A Full-Mouth Smile Reconstruction
Quite some time ago, I showed this case as an example of how badly teeth can be damaged by grinding them, whether at night, in the daytime, or both, and why something as simple and inexpensive as a nightguard (my recommendation is a NTI-tss). It is especially inexpensive in comparison to the cost of rebuilding a smile that is so broken down. This gentleman came to us in 2008, looking for options to feel good about his smile again for various reasons. After plenty of discussion, we agreed that the only option that would truly give him the smile that he wanted was a Total Smile Makeover/Reconstruction with porcelain crowns. After showing the Before-After pictures of his smile, I’ll discuss some of the issues you need to consider if you are thinking about significant cosmetic dentistry for yourself.
Frequently Asked Questions about Smile Reconstruction
When rebuilding a smile such as this, it is crucial to establish a proper bite relationship of the top and bottom teeth. Sometimes this can take a little while to figure out, because – when the teeth are so worn, the patient has long since adapted to a very bad bite relationship. The muscles have to be relaxed, accurate records taken, and excellent communication is necessary among the patient, the doctor, and the lab, to ensure that the crowns are made to look good, feel good, and last a long time. However, in severe wear cases, we always remind the patient that s/he already did a pretty good job destroying their natural set of teeth, so a nightguard is an absolute requirement as “insurance” to protect their investment, and even then they are more likely to break or chip the porcelain than others who don’t have that history. Simply put, these cases are far more complicated and require a great deal of time to get right, so you need to be absolutely committed to proceeding and working closely with your dentist to get a good result.
How Much Does a Smile Reconstruction Cost?
It’s not unusual for a patient to ask why it costs so much to do a Smile Reconstruction like this; it often seems like there should be a “volume discount,” so-to-speak, when doing a lot of crowns instead of just 1 or 2. The difference between such scenarios is the amount of time involved, the skill, training and experience required to successfully diagnose, complete, and treat, and that your dentist will have to work with a highly knowledgeable lab to make the crowns to not just look good, but fit properly and work smoothly in eating motions. Your dentist will likely spend at least a couple hours just in the planning stages! It’s usually a case of “You get what you pay for.” IOW – if you want a cheap smile makeover, you should reasonably expect a cheap outcome. To get excellence……it won’t come cheap. Depending on various factors, a case such as this will be the equivalent of buying a fairly nice car. The main difference, of course, is that you should expect to be “driving” your smile for a lot longer than most people keep a car!
- How Long Will This Take to Finish?
When doing so many teeth, you need to plan on a minimum of several appointments that could take 1/2-day to a full day each, as well as several other appointments to refine, modify if needed, polish, etc. From beginning to end, if everything goes perfectly, you might be done in as little as 1 month. That would be somewhat rare; more likely, you should plan on the entire process taking at least 2 months, and maybe many more. Extremely complex cases that involve implants, different specialists, and very complicated lab work may take a year or more due to the time needed for healing, verifying each stage is correct, and even just the time needed for lab technicians to do the custom work.
- What kind of Crowns will/should you get?
Due to improving materials and with the right techniques, in most cases nowadays you can have all-porcelain crowns made to rebuild a smile. The crowns used in this case are made of E.max porcelain, which is extremely strong and resistant to breakage. Numerous studies now show that this type of porcelain will likely last for 15-20 years, and quite possibly longer. For certain cases, though, and for patients who are even worse grinders than this gentleman was, gold crowns might still be necessary for the back teeth, simply because they are the strongest, longest-lasting crowns available. They can also take more abuse than any other material. Porcelain-to-metal crowns are also an option and have a long track record, but it is very important for the lab to be highly skilled so that you don’t see dark grey lines at the gum from the metal showing through.
- How Do I Choose the Right Dentist?
This is one of the trickiest questions, because the public doesn’t usually know enough about the training necessary beyond dental school that trains dentists to handle complex full-mouth reconstructions with skill and confidence. But here’s my recommendation: ask to see pictures of their other cases that might be similar to yours. That’s one of the reasons digital photography is such an instrumental and daily part of our dental practice – you will be able to see similar cases and know how the outcome will be before ever committing. The large majority of dentists who are well-trained in these cases also use digital photography, both for communicating with you as well as for documenting and tracking their own work over time. If you meet a dentist who can show you pictures of cases that were completed 5-10 (or longer) years ago AND s/he has recent follow-up pictures to show how well it has held up, THEN you should feel very confident that your dentist can take good care of you.
And then start imagining how much better you’ll feel when you can smile like Wayne does now!
Please feel free to ask questions or post a comment below, or to share with your friends! If you’re interested in a Complimentary Consultation in our office, please call 704-364-7069 or Request an Appointment Online.
The Most Commonly Asked Questions at a Six-Month Braces Consultation
These questions really aren’t surprising, and you’ve probably wondered about them already yourself if you’re considering this remarkable cosmetic dental option, so here are your answers:
1) Can you REALLY move my teeth that fast?
