Kelsy's Smile Before

Kelsy is a beautiful young woman whose smile didn’t match her bright and outgoing personality. One of her front teeth was chipped and discolored from a previous injury. Kelsy’s mom wanted to do something special for Kelsy’s 25th birthday and decided that the best present would be a new smile to match the rest of her. Kelsy’s mom only wanted the best for daughter so they came to Adler Cosmetic & Family Dentistry. After an initial consultation and exam to discuss exactly what Kelsy wanted, Dr. Adler recommended doing Zoom Whitening to brighten up her smile and even out the shades and then doing porcelain restorations on her two upper front teeth. He recommended placing restorations on both front teeth even though only one tooth was discolored because it is extremely difficult to restore a single front tooth and have the shape, size, and color match the tooth next to it. In order to keep the teeth looking natural and the smile symmetrical it is usually recommended to restore front teeth in sets of 2, 4, or 8 teeth.

Kelsy's Beautiful New Smile

The first step for Kelsy was preparing her two front teeth for the porcelain crowns. The teeth #8 & 9 were prepped for new the crowns and a stump shade was taken. The stump shade is the underlying color of the tooth after it has been prepared for a restoration. This shade is important because if a tooth has a dark underlying color then the darkness could show through a crown if the color or opaqueness is not adjusted to accommodate this. After the teeth were prepped and the stump shade taken then the temporary crowns were placed and looked almost as good and the final ones would.

Kelsy’s next step of treatment was Zoom Whitening. Cotton barriers that have been specially formulated by Zoom Whitening to block the effects of the light were placed around the gums and tissue. An additional barrier called Liquid dam was also carefully applied to the tissue to fully isolate it from the whitening solution and light. Once everything had been isolated except for the teeth, the whitening gel was then applied to the teeth and placed under a special light that activated the gel to give the dramatic results. The whitening gel and light were reapplied for each of the four 15 minute sessions. The results are typically 2-3 shades lighter then originally but some people have even gotten better results then that. Kelsy’s results were the dramatic white smile we were looking for without looking unnaturally bright. Custom trays were also made for Kelsy so she could continue to do touch up whitening at home. Once Kelsy was satisfied with the whiteness of her teeth – the shade was sent to the lab so they could match the color of her crowns to her existing teeth to make a seamless blend.

Beautiful Smile to Match Her Personality

Aurum Dental Laboratories in Las Vegas are known for their high quality work and attention to detail. Kelsy’s restorations were given the same personalized attention that we have come to expect from Aurum. The crowns were custom fabricated not only to match her existing teeth in color but also given the size and shape to best compliment her face and give her smile an overall aesthetic appeal.

The final step of Kelsy’s treatment was seating the final restorations. Kelsy was very excited for this appointment. The temporary crowns were removed and the teeth were cleaned with an antimicrobial solution and then the final restorations were chemically bonded to the teeth using the best and most advanced products available to make the teeth as strong as before. Now Kelsy’s teeth look and function better then ever and she has the beautiful smile to match her personality.

After a complete evaluation, Dr. Adler recommended that both bridges on her upper front teeth be removed and replaced with all porcelain bridges. The all porcelain bridges would give the teeth a more nature look and the color would be more translucent and not flat. This would also eliminate the unattractive dark line near the gum line. When Sandra smiles you can see her teeth all the way to her bicuspids, so Dr. Adler recommended replacing the two bridges but also placing crowns on her first bicuspids so they would match the shape and color of the bridges giving a better over aesthetic look to her smile instead of making her smile look like it stops short or making the difference in color from her natural teeth look too drastic. Sandra wanted a brighter smile so Dr. Adler also recommended Sandra do Zoom whitening to help all the rest of her teeth to match the new crowns and bridges so she could have brighter smile instead of matching the bridges to her current color that was darker then she wanted.

Sandra started with the Zoom whitening after having a thorough cleaning to insure healthy gums and a good result. It is important to have a cleaning within 6 months prior to whitening to insure the best results. Whitening dirty teeth is about as effective as painting a dirty car. During the Zoom whitening, Sandra’s gums and soft tissue are protected by a liquid dam. The whitening solution was then applied to the teeth and the activating light was used. The process was repeated in four consecutive sessions. The whole process took approximately two hours. Customized whitening trays were made during the appointment to allow for any needed touch ups at home. Sandra was at least two shades lighter by the end of the appointment.

Sandra was very excited to have the old ugly bridges removed. The teeth were then prepped for the new porcelain bridges and crowns. Impressions were taken of the prepped teeth and sent to Aurum Ceramic Dental Lab in Las Vegas so the crowns and bridges could be custom fabricated and have a custom shade match done. Temporary crowns and bridges were then placed that looked almost as good as the final crowns would and better then the old ones. Dr. Adler and the lab insured that the restorations were the best shape, length, and size to give her the best looking and most functional smile. Once the restorations were complete, then the temporary crowns and bridges were removed and the final restorations were chemically bonded to the teeth using the highest quality products to insure the strongest bond possible. When everything was done, Sandra had a smile that she could be proud of and she is happy to show off her teeth now.

Hans’ Smile Before

When Hans first came to Adler Cosmetic & Family Dentistry he was ready for a change. Hans had had fillings, crowns, root canals, and extractions in the past and he wasn’t happy with how his teeth looked or felt. He had lost most of his back teeth on the lower right side and had trouble chewing because of it. Hans wanted to have his smile completely made over so it was functional first of all but he also wanted his smile to look great. Hans is a very friendly outgoing guy with an active lifestyle and he needed a smile that matched his winning personality.

Dr. Adler saw that there were several different issues to be addressed to give Hans the smile he always wanted. The missing molars on the lower right had affected Hans’ bite and only allowed him to chew on one side. He also had teeth that were fracturing due to large amalgam fillings, teeth that were broken and decayed, and other teeth with fillings that had come out and continued to get cavities. Fixing these problems one tooth at a time would not give Hans the outcome he was looking for and would end up taking longer and costing more in the long run. Dr. Adler recommended that Hans fix all of his teeth at once and correct his bite with neuromuscular dentistry.

Dr. Adler began by addressing the immediate issue of a tooth that was causing Hans pain. The tooth on his upper left had broken a while ago but he had waited to get treatment due to a medical issue at the time. Now the tooth was beginning to cause Hans pain which is what prompted him to come in. A root canal was needed because the tooth had fractured and exposed the pulp chamber which had become infected causing the pain. During the root canal, Dr. Adler created an access opening to the pulp chamber. He then uses very small files to clean the nerve tissue or pulp from the chamber and canals along with the bacteria and any infected material. The chamber and canals are then irrigated and dried to sterilize it before gutta percha is placed to fill the canals and chamber to insure that bacteria can not reinvade the area. A temporary material is then placed to seal the access opening until the final post and crown are done.

With Hans now out of pain, Dr. Adler could focus on finding Hans’ correct bite. A K7 evaluation was performed to determine where Hans’ bite should ideally be positioned. During the K7, a series of tests are run using non-invasive computerized electronic instrumentation. The K7 produces scans that measure how the muscles are firing, how much force they can put out while clenching, test range of motion, and listen to joint noise among other things. EMG or electromyography measures the muscles at rest and during function-clench. CMS (computerized mandibular scan) measures joint function, habitual freeway space, swallowing, and range of motion. Sonography measures joint sounds. TENS or Transcutaneous Neural Stimulation relaxes the muscles in the face and neck to find their true resting state and establish the occlusion at that position. Material is then placed in the patient’s mouth to capture that ideal position, known as the bite registration or myobite.

