My Dentist San Francisco

The more I do dentistry, the more I feel it’s about how you make people feel. Grateful to be able to talk to so many people in a very intimate level, day in and day out. I love my job!

Happy New Year from our family to yours. I think soon Hannah has to hug me instead 😊

And just like that, 2023 came to an end. As always thankful to my team and missing the ones who couldn’t make it to our holiday party. So blessed to have each one of these amazing people by my side. Pat is going to retire partially 🤣🤣🤣🤣 At least it’s what she thinks!

This case was very emotional for me. Her mom was an excellent dentist. Before passing away, she turned down her request to veneer the front teeth. She told her to get me to do it. Because I am better than her. That was of course an overstatement. I posted this case to say not all cases are full mouth rehabilitation, but for pulling off a very challenging case like this, you need a rock star lab technician and need to guide them with pictures and chair-side custom shade. I am so lucky to have one of the best lab techs for Feldespathic porcelain veneers right next to me. The preps are minimal, the veneers are super thin and the result is a very happy patient and a satisfied dentist. The pictures are from 4 years follow up to the beginning of discolored composites. from the last :)

Custom tailored treatment plan. Each patient has unique needs and limitations. When we start with unlimited trust, we can deliver more than expected. This is a very unique case, we decided to optimize his options by getting the help of implant pathway, thanks to Wade for accommodating him. Upper is interim for now due to questionable last molars. Limited orthodontics was done by our very special dr. Rodriguez to improve occlusion, esthetics and teeth arrangement. As always, grateful to my supporting team and trustful patients. In our practice, everyone wins. ☺️

Recently, we needed to change our windows. Over the past 6 months, we got 8 opinions with 8 different brands/materials/fees. Each person trashed the previous person brand/material/fee. The difference between quotes are very significant too. Something around $50k. That made me think why we, dentists, charge what we charge and do what we do. And why patients chose us. We charge for our specialty. For our knowledge and years of education that gives us opinion. The opinion that is served as our patient’s best interest. Of course the patients trust us and that makes us different than the next door dentist. That’s the whole success key in a dental practice. I am humbled and honored to continue the care of my patients over decades who come from far (I mean as far as New Zealand or Japan) to seek my opinion and let me do their dentistry. There is so much goodwill from dr. Murakami in my practice. And of course so much good dentistry. Thinking about you Dr. Diane Murakami 💙

Smile make over, taking off years of wear and tear. Combination of Emax veneers and crowns. Molars are coming up next. As always, it’s very important to remember we are treating the patient and not only the teeth. We need to listen and pay attention to every bit of what the patient say on our consultation appointment. The incredible transformation didn’t achieve overnight!

I am so grateful for my support system. I have a handful patient who followed me over the years and that’s the ultimate satisfaction for me. To know my patients come to me because of who I am. Not because I am in network with their insurance. David is one of a kind. He definitely made my life in UCSF so much easier with that bridge! I finished my crown and bridge requirement so quick. Dental students know what I am talking about. And after that he showed up to my graduation ceremony which was huge. I don’t have my dad in this country and it was such an amazing gesture from him. I felt loved! I felt my dad was there. And after that, he becadme my family. He taught me so much about the history of San Francisco. I cherish this relationship so much. I get many reviews but this one by far, was the best. #

Upper jaw reconstruction with bridges. Thanks to Dr. Eslami for retreating all the failed root canals and Shoe at Regal Dental ceramics for beautiful ceramic work. Also big thanks to Dr. Akhavizadegan for his input. Next is the lower jaw to match the shade. Patient is over the moon.

Grateful to have one of the best dental teams in San Francisco. Each and everyone of these people, make me proud every day. Still Missing couple of my people in this picture. Also, thanks to our lovely patients to organize our gathering in their restaurant. Much gratitude and love! Food was top notch as usual. 💜💙

Patient neglected his mouth for many years because of anxiety. Ortho completed by Dr. Rodriguez to address the bite and level of occlusal plane. Thanks to comprehensive Ortho treatment, the rest was regular crown and bridge work based on a wax up. Patient is thrilled, orthodontist is thrilled, general dentist the same. I read under all the posts that “patient refused Ortho”, that is not right. If the doctor says Ortho is needed, most patients will go for it. It makes everything less aggressive and complicated.

This weekend I had the honor of taking BAARD course for overlay and onlay. I’ve been studying and exposing myself to biomimetics and conservative evidence based adhesive dentistry for the past few years. I had crazy amount of questions and dr. Steven Schiffenhaus answered all of them, with full generosity. Such a great teacher and educator. If you are interested in adhesive dentistry and preserving as much tooth as possible, I highly recommend his courses. I would do anything to be in his next week course “Biobase”. Of course meeting the Allemans was a plus. And yes, they were nice enough to give me a ride to the airport. Overall, a very well spent weekend.

This case was done with digilog approach, as dr. Bedrossian would call it. Started with an analogue immediate denture, made from patient’s existing bite before extraction. Later this denture, served for digital bite registration and also blueprint for PMMA prototype. Final impression with Trios scanner and Straumann scan bodies. We scanned the upper immediate with a wash of PVS, for blue print and for the bite. Primarily midline was off, 2 mm to the left side due to missing left lateral, which was transferred to the immediate denture. Patient was used to the midline and had no complains. I was able to correct the midline on the prototype and I also added some length to the centrals for more character with composite. The prototype was sent back to the lab for scanning and milling the zirconia hybrid. The intaglio of the prosthesis is flat and very cleans-able. As usual, the lab work is top notch and those little details and characteristics of each single tooth, made me look good in front of my patient.

There is a lot of planning for a smooth ex*****on. This implant crown delivered yesterday. My patient was absolutely excited. #19, furcation caries, extracted and grafted by Dr. Peter Lyu in 2017. After so many years, my patient trusted me with replacing this missing tooth. We did a CBCT and planned the surgery. The surgery takes around 10 minutes but the behind the scene planning is the main part and involves many professionals. I am always blessed to have a team of rock stars by my side.

Chipped incisal edge due to trauma. Apprehensive patient with nitrous mask on. Beveled the enamel, etch, SE protect, 3M B1B, all together 20 minutes, then 20 minutes of polishing with discs and one polisher.

Another year with my incredible team! I am totally grateful to have such a supportive team who believes in my vision. I wouldn’t be where I am without each one’s special position in the office. Happy New Year and cheers!

Quick bondings after Invisalign to give the teeth more harmony. Minor changes to make this beautiful lady happy!

8 patients/day, flexible hours and days. If you stay for long term, we can negotiate everything. I want you to feel comfortable in my office. If you are team player, personable, punctual, respectful, we definitely can work together for a long time. If so, give our office a try!

Trauma to #8,9 in 2014, bonding with composite placed and replaced two times after, every 3 years. She was tired of changing the bonding and she wanted a more long term solution. 2 minimally prep feldspathic veneers on refractory were made by the master ceramist. Bonded with warm composite.

3 days ago was the 2nd anniversary of this amazing woman, who made the biggest impact on me as a dentist and on a much deeper level, as a person. I only got a chance to meet with her very briefly, not more than 10 times, as she was dealing with her health issues. But we had been in contact on a daily basis for almost a year. I am also treating her patients(who has been my patients for the last 3 years) and that means I get to know her quality of work, her ethics, her enormously huge heart, her sense of humor and her generosity on a daily basis, through our mutual patients, mutual friends, her staff of 30 years and her family. She was truly loved by every single person I know. Not because she was the nicest or most appropriate one, But because she was generous. Generous in giving out her heart and her work. Every few days, I come across another life that she has touched through her generosity. I am for ever grateful for her trust in me and for raising the bar for my dentistry and my personal life. I learned integrity and excellence from her. I learned to be proud of my achievements and be humble of my advancements. I learned not to be ashamed of redoing a work if it’s not up to my standards. I learned to push aside my ego when it’s on my way to achieve excellence. I learned to be the strictest judge of my own dentistry because my patients trusted me and I know better than them what good dentistry is. I learned to try to be my best and be more forgiving of my shortcomings, if I believe I have done my best. Dr Diane Murakami, I am forever grateful to you for putting your trust in me. For choosing me between all the others. I am forever appreciative. Rest In Peace you, beautiful soul, beautiful friend, beautiful mentor and beautiful confidant. you are well remembered.
Side note on the second picture: the picture is me with my/her long standing friends/patients, in Florida, having a toast in her memory on the day of her anniversary, under a painting, gifted to them by her. Indeed, she is well remembered.

