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.

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.