Yes, we really can. I know it seems hard to believe, because most everyone thinks that you have to wear braces for 18 months to 3 years to get everything right. You can take a look at this Smile Gallery to see a whole bunch of people who’ve had their front teeth straightened in 6 months or less.
2) HOW do you move teeth that fast?
It’s quite simple, really, and it’s not magic or rocket science. Basically, since we’re really doing cosmetic braces, this is an alternative to porcelain veneers. That means we are just concentrating on straightening the front teeth, NOT trying to correct major bite problems. Answer these 3 questions and you’ll know if you’re a good candidate for 6MonthSmiles:
- Do you have any jaw or muscle pain, or a history of headaches?
- Do you have any difficulty chewing or biting normally, or is your bite really “off” in the back teeth?
- Do you have some spaces in the front teeth you’d like closed or crowded front teeth you want straightened?
If you answered NO the first 2 questions but YES to the last question, then you are probably a good candidate for 6MonthSmiles!
3) WHEN CAN WE START!?
This is, of course, the most fun question. It’s amazing how many times patients will want to start RIGHT NOW. As in, before they’ve even left the Complimentary Consultation appointment. And most of the time, we can accommodate. Getting started is literally as easy as getting molds of your teeth, a complete set of photos, and a panoramic x-ray (this one goes around your head and records your entire jaws, joints, etc. to make sure there are no complicating factors). We send the info to our 6 Month Smiles lab, which makes custom trays that let us put pretty much all the brackets on at once, just a couple of weeks later. It’s much easier and faster this way, I promise. And off we go!
One of my absolute favorite things to do, is to see patients for their Complimentary Portrait Session after they finish some type of cosmetic dentistry, whether it is Six-Month Braces, Porcelain Veneers, Teeth Whitening, or some combination of those. There is such a level of satisfaction when a patient LOVES to smile for pictures instead of hide their smiles because they’re embarrassed. Caroline is a perfect example of this; when she first came to see us, she was really unhappy with her crooked teeth. Given what an amazingly cheerful person she is, hiding her smile was not something she wanted, but — like so many others — she assumed that braces would take 2-3 years, and as an adult, she simply was not interested, but she also didn’t want to have her teeth ground down for porcelain veneers, nor did she want to spend that much. So, with a combination of Six-Month Braces, 2 Porcelain Veneers with our 1-Visit Crown system (CEREC), and Whitening Trays, we dramatically transformed her smile in about 10 months total. Just look at her smile now!
This is really what Cosmetic Dentistry is all about, really — it’s about helping you feel good and confident about yourself, about your smile. If you would like to smile with the confidence that Caroline now does, give us a call at 704-364-7069 or Request an Appointment Online!
Despite the solid research and years of terrific results that accompany the PerioLase MVP-7 dental laser in treating moderate-to-severe periodontal (gum) disease, it is amazing to me how slowly it is still catching on. I’m heading to Cerritos, CA on Wed., August 12th to attend the 3 days of Boot Camp, otherwise known as 3 days of a bunch of dentist geeks who really love providing the best care to their patients sitting around and talking laser physics. 🙂 LOL Yes, I’m one of those dentist nerds – we’ll even be talking about lasers, gum disease, etc. over dinner and drinks, late into the evening. But still…….once I receive my laser, I will be one of only 4 dentists in Charlotte – one of only 7 dentists in all of western North Carolina – and one of only 19 dentists in ALL of North Carolina to have this remarkable laser.
LANAP – the most effective, most comfortable treatment for periodontal (gum) disease available
The procedure is called LANAP, or “Laser Assisted New Attachment Protocol.” What it means in practical terms is that, following treatment with the protocol (which is extremely strict, which is why Millenium Dental, the manufacturer, does not even allow a doctor to have the laser until after the initial 3 days of training), your gums will actually REATTACH to your teeth, and oftentimes the bone will actually grow back! Yes, you read that correctly, this laser and protocol can actually stimulate your body to REGENERATE LOST BONE SUPPORT FOR YOUR TEETH! No other laser has ever been shown to have this capability.
But what else can the PerioLase dental laser do?
Laser Root Canal Treatment: the laser can be used during a root canal procedure to help disinfect the inside of the tooth, which may increase the success rate of the procedure, and minimize post-treatment flare-ups.
Laser Removal of Excess Gum Tissue: Especially during extended orthodontic treatment, it is not uncommon for the gums to overgrow and get big and puffy. With the application of some Ambesol-like gel to numb up the gums, the PerioLase can easily remove this excess gum tissue with barely any discomfort.
Release a “tongue-tie”: if your tongue is “tied” to the bottom of your mouth too tightly by the connecting tissue, it can make it more difficult to talk. This tissue can be “trimmed” or released with a laser-incision that then requires no stitches.
There will be other uses, but these will be some of the primary ones. I’ll let you know more once I get back from the training!
This is a question I’m frequently asked, especially when a patient is considering a significant investment of time and money into some form of cosmetic dentistry, such as:
- Porcelain veneers
- Bonding (tooth-colored fillings)
- Porcelain crowns and bridges
- Teeth whitening
- Even Six-Month Braces
It’s a very understandable question, and the simple answer to the question, “How long will my dental work last, Dr. Payet?” is “It depends.”
