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.
As much as people are often amazed at the idea that we can give them a straight smile with Six-Month Braces, there really are times when it doesn’t even take THAT long. Take a look at Karim’s before and after pictures — literally, we put her brackets on back on September 9th, and we took them off today, November 24th. That’s NOT EVEN 3 months with braces on, but look what a difference! As she put it….”I love the results!”
People often have difficulty believing that we can really move teeth to create a more beautiful smile in only 6 months. Here’s a case to show just how well it works – Lynn has only had her almost invisible braces on for 2 months, and look how far the gap between her front teeth has closed already!
Wow – this one even surprised me! Check out this summary of a recent study from the Journal of Sexual Medicine:
Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum.
Center for Health Promotion and Preventive Medicine, Medical Corps, Israel Defense Forces, Zrifin, Israel. email@example.com
INTRODUCTION: Both chronic periodontal disease (CPD) and erectile dysfunction (ED) are associated with cardiovascular disease and its risk factors, including smoking and diabetes mellitus. However, the association between ED and CPD has never been studied. AIM: To study the association between ED and CPD. MAIN OUTCOME MEASURES. Prevalence of ED, prevalence of CPD, ED severity. METHODS: The study population consisted of 305 men who filled the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect ED and assess its severity, and underwent a pair of standardized posterior dental bitewing radiographs in order to detect CPD. SHIM questionnaire scores 21 or less represented ED. Alveolar bone loss of >or=6 mm represented CPD. RESULTS: The mean age of included men was 39.5 +/- 6.7 years. Overall, 70 (22.9%) men had ED and 13 (4.3%) had CPD. CPD was significantly more prevalent among men with mild ED (P = 0.004) and moderate to severe ED (P = 0.007) in comparison to men without ED. CONCLUSIONS: ED might be associated with CPD. These preliminary findings are consistent with theories that associate these conditions with systemic inflammation, endothelial dysfunction, and atherosclerosis.
Ohhhhh, and I apparently forgot to mention (Oops! 😉 ): if periodontal disease is something you need treated, and you want the absolute best treatment currently available, please request a Consultation/Exam with us by either of the following ways:
Ok, then you’re in luck! Here is a video that will give you pretty good information about periodontal (gum) disease in general, as well as about conventional non-surgical and surgical treatment options, and then about LANAP (Laser-Assisted New Attachment Protocol).
Something very important to know: the Periolase MVP-7 dental laser, made by Millenium Dental Technologies, and for which the required training is provided by the Institute for Advanced Laser Dentistry (IALD), is the ONLY dental laser available that can be used with LANAP. DON’T BE FOOLED INTO THINKING THAT ANY OLD LASER CAN DO THIS! There are only 4 doctors in Charlotte, NC (as of today September 17th, 2009) who can offer this treatment to you, including me; make sure it’s the real deal. Dr. Robert Gregg and Dr. Delwin McCarthy, who founded Millenium Dental and developed the Periolase and LANAP, are passionate about protecting patients from harm by dentists who don’t have the right background or understanding of lasers, which is why they patented the protocol with the FDA. Only doctors who complete the initial 3 days of training receive a license and laser.
When most people think of “bonding,” they are thinking of tooth-colored dental fillings, or composite fillings. To be completely technical for a moment (I try to avoid that as much as possible to not bore you 😉 ), “bonding” is actually the series of steps and the products we dentists use to make the tooth-colored fillings actually STICK to the teeth. OK – technical moment is over. Whew, aren’t you glad of that?
An issue that many patients have experienced in the past, is that their new tooth-colored fillings seem to be mildly or even extremely sensitive to cold, and sometimes hot, foods and drinks, even just to tapping your teeth together. Naturally, it’s not a fun experience, and one that all conscientious dentists try to avoid for their patients, but even in 2009, when one would imagine there is a solution, many patients still run into this problem. Here’s the thing, though……..THERE IS A SOLUTION!
OK, you’re probably asking, if there’s a solution, why is it still a problem? Well, it’s simply a matter of technique, really, and getting the technique for bonding is actually more difficult than it might seem to be. In addition, just as in the rest of the world, there are MANY bonding products that dentists can use when doing tooth-colored fillings, but just because the companies that produce them supposedly have research behind these products, they’re not all they’re always promised to be. Some work better than others in strength, sensitivity, durability…..and it can honestly be rather tough to sort through all the stuff that companies throw at us, just like for physicians with all the stuff pharmaceutical companies throw at them. So it is CRITICAL that dentists really stay up on the latest research, but here’s the thing…..just because something has the “latest and greatest, newest and most improved,” labels all over it, that doesn’t mean it actually works as well as the old stuff all the time.
There’s one other REALLY CRITICAL FACTOR for long-term success of composite fillings, and that is keeping the teeth DRY while the bonding is placed and activated, then the filling material is layered into the tooth. Saliva contamination is one of the most common reasons for bonded fillings to be sensitive, and it’s also one of the most common reasons bonded composite fillings fail earlier than they should. There are a couple techniques dentists can and SHOULD use to do this – a Rubber Dam or something like the Isolite2 Dryfield Illuminator system. Both are pretty inexpensive for the dentist to have (we have both and use them as appropriate), both are pretty easy to use, and to tell the honest truth, they actually make it EASIER for us to complete your dental work faster and with better results. I really don’t know why not all dentists use 1 or the other; I can’t imagine practicing without them, ’cause it’s a lot harder to get good fillings!
So there you go: 2 of the most common reasons why bonded, tooth-colored, composite fillings are often sensitive to hot and cold foods/liquids or even just tapping your teeth together.
The good news in our office? I’m fortunate to actually know the man who basically INVENTED bonding, and I not only use the techniques he teaches, but I even use the most current materials that he himself has developed and/or recommends, and I can honestly say that ALMOST NOONE who gets tooth-colored fillings in my office ever has hot/cold sensitivity afterwards. There are rare exceptions, ’cause I’m not going to claim perfection, but they’re quite rare indeed.
OK – so I’m just going to be adding a LOT of information about periodontal (gum) disease and how the Periolase MVP-7 laser treats it so well; in addition, I’ll finally be getting around to adding more information on the significant health effects that gum disease can have, including:
- Increased risk of heart attack
- Increased risk of stroke
- Risk of worsening diabetes
- Increased risk of pre-term births
- Increased risk of low-birth-weight babies
Just so you know I’m not making this stuff up 🙂 , here are a few videos by national news programs that will help fill in the gaps:
And in case you missed Whoopi Goldberg talking about her gum disease on “The View,” don’t miss it again!
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!
Man oh man, am I excited! We are taking some bold new steps in technology here at Smiles by Payet Dentistry by upgrading to the newest version of our In-office, 1-Visit Crowns CAD/CAM system, the CEREC AC Bluecam, AND we’re FINALLY adding the Periolase MVP-7 laser to our practice, which is THE most effective treatment for gum disease available today. Lots more information will be forthcoming as we get closer to the equipment arriving. The Periolase will hopefully be in the office by late August, and the CEREC Bluecam by early September.
But what do each of these additions mean to YOU? Some pretty good things, actually:
1) The CEREC Bluecam is even faster and more accurate than my current CEREC 3D, and it’s software is designed to make doing 4-6 or more veneers/crowns much easier, faster, and better. The other really cool thing is that, even if we can’t do the actual restoration with the CEREC, it’s software allows us to take digital impressions and EMAIL them to the lab! That means NO MORE GOOEY IMPRESSIONS! And the accuracy is just phenomenal. With it’s speed and accuracy, we anticipate being able to complete a 6-10 tooth Smile Makeover in JUST ONE VISIT! How amazing would that be? It can be done with the current version I have, but it’s slow, clunky, and would take absolutely forever – no thanks.
2) As excited as I am about the Bluecam, what I’m MOST excited about is the Periolase MVP-7 laser. This is groundbreaking technology, but it’s not just the laser itself, it is that it’s backed by a FDA-approved, patented protocol for success, not just some company’s word that it works. The Periolase has more research backing it up on it’s successful treatment of gum disease than any other laser currently available. Periodontal disease is responsible for more teeth being lost/extracted even than cavities, and studies show that about 50% of all Americans currently have some level of gum disease, but only 7% actually get treatment. What makes this really crazy is that periodontal disease has been linked to a drastically increased risk of heart attacks, strokes, diabetes, as well as low birthweight and pre-term babies.
Much more news will be forthcoming about both of these fabulous new technologies that we’re adding for your benefit as we approach their delivery dates. Stay tuned, and be ready to call 704-364-7069 for a consultation or Make an Appointment Online.
I sure wish I had the HD video hookup for my dental microscope already, but since I don’t yet, I’ll keep showing you stuff with my Canon cameras. 🙂
One of the most incredible benefits of the microscope is the ability to work on levels of detail that aren’t even imaginable without one. And that means that I can do VERY VERY VERY VERY SMALL, CONSERVATIVE fillings. I use teensy little burs to remove the absolute minimum amount of tooth structure, not really big ones that dig out way more than necessary. I just wanted to show you an example of how this looks using a patient from this morning; the benefits of this are pretty obvious: