Tag Archives: Invisalign

Miami Dentists Now Offers Dexis Platinum X-ray

Cosmetic Dentistry, Digital X-ray, cosmetic dentists, Miami dentists, Fort Lauderdale dentists, South Florida cosmetic dentist, Boca Raton Dentistry, Fort Lauderdale Dentistry, Miami Dentistry, Invisalign Always at the cutting edge in dentistry, Dr. Charles Nottingham and his team at Smile South Cosmetic Dentistry are now offering the top-of-the-line Dexis Platinum Digital X-ray system to their patients. The Dexis system provides dentists with choices among various state-of-the-art sensors and comes with intuitive, easy-to-use imaging software.

Digital x-rays offer several advantages to patients. Gone are the days of waiting for X-rays to be developed. The cosmetic dentists can view the X-ray images instantly and review them with patients on the computer screen right away. Patients spend more time discussing their teeth with the dentist and less time waiting for the x-rays to be ready. Viewing digital x-rays with our Miami dentists and Fort Lauderdale dentists also means patients will have a better understanding of their dental needs and will be able to make informed decisions about their treatment.

Dexis digital x-rays are more environmentally friendly and expose patients to less radiation than other systems. The system is ergonomically designed to maximize patient comfort. The Dexis patented WiseAngle Cable Exit makes procedures more comfortable for patients and provides cable flexibil¬ity to reduce stress on the equipment and increase its reliability.

“The Dexis system is a very affordable and effective x-ray option,” says Nottingham, a South Florida cosmetic dentist “It gives me very precise and clear images, allowing me to make accurate diagnoses. It’s cost effective and it saves me time, which also lowers my costs. I’m able to pass those savings on to my patients in the form of lower charges.”

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South Florida Dentist Warns about Holiday Foods

When most people think of foods that can harm your teeth, they think of candy. “However, there are a lot of other foods to avoid,” says Dr. Charles Nottingham, a cosmetic dentist at Smile South Florida. “Unfortunately, many of them are popular during the holidays.”

Sugar: Sugar, of course, is the #1 culprit in causing cavities. The worst offenders are sticky foods like lollipops, hard candies, and gum drops. They give you a double whammy. Not only are they high in sugar, but they also stick to your teeth for a long time after you eat. Surprisingly chocolate is less like to be a culprit because it binds with fat molecules and doesn’t stick to teeth as well as other candies. If you do eat a lot of sugary foods, try to do so at mealtimes when increased saliva can wash sugar off teeth.

Starches: “Bread and potatoes are very popular parts of traditional holiday meals,” points out Dr. Nottingham. “But, the refined flour in white bread and the starch in potatoes are essentially sugars and so will affect your teeth the same way refined sugar does. So cut back on those rolls, mashed potatoes, holiday cookies, and potato chips.”

Alcohol: An occasional drink at a holiday party is okay. But excess alcohol wears away tooth enamel, discoloring teeth and making them vulnerable to cavities.

The good news is there are a lot of foods that are healthy for your teeth as well. “In general most fruits and vegetables help strengthen your teeth – as do a lot of foods containing protein,” says Dr. Nottingham.

Fruits and Vegetables: Any fruit or veggie with a lot of fiber will help out. Onions, celery, kiwis, parsley, and apples are all singled out by experts as being particularly good for your teeth. So look for holiday recipes that include these foods.

Dairy Products: In general cheese, yogurt, milk, and other dairy products (without added sugar), are good choices for the teeth. They help generate saliva which washes sugars off the teeth and they contain calcium, which strengthens them.

About Smile South Florida Cosmetic Dentistry
The cosmetic dentists at Smile South Florida Cosmetic Dentistry have offices in Broward County and West Palm Beach and provide Boca Raton Dentistry, Fort Lauderdale Dentistry and Miami Dentistry.

About Nottingham Consulting Group
Nottingham Consulting Group (NCG) is a business consulting firm specializing in business management, business coaching and marketing strategies.

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Dental Facelift Offered At Smile South Florida Cosmetic Dentistry

At Smile South Florida Cosmetic Dentistry, our top cosmetic dentists look at the whole picture when it comes to cosmetic and restorative dental work.

As we age, our teeth wear down and our faces appear more short. The cheeks also become sunken in and there is a collapse of the dental arches. This creates the appearance of more defined lines around the mouth and lower face, as well as an aging effect due to discoloration and reduced quality of the dental aesthetics. This is why Smile South Florida performs a dental restorative facelift.

dental facelift is the use of cosmetic dentistry to create the effect of a traditional facelift, without intrusive plastic surgery.

dental facelift can take years off of the face by restoring the fullness of the face lost over time. It can have a significant impact on not just the look of the patients face, but also on the function by having proper tooth, bite, and jaw alignment.

As we reach middle age, the dental arches, especially on the lower teeth, have a tendency to collapse inward given a sunken in look to the jaw. Widening the smile is one important method to help in giving back the fullness of the cheeks. We take into consideration replacing lost tooth structure and improving the height of the teeth. The teeth also start to become chipped, worncrooked, discolored, and can even fall out/be missing. This also presents severe aging effect to the mouth, and especially the entire face.

Here are some of the dramatic results that can be achieved through cosmetic and restorative dentistry at Smile South Florida:

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Smile South Florida Cosmetic Dentistry can give you back that youthful look to your ace, and keep you smiling all of the time.  Come in today for a complimentary consulation, and see if you are a candidate for a dental restorative facelift.  You can call our office toll-free or email us!

About Smile South Florida Cosmetic Dentistry

The cosmetic dentists at Smile South Florida Cosmetic Dentistry have offices in Broward County and West Palm Beach and provide Boca Raton Dentistry, Fort Lauderdale Dentistry and Miami Dentistry. The dentists specialize in dental aesthetics including porcelain veneers, dental implants, extreme makeovers, Invisalign, and sedation dentistry.

About Dr. Charles Nottingham

Charles Nottingham, D.D.S., Fellow in the Academy of General Dentistry, is an internationally and nationally renowned cosmetic dentist. He has been creating dazzling, healthy smiles for his patients since 1974.

About Dr. Kenneth Anenberg

Besides being an excellent cosmetic dentistDr. Anenberg specializes in Invisalign, a revolutionary alternative to metal braces, and sedation dentistrysleep dentistry.

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Smile South Florida Cosmetic Dentistry Is Offering A Limited Time Summer Invisalign Special To Both New And Current Patients

Many patients want to have the benefits of a beautiful straight smile, but do not want to be inconvenienced with wearing unsightly metal braces for several years. This is where the Invisalign method can make a difference. Invisalign is an alternative to traditional braces, where the patient uses a series of clear aligners that are custom molded to fit the patient’s teeth. The aligners are gradually repositioned over time to adjust the smile and give the desired result.

In contrast to traditional braces that are permanently fixed into the mouth during treatment, Invisalign braces are removable during eating and to brush the teeth. Heather, Marketing & Guest Services Coordinator for the South Florida Dentist, and current Invisalign patient said, “I wanted to have straight teeth for my upcoming wedding, but there was no way that I would be caught wearing metal braces for several years. This is my chance to have straight teeth in a short amount of time without anyone knowing that I am even wearing braces.”

Currently, Smile South Florida is offering a 25% off regular price special on Invisalign treatment that will run until September 1st, 2009. This offers a huge savings to the patient, especially since Invisalign is typically not covered by many dental insurance plans.

Dr. Kenneth Anenberg is the premier Fort Lauderdale Cosmetic Dentist at Smile South Florida, who specializes in the Invisalign treatment for patients. When discussing with Dr. Anenberg the reasoning for this discounted special, Dr. Anenberg mentioned that “there are so many patients who really need help, but cannot regularly afford this treatment…. This is their opportunity to get Invisalign.”

About Smile South Florida Cosmetic Dentistry

The cosmetic dentists at Smile South Florida Cosmetic Dentistry have offices in Broward County and West Palm Beach and provide Boca Raton Dentistry, Fort Lauderdale Dentistry and Miami Dentistry. The dentists specialize in dental aesthetics including porcelain veneers, dental implants, extreme makeovers Invisalign, and sedation dentistry.

About Dr. Charles Nottingham
Charles Nottingham, D.D.S., Fellow in the Academy of General Dentistry, is an internationally and nationally renowned
cosmetic dentist. He has been creating dazzling, healthy smiles for his patients since 1974.

About Dr. Kenneth Anenberg
Besides being an excellent
cosmetic dentist, Dr. Anenberg specializes in Invisalign, a revolutionary alternative to metal braces, and sedation dentistry & sleep dentistry.

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Beverly Hills Cosmetic Dentists of Bedford Dental Group Launch New Website

The Bedford Dental Group in Beverly Hills, California, gives everyone in the Los Angeles area a chance to experience the very best in general and cosmetic dental services. Thoroughly trained and experienced in all dental areas, cosmetic dentists Daniel Naysan, D.D.S. and Mehdi Nayssan, D.D.S. perform everything from Zoom! teeth whitening and Invisalign to porcelain veneers and dental implants, using a variety of safe and relatively painless practices. They excel in making your smile bright and attractive, and will cater to your every need throughout the entire process.

Bedford Dental Group recently launched a new website, www.bhdentists.com, to compliment their successful dental practice. The site is very informational and covers the many different services offered, such as dental implants, direct composite bonding, porcelain veneers, teeth whitening, dental crowns, dental bridges, root canals, porcelain fillings, tooth extractions, grafting, dental cleanings, dental check-ups and TMJ treatment. It also includes a variety of images, including before and after photos of their patients.

Daniel Nayssan, D.D.S. is a member of the American Dental Association (ADA), the California Dental Association (CDA) and Los Angeles Dental Society, and is also a member of the Alpha Omega dental fraternity. He has earned an advanced certification for treating patients with the Invisalign system, and continues to practice all forms of general and advanced cosmetic and general dentistry. Dr. Naysan is featured in a video to be found on the home page of the website. The video provides a brief tour of the dental practice, a glimpse into the office ideology, and includes real patient testimonials.

Whether it’s a routine dental exam to check for problems before they grow or receiving a dental implant to replace a lost tooth, Bedford Dental Group’s commitment to combining excellent dental care with indulgent customer service makes your visit one to look forward to! Call (310) 278-0600 or visit http://www.bhdentists.com to arrange an appointment.

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Las Vegas Invisalign Orthodontics Patients In Las Vegas, Nevada Now Have Something Amazing To Smile About

Dr. David Alpan and Aesthetics Orthodontics offer a virtually invisible way to get the straighter teeth and beautiful smiles they’ve always dreamed about—with no brackets, no wires, and no hassle. One of the most convenient and comfortable teeth straightening options available today, the Invisalign system lets each patient keep her orthodontic treatment to herself, using a series nearly undetectable aligners to produce a dazzling smile and the confidence she craves.

Affecting over 75% of the population in the United States, malocclusion, or the misalignment of teeth, is one of the most common reasons that patients seek dental care. The metal braces that have been used for years to treat malocclusion are difficult to care for, require restrictions on the patient’s diet, can be uncomfortable to wear, and are quiet noticeable.

In contrast, the Invisalign system consists of removable clear plastic trays that are both comfortable to wear and convenient to care for. These aligners gently shift the patient’s teeth, over time, into the smile he’s always wanted, with none of the bother of braces. Other types of invisible braces, like those worn on the backs of the teeth or those made of ceramic rather than metal, can certainly be less noticeable than traditional braces, but only Invisalign offers the patient complete freedom when it comes to what he eats and how he brushes—the trays are simply removed when necessary.

Invisalign aligners are created just for the individual patient, based on a custom treatment plan. Each set is worn for two weeks, and then replaced by the next set in the patient’s personalized series. As the patient works her way through her series of aligners, she begins to see positive changes in her smile. The aligners straighten teeth over time, ultimately leaving the patient with the beautiful smile she’s been waiting for.

A leader in the field and a top Las Vegas Invisalign orthodontist, Dr. David Alpan has been a certified Invisalign provider since 1999. Since 2001, Dr. Alpan has worked with Align Technology, the maker of Invisalign to train other Invisalign dentists in the use of this highly effective and popular tooth straightening method. To date, Dr. Alpan has trained over 6,000 Invisalign providers, and he currently works as a study club leader for new Invisalign orthodontists.

Dr. Alpan is a 2009 Elite Invisalign Premier Provider and a member of the InvisalignCentury Club, an honor awarded to the top 100 Invisalign providers in the United States. Dr. Alpan and his team at Aesthetics Orthodontics work hard to stay abreast of the latest advancements in the field in order to bring their patients the most comfortable and effective treatments modern orthodontics has to offer.

In addition to the Las Vegas office, Dr. Alpan has locations in Beverly Hills and Los Angeles.

His team at Aesthetics Orthodontics is committed to delivering comfortable, effective orthodontic treatment in a pleasant, caring environment. Along with Invisalign and other treatments for malocclusion, Dr. Alpan and his team provide TMJ/TMD treatment and treatment for Muscular Skeletal Disorders (MSD) to help provide relief for patients suffering from headaches, neck and back pain, and other neuromuscular symptoms.

Las Vegas Invisalign, Las Vegas braces, clear braces, teeth straightening options, invisible braces, invisiline braces, invisalign dentist, straighten teeth tooth straightening, malocclusion, braces, aligners, teeth, dentist, orthodontics, Las Vegasorthodontist

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Los Angeles Invisalign

At Los Angeles Invisalign Orthodontists – there is effective and definitive treatment available to address your crooked or misaligned teeth or jaws. In Beverly Hills and Los Angeles you need Dr. David Alpan and his Aesthetic Orthodontics team. Aesthetic Orthodontics is your source for information on orthodontic alignment including the new option to traditional, visible braces: Invisalign.

While many patients will still require the use of traditional braces to achieve optimal results,Invisalign is fast become a preferred option of treatment where possible. Invisalign does precisely what it name implies: It aligns teeth invisibly. Invisalign features a series of trays that are worn on the teeth. Each tray is used in sequence (changed every two weeks) and incrementally moves teeth into their ideal position. This process usually takes two years.

Traditional orthodontic treatment also can take up to two years, and sometimes longer for particularly complex cases, or cases involving mature patients (over the age of 25). Traditional orthodontic treatment may include the wearing of braces only, or may include surgical treatment. The exact staging of your treatment including any extraneous surgeries will be planned with Dr. Alpan, your general dentist and oral surgeon if necessary. If general dentist or oral surgeon services are required during this process, they will discuss their roles in your treatment specifically and offer you estimates for their aspect of the treatment.

Each treatment plan is designed according to each individual patient to address their needs and wishes. Your treatment plan may include:

1) The wearing of orthodontic brackets to move teeth into their ideal position;

2) Extraction of wisdom teeth: Wisdom teeth are known nuisances to ideal orthodontic alignment. There is the potential that they could affect successful alignment of teeth, or it may be that their removal will provide sufficient space to allow movement of the neighboring teeth. Wisdom teeth can also affect jaw alignment surgery;

3) Jaw alignment surgery. If this is an option in your treatment, it will often be done at the same time as extraction of your wisdom teeth. This surgery is meant to set the upper and lower jaws in their optimal position in relation to each other. This helps establish a function and healthy bite while chewing and a better facial profile in cases of underbites and overbites;

4) Expansion appliances may also be necessary to expand the upper jaw so that teeth meet properly for chewing.

Many times orthodontic alignment is also a chance to fix certain structural and profile issues associated with the mouth, cheeks, and lips and other deformities. Perhaps this is one other reason you have decided to investigate orthodontic movement. If not, it is something that you should be aware of. Dr. Alpan can discuss all the potential outcomes and risks involved. If you have any questions whatsoever, please discuss them before deciding to go ahead with treatment. If over the course of treatment you have questions or concerns, do not hesitate to contact Aesthetic Orthodontics’ Los Angeles office.

Remember each treatment plan is client specific and can only be determined and developed upon consultation and visual and radiographic evaluation by Dr. David Alpan. Please schedule an invisalign consultation, today, to discuss your treatment options.

Los Angeles Invisalign – Invisalign Los Angeles, California.

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Full-Mouth Rehabilitation and Bite Management of Severely Worn Dentition

Introduction
Creating a beautiful smile for a patient is extremely rewarding for the dentist as well as for the team, and this should never be taken for granted. We are blessed with the ability to change someone’s self esteem, confidence and, possibly, the course of their life.

The case presented here was featured on the cover of the Spring 2008 issue of The Journal of Cosmetic Dentistry. While it was quite challenging, I will never forget this case,, as it changed the life of a recovering bulimia patient. Eating disorders affect approximately seven million people in the United States. Although I have seen the effects of bulimia on the dentition previously, never have I witnessed it to this extent.

The patient was diagnosed with loss of vertical dimension as a direct result of bulimia and bruxism.

Patient History
The patient, a 30-year-old female, wanted to improve her smile and to address the constant fracturing of her teeth. Although it was difficult for her to discuss, she told me about her history of bulimia and that after a long struggle, she is now recovered. She was ready not only to change her smile, but also to see what could be done about her “collapsing” face, as she put it. She confessed that her unwillingness to smile was affecting her socially and that she always covered her mouth when she laughed (Fig 1).

Clinical Evaluation and Diagnosis
After performing a thorough clinical examination, I noted a severely worn dentition, widespread abfraction lesions, and multiple fractured teeth and restorations. The palatal surfaces of the maxillary anterior teeth were completely eroded and devoid of enamel, as is typically seen with bulimic patients (Figs 2 & 3). As expected, the patient’s teeth were very sensitive to temperature changes. Tooth #5 had been extracted due to a fractured root, and in its place was a successfully osseointegrated implant (Straumann USA; Andover, MA) that had been placed one year earlier. She had lost approximately 30% of the length of her central incisors due to attrition. Upon radiographic examination, no severe decay or pulpal pathology was evident. Periodontal probing depths were within normal limits.

The patient suffered f r o m many typical symptoms of temporomandibular disease (TMD), such as joint pain, severe headaches, tinnitus, and orofacial muscle pain with spasms.1These symptoms were not surprising, as craniomandibular dysfunction is often seen with loss of vertical dimension. She was also a severe bruxer and said this provided her with relief. Due to this vertical loss, the lower third of her face was collapsed and disproportionate. The patient was diagnosed with loss of vertical dimension as a direct result of bulimia and bruxism; this was accompanied by multiple fractured, eroded teeth, and worn restorations. Additionally, the patient had facial asymmetry and multiple TMD symptoms due to craniomandibular dysfunction.2

She tolerated the orthotic well and felt much better with it in place.

Treatment Plan
Initially this case was overwhelming, as there were so many factors necessary to achieve a successful treatment outcome. After mounting and studying the casts, it was obvious that the patient’s vertical dimension had to be increased to a proper, comfortable position, which has been called the physiologic neuromuscular position.3 Once this position was determined, an orthotic appliance would be worn to verify that this proposed position was in fact well tolerated and that the TMD symptoms had decreased significantly. During the orthotic therapy phase, this appliance would be worn for a minimum of three months (for a minimum of 22 hours a day), to determine whether it would help before any permanent alteration of the patient’s teeth.

During this time, her condition would be evaluated for elimination of symptoms, proper occlusion, improvement in facial symmetry, esthetics, and acceptable phonetics. If we had not seen improvements during the orthotic phase, the first thing we would have looked at was compliance. If it had been determined that the patient was not wearing the appliance as instructed, or if the therapy had had to be extended beyond three months (due to inconsistent symptoms or an unstable bite position), we would have used a fixed orthotic appliance, which would have been fabricated to the same vertical dimension as the removable orthotic.4

The goal, for any clinician, is to find a position in which the patient’s symptoms are eliminated, or at least decreased significantly. The facial and dental esthetics also must be greatly enhanced. Although there is more than one way to find this physiologic position, in this case I objectively measured muscle activity by using electromyography (EMG) instrumentation (Myotronics-Noromed; Kent WA). This enabled me to locate the correct resting position for the mandible where the muscles are at rest, as well as the correct opening and closing trajectory.5 During the course of orthotic phase therapy, which can last several months to a year, the patient returns to verify the bite and evaluate symptoms several times. Once it is determined that the patient is comfortable, facial esthetics are improved, and the EMG muscle activity is verified to be physiologic, then the restoration phase can begin.6,7

Treatment Discussion
The first step in this case was to determine how much to increase the patient’s vertical dimension. Once this position was determined, it was imperative to test and verify it; and, most importantly, to maintain it throughout the different phases of treatment. The treatment phases were as follows: Orthotic, preparation, temporization, and cementation.

Finding the Bite
To evaluate the state of the patient’s habitual bite position, we had to record and evaluate EMG readings of several muscle groups bilaterally (K7 instrumentation, Myotronics-Noromed). The muscle groups measured were the anterior and posterior temporalis muscles, the masseters, and the anterior digastrics. Electrodes were placed over these muscle groups and electromyographic recordings were made. High EMG readings represented a state of muscle hypertonicity and unrest. The goal was to find the occlusion where the muscles that control jaw position are in a relaxed state, and therefore are at their ideal resting length for optimal function and comfort.8,9

To find a more optimal bite position, a series of diagnostic tests were performed. These included electrosonography to record and analyze joint sounds, electromyography to record and analyze muscle activity, and computerized mandibular scanning (CMS) to track and analyze jaw movements. It was determined that the patient’s habitual occlusion was in a muscular state of hyperactivity when at rest and in light centric occlusion (Fig 4). In order to relax her muscles, which were in a chronic spasmodic state, ultra-low frequency transcutaneous electrical neural stimulation (TENS) was applied using a myomonitor (Myotronics). The myomonitor stimulates cranial nerves V, VII, and XI to relieve hypertonicity, restore normal blood flow, and wash away toxic wastes such as lactic acid. This restores the muscles temporarily to a relaxed and normal resting length (Fig 5). These muscles become “deprogrammed,” and, by measuring their pre- and post-relaxation status, we are provided with precise and objective comparative data.10,11 The details of all the tests performed during the three-hour diagnostic appointment are beyond the scope of this article.

The position at which this patient’s muscles were in their most relaxed state was captured by using a polyvinyl siloxane bite registration material (Regisil, Dentsply Caulk; Milford, DE). Impressions were then taken (Aquasil Ultra, Ivoclar Vivadent; Amherst, NY) and sent to the laboratory with the bite to fabricate a lower removable orthotic. Upon delivery of this appliance, I explained to the patient that it must be worn a minimum of 22 hours a day. Each follow-up visit always consisted of 45 minutes of TENS, followed by any necessary occlusal adjustments to the orthotic. The patient was seen at one-, two-, three-, four-, and sixweek intervals. She tolerated the orthotic well and felt much better with it in place; therefore, compliance was not an issue.12,13

Once it was determined that the bite was stable and that symptoms were significantly reduced, EMG recordings were taken again to verify that the muscles were not hypertonic in this new position. In this case the EMG readings were more than satisfactory, and the patient’s headaches and other symptoms were reduced significantly. Therefore, I had great confidence as to where to restore her occlusion.14 Her bite was opened 4 mm. The next phase of treatment was the restorative phase.

Bite Management
(Laboratory Phase) Much effort was spent determining the proper physiologic position for this patient, and much care had to be taken in managing and maintaining this position throughout the course of treatment. Prior to the preparation appointment, new impressions were taken and sent to the laboratory, along with the actual adjusted orthotic to mount the case. In addition, three measurements were provided so that the laboratory could verify that the case was properly mounted. These measurements were taken with a digital Boley gauge. The areas measured were where the most apical areas of tooth surface intersect with the gingiva between teeth #8 and #25, #14 and #19, and #3 and #30 (Figs 6 & 7). In this situation, the dentist and the laboratory must measure in the exact same three locations throughout the course of treatment, so as to ensure accuracy and precision in maintaining the new vertical (Figs 8 & 9).

Once the laboratory mounted the casts with the adjusted orthotic in place and the three measurements were verified, a bite stent (Sil-Tech, Ivoclar Vivadent) was made, to be utilized during the preparation appointment to ensure accuracy in maintaining the new vertical dimension. The appliance was then immediately returned to the patient so that she could continue to wear it. The laboratory also was provided with detailed instructions concerning the smile design, including widths and lengths of anterior teeth, shapes, and proportions.15

Because the patient’s maxillary anterior teeth were short, it was determined that crown lengthening was necessary to support the restorations. Therefore, the proposed amount of hard and soft tissue removal was relayed to the laboratory so that they could compensate for the change in measurement in this area. With this information in hand, they waxed up the 28 teeth in the new position, taking into consideration the hard and soft tissue reduc-tion in the anterior; and once again verified the three measurements (Fig 10). From this wax-up, they prepared a temporization stent made f r o m Sil-Tech putty and relined with a light-body wash material (Aquasil XLV, Dentsply Caulk). This would be used to fabricate the 28 temporaries after tooth preparation, with the same vertical dimension and occlusion as the orthotic.

Bite Management
(Preparation Phase) Prior to the preparation appointment, I ensured that I received everything necessary f r o m the laboratory. First, I verified that the waxed-up models were consistent with the three measurements I had provided to the laboratory, by measuring the teeth in the exact same three locations. Second, I verified that I was satisfied with the smile design and occlusion. As this was to be a lengthy appointment, the clinical team met and reviewed procedures.

After the patient was seated, I verified the bite stent that had been made on her unprepared, mounted models by placing it in her mouth and having her close down on it. I again measured the same three locations and verified that those measurements were the same as they were with the orthotic in place (Fig 11). I was confident that all of my numbers were accurate, so it was time to begin preparing the teeth.

It was imperative not to lose control of the bite at any time during the preparation.

After anesthetizing the patient, the first step was to perform the soft and hard tissue crown lengthening in the maxillary anterior region to improve the length of her short clinical crowns. To accomplish this, I used an Er,Cr:YSGG hard/soft tissue laser (Waterlase, Biolase Technologies; Irvine, CA) and at the same time performed a frenectomy between the maxillary central incisors. Using this laser provided a predictable result and gave me a clean field within which to work. I removed 1.2 mm of tissue and therefore changed the location of my uppermost point for measurement after the crown lengthening. I had to adjust my number for verification f r o m this point on, in this area only16 (Fig 12).

It was imperative not to lose control of the bite at any time during the preparation. To help in maintaining this vertical dimension, I used the bite stent provided by the laboratory to sequentially reline it while I prepared one quadrant at a time. Beginning with the upper right quadrant, I prepared ##3-8, while leaving #2 unprepared to provide extra stability while I relined the bite stent. To register the bite, I sat the patient upright and placed a small amount of fast-setting bite registration material (Regisil Rigid) in the bite stent, being careful not to overfill it and to reline only the prepared teeth. This was then placed in the mouth with the patient biting into it. While the stent was in her mouth, the same three locations were measured again, remembering that the anterior area had a new measurement. If the measurements had not matched those taken previously it would have been necessary to repeat the reline, as the patient might have been biting incorrectly or the bite stent might not have been seated over the teeth properly.

Once it was determined that the measurements were correct, the stent was removed, trimmed, and set aside for the next quadrant. The same procedure was repeated for the upper left quadrant, preparing ##9-14 and leaving tooth #15 unprepared. This quadrant was then relined the same way. After the measurements were verified, I prepared #2 and #15 (Fig 13). This procedure was repeated for the bottom right quadrant and then the bottom left. A final check of the measurements was made and the bite stent was set aside to send to the laboratory along with final impressions. For these, I used a PVS heavy-body material and an extra-low viscosity wash material (Aquasil Ultra-heavy and XLV). A symmetry bite was also taken, indicating to the laboratory the proper occlusal plane and midline. Photographs of the preparations, which showed the measurements with the final bite stent seated and with the symmetry bite in place, were provided for the laboratory.

Temporization
The provisional restorations were fabricated using the temporary stents made f r o m the wax-up. The stents were filled with temporary material (Luxatemp shade B1, Zenith/DMG; Englewood, NJ) and placed over the maxillary prepared teeth. After three minutes the stent was removed, as was a small amount of flash. This procedure was repeated for the bottom teeth. Once the provisionals were in place, all three measurements were once again verified; at this time we evaluated esthetics and occlusion. To properly maintain the health of the gingival tissue during the four-week provisional phase, the patient was given a sonic toothbrush (Sonicare, Philips Healthcare; Andover, MA), as well as instructions on how to use rubber tips to massage her tissue. A follow-up visit was scheduled for the next day to confirm that the occlusion was comfortable and that we were both satisfied with the smile design.