Just like a car, your teeth and gums require regular care to ensure that they are working properly. Sure, you can go 10-20,000 miles between oil changes given how improved cars are nowadays, but do you really want to take the risk? Same thing with teeth……….some people go for 5-10 years with no dental check-ups and are fortunate when they come in to find no problems, such as cavities or gum disease. But it’s not many people that are so lucky!
I always remember a quote from some lecturer at a dental conference years ago telling us his response whenever a patient asks the question, and it’s really the most honest, best answer that can be given, “Clearly the teeth that God gave you haven’t lasted your entire life, and since I can assure you that my work is not nearly as good as God’s, unless you die first, the work I do (no matter how excellent) will not last forever either.”
So what can cause your dental work to fail?
- Grinding your teeth — when the human jaw clenches, it can create an amazing amount of force, and over time, enough clenching will cause teeth to crack and break.
- Acidity — anything that increases the acidity in your mouth is good for the bacteria that cause cavities in particular, including Acid Reflux, Sodas, Power drinks (Monster, Red Bull, etc), Sports drinks (Gatorade, Powerade, etc).
- A very sugary diet — the bacteria that cause cavities love sugar. High sugar content means the bacteria feed like crazy, produce acid, and the acid is what eats away the teeth to cause cavities.
- A compromised immune system — your saliva contains important antibodies that help keep the cavity-causing bacteria under control. If your immune system is knocked back due to a disease or some medication, those antibodies will be decreased, allowing the bacteria to grow uncontrolled.
- Decreased saliva (dry-mouth syndrome) — again, due to medications or illness, the amount of saliva may be decreased. With less saliva, there is less “washing” action of the teeth.
- Trauma — obviously. LOL One of my patients a few years ago fainted and fell face-first into a brick wall, shattering a front tooth. Another ran into a pole, shattering another front tooth. Clearly, if you are injured in such a way that your natural teeth would break, any dental work will break, too.
- Bad habits like chewing hard candy or ice regularly — hard candy and ice are just that — HARD! Ice, in particular, is easily as hard as your enamel and as porcelain or bonding. So if you bite down on ice frequently enough and/or hard enough, you can break your teeth and dental work.
That covers most of the major causes of dental work failing. With regular care, use of appropriate mouthrinses and toothpastes, proper brushing and flossing, regularly scheduled check-ups and dental x-rays, using a nightguard, and being aware of diet, etc, your dental work can and should last a very long time.
But always remember — my dental work isn’t as good as the natural teeth God gave you, so my work probably won’t last forever either. 😉
ALIGN Technology, the company that makes Invisalign orthodontic aligners, has not yet made any indication that they will be reversing their decision on June 1st to require dentists and orthodontists to do a minimum of 10 cases each year and complete 10 hours of their Continuing Education courses each year. The backlash among dentists and orthodontists, however, continues to get stronger, as this is a fairly blatant move by a for-profit corporation to intrude on a doctor’s autonomy and decision-making rights as to which cases are appropriate for Invisalign and which are not. Several professional organizations, including the Academy of General Dentistry and the New York State Dental Association, are already responding with letters to ALIGN Technology’s Board of Directors and President, stating that there is simply no evidence that the so-called “proficiency requirements” have any basis in science, and unless they can come up with something to substantiate the claims the company is making, they should immediately withdraw the requirements. If ALIGN Technology continues on this course, patients should fully expect to see an enormous drop in the availability of Invisalign as more and more dentists and orthodontists simply drop their service.
The good news is that there are alternatives to Invisalign, and they work as well or better, AND they’re even less expensive! For some info and examples, check out our Six-Month Smiles in Charlotte! Then you can Request a Complimentary Consultation to see how fast you can feel good about your smile again with straight, white teeth! And if you’re concerned about cost, if you sign up for our Dental Discount Plan or choose Interest-Free Payment Plans with Care Credit, you can save some real money, too.
Following on the dumb move made by Invisalign a couple weeks ago to severely restrict the number of dentists and orthodontists who will be able to offer Invisalign to their patients (see my most recent post), it has been interesting to note that ALIGN Technology’s stock value has dropped by almost 18% in just the last 2 weeks since they made their announcement. Boy am I glad that I found out before attending their course and wasting my money and time.
However, this has led me to FINALLY get involved with a different company, whose founder – Dr. Ryan Swain – I have been proud to call a friend for about 7 years now. Dr. Swain started a ground-breaking niche practice in New York that focused exclusively on Six-Month Braces and Cosmetic Dentistry. His practice model has been so explosively successful that he’s been teaching dentists all over the country how to use the techniques that he teaches, which create dramatic Smile Makeovers, often in 6 months or even less, for adults wanting straight front teeth but wanting their braces to be “invisible.” With Invisalign no longer a company I want to partner with, it seemed to finally be the right time to partner with Dr. Swain and 6MonthSmiles.com. That’s why I’ve now added a new logo to the into post on our blog and our website: