Full Mouth Neuromuscular Dentistry Restores Smile

Boulder, Colorado Dentist


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.

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.

At this stage, impressions of Hans’ teeth and his new bite were sent to Aurum laboratory so they could do a wax-up. The wax-up is a wax model of how the final restorations and bite will look. This was done so that Dr. Adler could confirm that all the measurements for Hans’ bite were correct and that the restorations were the right shape and size to give Hans the best looking smile for his features and facial type. Once approved, Hans was ready to begin prepping his teeth for his final restorations.

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.

Like the prep appointment, the crowns were seated in a single visit. The temporary crowns were removed and the teeth cleaned with a disinfectant. Each crown was then chemically bonded to the teeth to insure the strongest hold possible. The crowns were then cleaned and scaled by our hygienist to insure that any excess bonding material had been removed. By the end of the appointment, Hans’ teeth looked great.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.