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.

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.

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.

Jim’s Teeth Before the Restorations

Jim had a smile that he was not proud of and that didn’t represent him well. He travels across the country frequently for business and wanted a smile that would make a good first impression. Jim came to Adler Cosmetic & Family Dentistry because he wanted a quality smile that would give the best impression.

During Jim’s consultation, he was able to discuss with Dr. Adler what his needs and concerns were. He wanted to have restorations placed on his upper teeth to improve the look of him smile and would plan on doing the lower teeth at a later date. Jim also needed to have treatment completed in a relatively timely manner because his hectic travel schedule did not have him in town for more then two months before he had to fly out again. Dr. Adler knew that he could give Jim the smile he was looking for and so was up for the challenge.

Jim's Smile Before

Jim began by doing Zoom Whitening to lighten all his teeth so that his lower teeth would better match the new restorations. All of Jim’s tissue was carefully isolated to insure that it was not exposed to either the whitening solution or the light. Once the tissue was fully isolated, the Zoom whitening gel was applied to the teeth and then activated with the Zoom light for 15 minutes. This process was repeated four times to insure the best results. Afterwards, Jim’s teeth were dramatically whiter.

Dr. Adler and Jim had decided that eight restorations would be placed on his upper anterior teeth. They wanted to make sure that when he smiled that people would only see his great smile and wouldn’t notice that the restorations were not his natural teeth. Eight restorations were chosen so that when Jim smiled the restorations would go back as far as his smile and there wouldn’t be any awkward area visible between where his restorations were and his natural teeth started. Because Jim has a deep bite, his lower teeth are not visible when he smiles which was part of the reason he decided to wait to have the lower teeth restored.

Jim's Great New Smile

The eight upper anterior teeth were prepared for all porcelain restorations. Any existing decay was removed and the teeth were shaped for the restorations. A shade of the underlying tooth color was taken so that the lab could take that into account when designing the shade of the restorations. The lab will use multiple shades in each restoration to insure that it looks as natural as possible. A darker shade is chosen for around the gum line and then the color gradually lightens toward the tip of the tooth. The end of the restoration will have some translucency to mimic the natural look of a tooth. Many crowns will look fake because they are a single shade and are not translucent so they look dark and flat in color. Our lab makes sure that the crowns are as close to the real thing as possible. After the teeth were prepped for the restorations, impressions were taken so they could be sent to the lab for custom fabrication. Temporaries were then placed. The temporaries are not as good looking as the final restorations but they come pretty close and still look better then what he had.

Once the final restorations were returned from the lab, Jim came in to have them seated. The temporaries were removed and the teeth cleaned with an antimicrobial solution to disinfect them. The teeth and restorations are etched to insure a good bond. A bonding liquid is then placed along with the cement to chemically bond the restorations to the teeth. Dr. Adler is constantly upgrading his materials to insure that the finest products are being used and that the patient is getting the strongest bond. Once cemented the bite is checked, any excess cement removed and the restorations are polished. The final result is a great smile and some good looking teeth. Jim now has the lasting smile he was looking for and will be able to make a great first impression.

Elizabeth's smile before

Elizabeth had just moved to Colorado from Florida and was ready for a new smile to go with her new start. Friends had recommended she see Dr. Adler of Adler Cosmetic & Family Dentistry. Elizabeth felt that her smile didn’t look good and wasn’t happy with how some of her restorations were looking. She had a Maryland bridge on her upper left front teeth to replace tooth #10 for about 8 or 9 years. She also had a very small lateral incisor, #7, that had been “built-up” to give it a larger appearance.

Maryland bridges are a slightly different design than traditional bridges. Traditional bridges have crowns on the two teeth adjacent to the missing tooth and are fused to a pontic crown which replaces the missing tooth. A Maryland bridge has a pontic fused to a crown on one side and a rest that attaches to the tooth on the other side. Maryland bridges can cause undue stress on the crowned tooth since it is taking the load of two teeth where as a traditional bridge distributes that pressure between two or more teeth. Since anterior teeth have a single root then it is important to have the load distributed among more teeth to insure that the root of the tooth is not reabsorbed because of the undue stress. Elizabeth wanted to replace her bridge and make the small incisor that was built up also look better. Most of all she wanted her whole smile to look good and balanced. She was tired of her smile looking pieced together. Dr. Adler recommended that she replace her Maryland bridge with an all porcelain bridge and also place porcelain restorations on five of her remaining upper anterior teeth to insure that her smile would be symmetrical and look amazing.

Elizabeth first whitened her teeth with the ZOOM! Whitening system so that her lower teeth would be as white at her new upper teeth would be. During the Zoom whitening procedure, all of her gum tissue was isolated to keep it from getting exposed to the whitening solution and activating light. The whitening solution and Zoom light were applied in four 15 minute sessions. Elizabeth was dramatically whiter by the end of the Zoom treatment.

Elizabeth's great new smile

Eight of Elizabeth’s upper anterior teeth were prepped for the restorations including the bridge. Once the teeth had been properly shaped for the restorations, temporary crowns and bridge were placed. The temporaries looked almost as good as the crowns would and better than what she had had before. The impressions of the prepped teeth were sent to the lab for fabrication. Each restoration is custom made to insure that the overall smile is symmetrical, functional and aesthetically appealing. Once the crowns and bridge were back from the lab the temporaries were removed and the crowns were chemically bonded to the teeth to insure the strength and longevity of the restorations.

The results are dramatic. Elizabeth looks like a new woman with her great new smile.

Boulder, Colorado, April 26, 2010 – The cosmetic dentistry office of Dr. Michael Adler today released an announcement confirming the expansion of cosmetic dental services to the Denver metro area. Dr. Michael Adler has received advanced training in cosmetic dentistry and holds a fellowship from the Las Vegas Institute for Advanced Dental Studies (LVI). Adler Cosmetic Dentistry is widely known in Boulder, along the Colorado Front Range, and nationally for its exceptional skills in the practice of cosmetic dentistry.

Adler Cosmetic Dentistry is committed to providing the highest level of cosmetic dentistry services to all patients interested in enhancing the aesthetic appearance of their smiles as well as improving overall dental health. Cosmetic dentistry services today are very affordable for most patients. More extensive procedures can easily be financed by a wide variety of lending companies that specifically work with Adler Cosmetic Dentistry.

Cosmetic dentistry includes everything from safe teeth whitening, veneers, white fillings, to complete smile makeovers. The results are often times dramatic in improving patients’ smiles and self esteem simultaneously. The practice features a variety of case histories with before and after images on its website and blog.

For misshapen teeth, unsightly gaps, or deep discoloration, porcelain veneers may be the best approach. Veneers are thin porcelain coverings that fit over and are bonded to your teeth, look natural, and are made from the most advanced dental ceramics available. Since veneers are so thin, often little to no tooth reduction is necessary. For teeth whitening Adler Cosmetic Dentistry recommends the ZOOM Teeth Whitening system. The ZOOM Teeth Whitening system can be applied in a single office visit.

Adler Cosmetic and Family Dentistry is open weekdays by appointment. Additional information about the practice and services offered is available at www.adlerdentistry.com.

About Adler Cosmetic and Family Dentistry
The cosmetic and family dental practice of Dr. Michael Adler is based in the Colorado community of Boulder, a convenient and scenic drive from most locations in the Denver and Front Range areas. Boulder, Colorado is also an inviting destination location for visiting out-of-state patients seeking Dr. Adler’s specialized attention. Dr. Adler is nationally recognized for his work and is committed to providing his patients with the highest level of care in both cosmetic and family dentistry. The practice maintains a website at www.adlerdentistry.com and regularly publishes information on its blog at www.adlerdentistry.com/blog.

Contact
Name:  Heather Ramsey
Email:  heather@adlerdentistry.com
Phone:  (303) 449-1119

Adler Cosmetic and Family Dentistry
1810 30th Street
Boulder, CO 80301

Jonathan Before

Jonathan came to Adler Cosmetic & Family Dentistry at his fiancé’s recommendation.  He wanted to make sure his teeth were going to look good in time for his wedding.  This was a major concern for Jonathan because two of his front teeth were dark and discolored from previous root canals and he didn’t like the spacing or color of his other teeth.

Dr. Adler addressed Jonathan’s concerns by offering him several treatment options.  One option was Zoom whitening to brighten the color of his other teeth, Invisalign to straighten all of his teeth, a post for #8 (his upper front right tooth) for support and veneers for his front teeth since teeth darkened because of root canals would not lighten to the extent of his other teeth with just Zoom alone.  A second option was veneers on the front four teeth with a post in #8 and the Zoom whitening with no Invisalign.  This second option would fix spacing issues only in the front four teeth but not any of the other teeth.  Jonathan chose the second option in order to have the treatment completed in time for his wedding and will consider doing Invisalign in the future.

Jonathan started 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, Jonathan’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.  Jonathan was at least two shades lighter by the end of the appointment.

In order to fabricate the veneers and post, impressions were taken of Jonathan’s teeth and set to the laboratory so they could create a wax-up.  A wax-up is a wax model of what Jonathan’s veneers will look like on actual models of his teeth.  This was used to insure that the look and size of the veneer would be correct to give Jonathan the most aesthetic smile.  Once approved, Dr. Adler prepared the four upper front teeth for the veneers and post.  Veneers require very little of the natural tooth to be removed in order prepare the teeth.  The post on #8 was needed to give added support since that tooth had been root canalled previously.  Temporaries are then placed on the teeth until the final crowns are ready.  Even with just the temporaries on, Jonathan’s teeth were already looking good.

When fabricating any teeth, especially front teeth, Dr. Adler and the lab make sure that they have the best color match possible to give the patient a bright but natural smile.  The aim is to have great looking teeth but not be able to pick out which ones are real and which ones are not.  Careful consideration was taken to make sure that Jonathan’s teeth were both well shaped and shaded.  Once the custom fabrication was completed, Jonathan returned to have the final restorations cemented.  The temporary veneers where removed and a high quality translucent cement was used to chemically bond the veneers and post to the teeth. The results were dramatic.

Jonathan After - The Happy Groom

Now Jonathan has strong great looking front teeth.  Jonathan was all smiles for his wedding pictures.

Adam After the Accident

Ice is one of the hazards of winter that has slipped us all up at some time or another.  Adam was no exception to this.  He slipped and fell hitting his face on the ice.  His face took the impact of the fall and tooth #8 (upper right front tooth) was severely broken.  He immediately sought treatment from Dr. Adler of Adler Cosmetic & Family Dentistry.  Dr. Adler used x-rays and images from the interoral camera to help determine the extent of the damage during his examination of Adam.  Tooth #8 was severely fractured through the nerve space, causing pain.  It is unusual to see damage to only one tooth when someone falls.  The adjacent teeth need to be evaluated carefully for damage or trauma.  The interoral camera revealed that the adjacent teeth also showed signs of fracture.

To relieve Adam’s pain, Dr. Adler preformed a root canal on tooth #8 and removed the damaged nerve.  The root canal was necessary because the severe fracture exposed the pulp of the tooth to bacteria that live in the saliva.  If left untreated, the tooth would continue to be a source of infection and eventually weaken the body’s immune system.  The pulp is contained within an inner chamber of the tooth called the pulp chamber.  Pulp is commonly referred to as the nerve but is actually a soft tissue make up o nerves, arteries, and veins.  The pulp extends from the pulp chamber down through narrow channels, called the root canals, to the tips of the roots.  The fear and pain associated with root canals are over rated.  For most patients, getting a root canal is no more traumatic that having a filling done.  During the process of the root canal, the doctor goes into the tooth and removes the pulp, cleaning the cavity.  After the root canal, the tooth was temporarily bonded to give it a normal appearance while Adam was completing his treatment.

Prior to the crowns being custom made, Adam had his teeth whitened using our in-office ZOOM laser whitening.  The main ingredient in Zoom is hydrogen peroxide, which works by oxygen enter the enamel and dentin was it breaks down.  The oxygen bleaches colored substances and doesn’t harm the tooth structure.  The Zoom light aids in activating the hydrogen peroxide and helps it penetrate the surface of the tooth.  It is a simple procedure that can produce great results.  With this new brighter smile, Adam was ready to have the shade taken for his new crown and veneers.

Once a root canal has been performed, the tooth is structurally weakened and prone to fractures and breaking if left as is.  In Adam’s case, tooth #8 was crowned not only because of the root canal but because of the fractures caused by the accident.  A carbon fiber post was placed on tooth #8 to adequately support the crown so the bite force would be properly distributed so that the tooth did no fracture.

Due to the fractures, teeth #7, 9, and 10 were prepared for veneers.  A veneer is a thin shell of porcelain that is bonded to a tooth to improve its color or shape. A veneer generally covers only the front and top of a tooth.  Veneers can be used to close spaces between teeth, lengthen small or misshapen teeth, or whiten stained or dark teeth.  When teeth are fractured, as in Adam’s case, or beginning to wear, veneers can protect them from damage and restore their original appearance.

Adam's Great New Smile

The teeth were prepared for the crown and veneers by removing any damaged areas.  The teeth were then shaped to securely hold the crown/veneers.  An impression of the teeth were then taken so the dental lab could make an accurate model of Adam’s mouth and then created a crown that precisely fit his mouth and bite.  Unlike porcelain fused to metal crowns, all porcelain crowns are translucent and allow light to pass through the tooth like a natural tooth opposed to reflecting all the light which can make the tooth appear dark.  Porcelain fused to metal crowns can also have a dark ring near the gum line which is not present with all porcelain crowns.  The shade of the teeth is also very important to maintain the natural appearance.  An underlying shade is taken of the prepared tooth, known as a stump shade, to better match the natural and subtle hues of the tooth.  The shade of the crown is also determined by the adjacent teeth.  Whitening was done before this outer shade was taken to make sure the crown closely matched the other teeth and because crowns are not effected by the whitening process and so remain the same color as they are made.

Now Adam has a great new smile that he can’t help but show off and the results are dazzling.

Barbara After Extraction

As a child, Barbara had had a root canal done on her upper right front tooth, tooth #8.  Over the years, Barbara had several crowns on that tooth but never really liked how they looked.  For 45 years, the tooth did not cause any pain until one day she began having pain and pressure especially when chewing.  This is when she first sought treatment from Dr. Adler.  Based upon the exam, x-rays, and prior history of a root canal, Dr. Adler recommended that Barbara have an apicoectomy.

An apicoectomy is usually performed after a tooth has had at least one root canal but continues to develop infections.  Root canals are very complex, with many small branches off the main canal.  Sometimes, even after root canal treatment, infected debris can remain in those branches and possibly prevent healing or cause re-infection later.  During Barbara’s apicoectomy, the root tip was accessed directly through the bone instead of up through the tooth as in a root canal treatment.  The root tip, or apex, was removed along with the infected tissue.  A filling was then placed to seal the end of the root and a suture is placed to close the access opening.  In order to stabilize the tooth, Barbara then had an all porcelain crown and carbon fiber post placed.

Healing Cap

For a year after the apicoectomy, the tooth was symptom free but unfortunately the tooth became infected again forming an abscess.  A tooth or root abscess is pus enclosed in the tissue of the jaw bone at the tip of an infected tooth that usually originates from a bacterial infection that has accumulated in the soft pulp of the tooth.  If left untreated, an abscess can continue to grow and may become large enough to perforate bone and extend into the soft tissue.  It will continue to follow the path of least resistance and spread either internally or externally which can lead to severe complications.  Dr. Adler performed another apicoectomy in an effort to save the tooth hoping that it was another root tip infection.  During the procedure, Dr. Adler saw a fracture in the tooth that extending from tip to crown and it was determined that the tooth could not be saved due to the vertical root fracture.

Ziconium Post

The tooth was extracted and a bone graft, allograft, was placed by Dr. Cheri Brown to help replace the bone that had been lost due to the abscess.  Dr. Cheri Brown, a periodontist, works with Dr. Adler at Adler Cosmetic & Family Dentistry.  A removable temporary partial, custom made prior to the appointment, was fitted so that Barbara was able to leave the office without a gap in her smile while she continued to heal.  While the graft was healing, Dr. Adler was able to perform guided tissue recontouring.  Guided tissue recontouring reshapes the gum around the tooth giving a more aesthetic look.  This was done for Barbara by slowing adding material to tooth on the temporary partial where it presses against the gum line.  Overtime the tissue is gently formed into the desired shape to better match the other teeth.

Barbara After

Once the graft had healed and become stable, Dr. Brown placed the titanium implant.  The implant was placed during a surgical procedure, directly into the jawbone and under the gums.  The implant with a healing cap attached was then allowed to heal for four to six months so that the bone will grow around the implant and “osseo-integrate”.  Dr. Brown later placed a soft tissue graft because Barbara needed more connective tissue to support the implant.  After six months of healing, Dr. Adler placed a zirconium implant post, also known as an abutment, that connected to the implant.  The post was made of zirconium to allow for ideal translucency once the all porcelain crown was place about a month later.  So today, Barbara is no longer bothered by that troublesome tooth and she looks great.

Barbara's New Smile