky substance found in rubber trees (Hevea brasiliensis).??While many people come in safe contact with latex-containing products every day, some susceptible individuals have developed hypersensitivity to proteins derived from natural rubber latex, which can cause allergic reactions.

 

 

By: Brian R. Guldbek, D.D.S.

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Provisonal Restorations Part 2

We discussed in Part 1 the difference between a temporary crown and a provisional restoration. In Part 2 we will go through the actual lab phase of how we fabricate a provional restoration.

Step 1

We take a pre-op impression of the tooth/teeth we are going to prpare for a crown. Here is a picture of the patient before treatment.

 bing preop

 Step 2

 In the lab we pour up a silicone model of the pre-op impression

Silicone Model

Silicone Model

 Step 3

A wax up of the broken or misaligned teeth on the preop model  is made to the size, shape and contour that we want to achieve. Then we make a putty matrix of the altered cast.

Wax up of Pre-op model

Wax up of Pre-op model

Putty Matrix

Putty Matrix

Step 4

A self cure composite is flowed into the putty matrix and the indexed silicone model is inserted and removed after material has set.

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Putty matrix with model and composite material

Provisional immediately after removal from matrix

Provisional immediately after removal from matrix

  

Step 5

After trimming , finishing and polishing the provisional restoration is ready to be delivered to the patient.

Provisional Restoration

Provisional Restoration

 

 

By: Brian R. Guldbek, D.D.S.

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4 e.max all ceramic crowns

We delivered 4 e.max all ceramic crowns for our patient today.

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4 emax crowns

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Full Face photo of 4 emax crowns

Two photos immediately after cementation.

 

 

 

 

 

Check out the before photos on our main website www.libertyviledentistry.com under the current cases tab

 

By: Brian R. Guldbek, D.D.S.

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Diastema Closure

This is a recent case of a patient who was dissatified with the large space between her front teeth. Despite the challenges of a large space and alreday wide teeth, we achieved an excellent result. This was achieved with Direct Composite Bonding.

diastema preop

Pre-op Photo of Diastema

Diastema Postop

Post -Op Photo with Closure

 

By: Brian R. Guldbek, D.D.S.

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E-Max Lower Anterior Crowns

This was a case of crowded lower anterior teeth which many of my patients complain about after years after orthodontics. There are of course many treatment options to correct the crowding but in this case it was decided that a restorative route was the best solution. As you can see the esthetics of the Emax crowns are outstanding but what is even more important is the proper contour, shape, alignment and fit which we have achieved.

Emax Crowns

Emax Crowns

 

 

By: Brian R. Guldbek, D.D.S.

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All Ceramic Crowns

IPS e.max has become the industry standard material for metal-free, all-ceramic restorations.  IPS e.max provides unmatched strength (360 – 400 MPa flexural strength) and versatility.   Here at Heritage Dental we use e.max as the primary ceramic material for our layered crowns, pressed monolithic crowns, veneers, and inlay / onlays. These crowns are extrememly strong and esthetic. Take a look at a recently cemented e.max crown we did for one of our patients.

                                      EMax Crown

 

 

 

 

 

By: Brian R. Guldbek, D.D.S.

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Where Does Your Dentist Get Their Crowns From?

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    Dental Work Made in China Might Contain Lead

    When Faye Lewis became concerned about her painful new bridgework, she had it checked out and received some disturbing news: Her bridge was manufactured in China and tainted with lead.

More dentists are using crowns and bridges made in China. According to the United State Customs Office, the number of dental products coming into the United States from China has doubled in the last year.

An investigation by ABC News affiliate WJLA-TV found that at least some of those dental products contain lead.

 

At Heritage Dental all of our Crowns and Bridges are fabricated at Bayview Dental Laboratory in Virgina.

Check them out at   Bayview Dental Lab

 

 

By: Brian R. Guldbek, D.D.S.

 

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Provisional Restorations Vs Temporary Crowns

Part I

Have you ever had a crown prep by a dentist only to have a temporary crown placed that doesnt fit and looks like the original broken down crown? And for the next two weeks you complain that the temporary constantly falls off and the tooth is sensitive?

Many dentists look at temporary crowns as just that: Temporary.  Hey, why should I spend a lot of chairtime  on a temporary that I will throw away in two weeks.

I have a completely different approach to providing  coverage to a crown prep:  Provisional Restorations

As the name doesn’t imply, there is nothing temporary about the restoration. As a matter of fact, provisional restorations  provide important functions which ensure the success of the final restoration. The provisional restoration provides thermal protection, positional protection and restores form and function to the tooth while the permanent crown is fabricated. It should look and feel as good as the permanent crown and provisional restorations facilitate an easy delivery of the final restoration.

In Part II,  I will show you how I fabricate a provisonal restoration in the lab and not in the patients mouth and why this is a superior treatment approach.

 

By: Brian R. Guldbek, D.D.S.

 

 

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Interesting Dental Facts in the Animal World

*  The  mouth of a snail is no larger than the head of a pin, but it can have over 25,000 teeth!  

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  * The Elephant grinds down its molars and grows new ones. This happens six times in its lifetime!

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* The elephant’s molar is about 7″ square!!!

 

 

 

* The Blue Whale is the largest mammal on earth, but it eats only tiny shrimp because it has no teeth!

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By: Brian R. Guldbek, D.D.S.

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Singing Dentist

For all of my patients who have complained about my singing during treatment I would like to share this from the American Dental Association:

Have you ever wished that your dentist would turn up the music while he/she is drilling your tooth? The American Dental Association recommends that patients listen to music in the dentists office as a form of distraction. A combination of music and an anesthetic during dental procedures can reduce the patients blood pressure and pulse rate more than an anesthetic alone. It has also been noted that patients who listen to music at the dentist office tend to have lower levels of stress-related hormones. Many dentists are aware of this anxiety-reliever and provide their patients with headphones.

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By: Brian R. Guldbek, D.D.S.

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Toothpaste

Did you know that the toothpaste we use today used to be very different. Ashes, chalk, charcoal, honeyand lemon juice have all been used as a cleaner for the teeth. Over the ages people have even tried things that are dried and rough, such as crushed egg shells and parts of animal hooves to clean their teeth. A form of minty cream used to clean the teeth was first invented at the beginning of the 20th century.

eggshells

Eggshells

Charcoal

Charcoal

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Thank Goodness for Toothpaste!

 

 

 

 

 

 

 

 

By: Brian R. Guldbek, D.D.S.

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Remember….Floss is Boss

 

 

By: Brian R. Guldbek, D.D.S.

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Proper Nutrition and Dental Health

 Sugars from soft drinks and non-nutritional foods combine with the bacteria in our mouths which produces acids that can attack the enamel of your teeth. This can lead to cavities and periodontal disease. Limiting the amount of colas and foods that are high in sugar will  help maintain good dental and general health.

Limit Your Intake of Soft Drinks

 

By: Brian R. Guldbek, D.D.S.

Eat More Fruits and Vegetables!

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CDR Brian Guldbek is Awarded Meritorious Service Medal

On Dec 08, 2012 CDR Brian Guldbek, Dental Corps, United States Navy was awarded the Meritorious Service Medal by BGEN Machut, Commanding General, 4th Marine Logistics Group, Marine Forces Reserve.  This award was for meritorious service as Company Commander, Surgical Company Alpha, 4th Medical Battallion from Dec 2008 through Nov 2011.

 

Brigadier General Machut and CDR Guldbek

 

By: Brian R. Guldbek, D.D.S.

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Press Release: Out of the approximately 158,000 dentists in the United States of America, 26 graduated as Scholars of The Dawson Academy. These dentists were awarded with the Concept of Complete Dentistry Award, which recognizes their commitment to learning.

Brian R. Guldbek, D.D.S. Trained at the Dawson Academy

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Heritage Dental Group and XSport Fitness

Heritage Dental Group is pleased to announce our offical partnership with XSport Fitness in Libertyville. We are pleased to have been selected as the exclusive dental partner with XSport in Lake County. Check back soon for specials and opportunities.

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American Dental Association: Dental X-rays Should be Used Sparingly To Reduce Radiation Risk – American Dental Association – ADA.org

HDG Patients: Many of you have recently seen the article in Journal Cancer in which the study stated that “dental X-rays double the risk of brain cancer”. I would like to take this opportunity to provide amplifying remarks to the study and outline all of the improvements in current x-ray technology. Additionally, you will find the link to the ADA’s press release at the beginning of this blog.

1. Patients contacted for this study were asked to remember the number of X-rays that they have had over their lifetime. This method is known to result in what is commonly called “recall bias” which commonly leads to over reporting. In previous studies in which this method was used, dental records were crosschecked against the patient’s memory. This study did not crosscheck records.

2. The average age of the study patient was 57.5 years. This means that most of these patients were exposed during the 1950′s and into the 1960′s so exposure to ionizing radiation was at a much greater level than we use with today’s digital X-ray systems. The generally accepted estimate of patient exposure is approximately 1/4 of the exposure during the era this study looked at. A statement from one of the lead investigators (Claus) actually stated “Our study refers to exposures in the past rather than exposures that people are receiving in this day and age”

3. The following is information on the ADA guidelines to prescribing dental x-rays and the ALARA principle.

“The ADA’s long-standing position is that dentists should order dental X-rays for patients only when necessary for diagnosis and treatment with the ALARA Principle (As Low as Reasonably Achievable.

Rest assured that at HDG we use the newest digital X-ray Systems which significantly lower exposure and apply the ALARA principle.

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Vitamins and Minerals that Keep Teeth Healthy

Vitamins and Minerals that Keep Teeth Healthy

As we age, our teeth and gums change. Proper care of your teeth as well as eating a good diet can keep your smile beautiful and strong. Certain vitamins and minerals also help promote optimal oral health.

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Cosmetic Dentistry Not Just for Women

Cosmetic Dentistry Not Just for Women

It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for ‘lorem ipsum’ will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).Often, advertising for cosmetic dentistry focuses on women. Photos in magazines and on Web sites show attractive females with gorgeous smiles. Although these campaigns often target women, men can benefit from cosmetic dentistry too.

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