I think as a dentist, it’s very important to take CEs. I feel privileged to be able to take time off from my practice to take courses. I feel it’s super important to keep learning. In any course that I attend, i get to know many amazing dentists and specialist. I also add a new tool to my tool box. I might not use what I learned right away but I always have some standby cases that can benefit form a new tool/new skill. For sure surgery is what I am passionate about. I am also grateful to Instagram for being a platform to learn from other professionals. Thanks to dr. Puterman, whom I stalk everyday for amazing soft tissue management. ̇mplantdentistry

Very nice lady with a fallen veneer #9. Chief complaint: she was not happy with the length, color and shape of the two incisors, #8,9. I made her a free hand comp veneer without bonding it to the tooth structure and corrected the length of #8. After her approval of shape and length of temporary crowns, I removed both and made her 2 feldspathic veneers. The papila will fill the black triangle in 4-5 weeks. She was very happy with the results.
One more case that my ceramist made me look like a rockstar!

Old bridge from #2-4 came out, #4 was not restorable due to advanced caries. Patient decided to get rid of the bridge with 2 implants. #2 crown, changed separately and permanently cemented. #3,4 implant placed with 45 Torque. Healing caps placed.

Today, we celebrated Pat’s birthday. She has been with our practice for a very long time. She is so loved that our patients get angry when she is not here. Many of them schedule their appointments to be on her working days, just to see her and have a little laugh. She has the best sense of humor. As always, I am super grateful to my team and blessed to have each one of them by my side. 💜💜💜

One of the most challenging situations is a single anterior crown to be matched with old extensive dental work. This patient has all crown/veneers on the maxilla. #10 started with a smell and bad taste and bleeding upon flossing. It’s veneer was from 2013 and got recemented few times. The last two times, I knew there is a huge gap between the veneer and the tooth because there was no excessive flow of cement when cementing it in. So after she started showing symptoms of leakage, we decided to change the veneer to a crown. The first emax crown turned out yellow and not lucent enough. The second one was a cut back and layered emax, with custom shade and lucent on the incisal. Gum tissue is doing amazing, no smell or bleeding or bad taste with the temp. I will post a picture of the gun tissue today, before cementation. layeredemaxveneer

Screwmentable implant crowns benefit from being screw retained and having custom abutment and also adding to the contact is easy for the lab tech. Why it’s important? The first reason for implant failure is cement remaining under the crown and near the neck of fixture. So when ever we can, we have to avoid cement retained implant crowns. Also the abutment screw is retrievable, meaning we can always get access to the screw with drilling the access hole. The abutment is customized to the gum profile, which has the least amount of food impaction and the closest profile to a tooth. So gum is the healthiest possible around custom abutment. One more important feature is the cementation can happen in the mouth or on the model and can be adjusted by the lab in 20 minutes if the contact needs adjustment. !!!!!

Anyone knows how to solder these two pieces together? At least to use it as temporary? Is it too much more work than making a new stay plate?

4 years follow up on Straumann BLT, Roxolid, regular platform with screw retained Ti—base zirconia crowns. Perfectly maintained bone level. 2 important points: the first one is how an implant was made and the surface was treated in the manufacturing company is important. Not all brands are equal. The amount of surface pores and the size of the pores are important. Secondly, the depth of placement is very important. I recently go 2-3 mm below the crest and it seems to be effective for preventing bone loss. Once you get some threads exposed, the bacteria start living in there happily and in few years, the amount of bone loss would be unacceptable.