Based upon the information gathered during the K7 evaluation, it was determined that the best course of treatment would be for Hans to be fitted with a fixed orthotic that would be bonded to his lower teeth would reposition his bite and jaw into its ideal position. Dr. Adler recommended that once Hans’ bite had settled into the proper position to then do a full mouth reconstruction where all of his teeth would be crowned to rebuild his bite into the correct place permanently without the continued use of an orthotic. Impressions of Hans’ teeth and the Myobite were sent to Aurum Ceramic Laboratory in Las Vegas because they specialize in neuromuscular dentistry. The lab fabricates a bite stint or impression of the fixed orthotic. Dr. Adler then fills the bite stint with a material that is temporarily bonded to the lower teeth forming the fixed orthotic. Hans continued to come in to TENS and adjust the fixed orthotic to fine tune exactly where his bite should be. Once his bite had stabilized then he was ready for the next step.

Hans' Great New Smile

In a single appointment, all of Hans’ teeth were prepped for his final restorations. The fixed orthotic was removed and each tooth shaped into the proper form for the final restoration. Impressions of the prepped teeth were sent to the lab and temporary crowns were placed that looked almost as good as the final ones would. Because of the amount of bone lose that had occurred where the missing lower right molars were, implants were not a feasible option. In order to restore teeth on that side so Hans could again chew on either side, the lab would fabricate a partial denture that would lock onto the restorations to insure a secure fit but would still be removable for easy cleaning. Along with the partial, the lab custom fabricated every crown to insure the best possible look and function. This attention to detail was also very important in making sure that Hans’ final bite would be in the correct position.

Hans now has the smile to match his great personality and the transformation has been overwhelming. He not only looks great but he is finally able to chew normally again and his bite feels great.

The beginning of the year is also a great time to get that dental treatment you have been putting off done. Many insurance plans start over after the first of the year, so now is the perfect time to take advantage of those new benefits. Spending your Christmas money on your teeth may not seem as glamorous as a new flat screen TV but unlike the TV, healthy teeth will last you a lifetime.   A great healthy smile is always worth the money.  One visit, CEREC crowns make it easy and convenient to get the work you need done.  Unlike traditional crowns that take a minimum of two visits and you have at least two weeks in a temporary crown, CEREC crowns are designed and milled right in our office during your appointment.  In about an hour and a half, your tooth is as good as new and you leave with your permanent crown.

Good dental care is a resolution that is easy to keep and will help you to enjoy those great holiday meal for a lifetime. If you are one of those people that is a really good flosser just before and after your last dental visit but not so much the rest of the year then an easy resolution is to make it a daily habit. It doesn’t cost much and we always tell people to only floss the teeth they want to keep. Trust us, your gums will thank you for it.  So call us today to schedule your next dental visit.  Don’t you deserve a great smile?

Dr. Jim Harding, DDS

Adler Cosmetic & Family Dentistry is proud to welcome Dr. James Harding as the newest member of our team. Dr. Harding will be in our office on Wednesdays and Thursdays. He will offer the finest treatment in general, restorative, and cosmetic dentistry. Dr. Harding is trained and skilled in aesthetic and neuromuscular dentistry in addition to the placement and restoration of implants. He also treats sleep apnea.

Dr. Harding is a graduate of University of North Carolina with a DDS and a degree in Psychology. Dr. Harding also has a practice, The Vail Valley Center for Aesthetic Dentistry in Avon, Colorado. He has been an LVI clinical instructor since 2001 and teaches ten or more courses a year. Dr. Harding has received a fellowship from the Las Vegas Institute for Advanced Dental Studies (LVI) and the International Congress of Oral Implantologists (ICOI). He was president of the International Association of Comprehensive Aesthetic Dentistry (IACA) from 2007-2008. He is the official dental provider to the US Ski and Snowboard Teams and the dental provider and team dentist for Ski and Snowboard Club Vail. Dr. Harding is a member of many well-known organizations including the American Dental Association, Colorado Dental Association, American Academy of Dental Sleep Medicine, and the International College of Oral Implantologists to name just a few. He has also published several articles and papers.

Adler Cosmetic & Family Dentistry is excited to welcome Dr. Harding as a great addition to our team and will be both a very skilled and valued member.

Correcting a Pathologic Joint Position using Mandibular Torque and a Fixed Orthosis

Neuromuscular dentists are often criticized as dentists who just open the bite. What happens when we open the bite and maybe things don’t go exactly as planned? The patient still may be suffering from symptoms, restorative treatment gets delayed and the patient begins losing confidence in the dentist to solve their problem. What happens when the patient is your father!

Roy’s teeth before they were restored

My father, Roy Adler, who I treated for many years, had a severe traumatic painful episode in his left TMJ while eating an Italian ham sandwich on a French baguette. I have to be specific because my father takes his food very seriously. You see… I know his eating habits well. I also have a long dental history to fall back on, clues as to why this happened at this stage in his life. The clues that led directly to his episode helped me ultimately to determine the treatment that would relieve his pain… although the solution was not clear at first.

My father was well aware of my neuromuscular dental practice. He called from New York and told me he could no longer bring his teeth together normally. The pain was more dull than sharp. He experienced pain while chewing on both sides or tearing with his front teeth. The pain was strongest when first clamping down on food, but then lessened with subsequent chewing. He kept getting a dull ache when he pushed the jaw on the right side of the face to the left. Upon opening and closing the mouth he could hear bone rubbing against bone in the left TMJ. When he opened his mouth as wide as possible he sometimes felt the left TMJ catch, occasionally the right also. There was no pain or discomfort in the right joint. Opening the mouth wide to bite on food produced an ache, but doing the same maneuver without food did not. Directly after the initial event, there was a change in his bite. Upon waking in the morning he could close his teeth on the right side so that they met. However, soon after he would not be able to close down on the right side without difficulty, he would only hit on the left. So chewing food on the right side became a problem.

We used the Myotronics K-7 to evaluate his function. Scans showed that his muscles were firing at elevated levels in his temporal (temples) and cervical (neck) group. After 60 minutes of TENS (neuromuscular stimulation) there was improvement but the left cervical group remained elevated. His clench scores remained low, meaning that his muscles were not able to produce the proper amount of force when biting down. His bite was unstable. He had difficulty opening and was able to force himself to open to approximately 37 mm. The Sonography (scan of his joint noises) showed grating and popping noises on both sides. He was placed in a removable orthotic to open up his bite. The I-CAT scan without the orthotic shows boney degeneration.

When I placed my father in a neuromuscular removable orthotic there was little improvement. In fact the pain might have been slightly worse in the left TMJ although he was now in the proper bite. The orthotic had brought him down and forward, but his I-CAT scan revealed a disturbing fact. His joint on the left side was grinding against bone. Could we find a bite position that would relieve his pain within his joint? My father never really complained of muscular pain throughout this experience.

Repeated evaluations with the K-7 system showed that the orthotic was on Myo-trajectory – placing him in the correct bite. This created a dilemma; every Myo-bite taken left him in a bone to bone situation on the left side. We originally began with a removable orthotic to attempt to alleviate his condition. However his bite relationship without the orthotic did not leave him with a functional bite to eat with. We were not making much progress with the removable orthotic anyway. We made the decision to change to a fixed orthotic. We then used a new Myo-bite for Roy’s fixed orthotic. As you can see there were extensive degenerative changes now in the left joint as time went on. We can see the joint grinding against bone and the formation of joint mice or calcified bodies and bone fragments floating within the joint space. His opening became even more limited.

It was getting very hard to believe that things were going to get better. Was surgery going to be the only option? Was my father going to have to live with pain and suffering after paying for my education? He was traveling from New York to Colorado once a month for treatment. My father is a research mathematician. His scientific nature leads him to question everything in the minutest detail. He was well aware of my neuromuscular practice and successes with others. The problem had really hit home. The pressure was building. It was time to prove that neuromuscular dentistry was the way to go and was not quackery.

When we looked at his original radiograph things almost looked better before treatment. I had several thoughts about what to do. Should I remove the orthotic and see what happens. Well without the orthotic he was in constant pain with no bite. And he was in pain with the orthotic on Myo-centric trajectory but at least he could chew. I began to think about his dental history, the chronic break down of the left posterior teeth and subsequent crowning one after the other over the years.

Perhaps the years of pathologic muscle function combined with the degeneration within his joints was preventing me from finding the ideal functional position. The atrophy of the system was not allowing TENS to correct the X/Y plane. If the torque created by the occlusal breakdown had led to this problem then maybe torquing the occlusion the opposite way might correct him.

Roy's New Pain Free Smile

On his next trip I decided to alter his orthotic. It seemed to make sense that we needed to torque the left side to rotate the condyle away from the bone. On his next trip we began with one hour of TENS. Then I began adding to the left side. I added a small amount of composite resin to tooth number 19 since it would give me the most secure stop. I checked my measurements and I had indeed increased the vertical on the left side by one millimeter. He was now hitting on both sides … Harder on the left but some on the right. I decided to leave him like that and let his own muscle function do the work. That night he noticed no difference in the pain he was experiencing while eating. I was lucky I could monitor the patient this way. I was able to watch every bite. He seemed like he was opening a little wider while eating. My father grabbed a raw carrot and crunched through it without complaining. I was afraid he was going to fracture the orthotic. The next day we tensed for one hour and began checking the bite. He was now hitting on both sides. With a slight adjustment to the right side and adding a little resin to the cusp tips of his right first bicuspid, he was now hitting evenly again.

My father returned to NY. I called him regularly for a week and asked how he was doing. My father could not tell me if he was improving. So I stopped calling. Two weeks later my father phoned… he realized he was completely out of pain. He has been out of pain ever since.

Three months later he flew out and we started with new I-CAT scans. The results were amazing. His left condyle had moved dramatically, the joint mice were gone. The K-7 scans showed great improvement in function. He was now able to open wide enough to restore him. He was on Myotrajectory. My father has had no recurrence of pain since adjusting his orthotic by correcting the torque. We then restored to the new position using the LVI protocol for full mouth reconstruction. My father remains pain free. What a difference one millimeter can make.

Robert's broken smile

Robert had just moved to Boulder to start attending the University of Colorado when he broke part of his front tooth. Robert had previously had had a restoration placed on both of this upper front teeth. A piece of the restoration on one of these teeth is what had broken off. Not wanting to start college with a broken front tooth, Robert came to see Dr. Adler of Adler Cosmetic & Family Dentistry. After examining Robert, Dr. Adler recommended that Robert replace his existing restorations with all porcelain veneers. Since Robert had the piece of the restoration that had broken off, Dr. Adler was able to temporarily bond that back onto his tooth to keep the restoration from breaking further and to keep the jagged surface from bothering Robert’s tissue until he would be able to come in for the veneers.

Robert's new veneers

Teeth #8 and 9 were prepped for the veneers. Veneers are a thin shell of porcelain that are chemically bonded over the front of a tooth so very little tooth structure needs to be removed in the preparation. The chemical bonding insures that they are strong and secure. Once the teeth have been prepped for the veneers, then impressions are taken of the teeth to be sent to the lab for custom fabrication and shade match. Temporaries, that look almost as good as the real thing, are then placed on the teeth.

Rober with his confident new smile

Robert then came in for Zoom Whitening. Since restorations do not whiten, we wanted Robert’s other teeth to be a light as possible before having his veneers placed. This gives Robert the best smile possible and also allows him to keep his smile whiter over the long term. Robert’s tissue was isolated to keep both the activating light and the whitening solution off of it. Whitening solution is then placed on the teeth and the activating light is used for 15 minutes. This process is repeated 4 times to get the best results. Robert was also given custom bleaching trays so that he could do any touch up bleaching at home as needed. Robert’s teeth whitened up beautifully and the shade was sent to the lab for a custom match.

Once the veneers were returned from then lab, then Robert’s temporaries were removed and the teeth were disinfected, etch, and primed for the final cementation. A bonding agent was placed on the teeth just prior to the placement of the cement and restorations. This insures that a strong chemical bond is formed that will keep the veneers firmly attached to the teeth and looking great. Robert’s final results look great. His smile looks both natural and balanced. He now has a great looking smile that he can flash all around campus and give him the confidence to start his college career on the right foot.