Laboratory Communication
Proper communication with the laboratory is crucial for a successful outcome in each and every case sent to our ceramist. In this case, it was important to send as much information as possible with regard to maintenance of the patient’s vertical dimension, as well as esthetics. Photographs showing all three measurements in the final bite stent, as well as in the provisionals, were sent to the laboratory. In addition, retracted frontal and lateral views of the preparations were provided, as well as a picture showing the prepared shade (Vita A3, Vident; Brea, CA).17 When the laboratory received the case, the first step was to verify the measurements after mounting the prepared models. This was accomplished by using the relined bite stent and verifying the accuracy of the vertical dimension in the same three locations.

For the smile design, we decided on a “soft” look with square oval central incisors and slightly rounded laterals and canines, with the lateral incisors 0.5 mm shorter than the centrals. The requested width of the central incisors was 8.25 mm and the length was 10.75 mm. The lateral incisors were approximately 10.25 mm long. Golden proportion rules and smile design principles were adhered to, which provided the patient with a very soft and esthetically pleasing smile. Our final shade choice was OM2 body with a cervical blend to OM3 (Vita 3D Master shade guide), with the canines blending f r o m OM2 to 1M1 cervically. We selected Authentic pressable ceramic (Jensen Indus-tries; North Haven, CT) for all anterior teeth and bicuspids, using an OP1+ ingot with cutback technique and adding intense opaque modifiers to increase vitality and a natural appearance (Fig 14).18All of the molars were restored with Noritake CZR pressable ceramic (Zahn Dental, Henry Schein; Melville, NY) over zirconia copings.19 The #5 implant was restored with a custom abutment with Creation porcelain (Jensen Industries). Prior to the fabrication of the restorations, the models were mounted using the preparation bite stent, and all the measurements were verified by the laboratory (Figs 15-18).

Cementation
After we received the case f r o m the laboratory, I checked the restorations on the models for proper margins and contacts, and to ensure that the smile design had been followed. Once all the restorations were mounted on the models, the three areas were measured to verify that the laboratory maintained the vertical dimension. Once the patient was anesthetized, the provisional restorations were removed. The prepared teeth were cleaned with pumice, followed by hydrogen peroxide and chlorhexidine (Consepsis, Ultradent; South Jordan, UT). Each restoration was tried on with water and inspected individually. Contacts and margins were examined, as was the overall smile design.

Once we were satisfied with restorations, they were cleaned with 37% phosphoric acid, rinsed, dried, and set aside. The molars were cemented first using Multilink (Ivoclar Vivadent), a self-etching universal resin cement, with the inside of the restorations coated with the metal/zirconia primer (Ivoclar Vivadent). Then all of the remaining upper teeth except #5 were etched with 37% phosphoric acid and rinsed, after which a wetting agent was applied (Super Seal, Phoenix Dental; Fenton, MI).20 Then the bonding agent (Excite, Ivoclar Vivadent) was placed on the teeth according to manufacturer’s directions and light-cured. The restorations, which had previously been etched with hydrofluoric acid, were coated with Silane primer (Kerr; Orange, CA). The luting resin used for cementation was Variolink Veneer +2 (Ivoclar Vivadent). All of the restorations were placed simultaneously and spot-cured. The excess was then removed, followed by the final light-cure. Tooth #5 was cemented with implant cement (Premier Dental; Plymouth Meeting, PA).21 The same technique used on the maxillary teeth was applied to the lowers. Once all teeth were cemented, the three measurements were once again verified to confirm maintenance of the vertical dimension (Fig 19). The patient returned for follow-up appointments to make sure her bite was stable and that she remained symptom-free.

Conclusion and Discussion
This patient’s case involved many of the challenges we face daily in our practices. Just a few years ago, however, I would not have known in which direction to take her treatment. Perhaps I simply would have provided her with a bruxism appliance, while “patching up” some of her fractured restorations and attempting to improve her smile by restoring some of her anterior teeth with direct resins. These would have failed repeatedly, causing us both much frustration.

I conducted a series of diagnostic tests using computerized instrumentation, which provided me with objective data that I was able to use in my treatment planning.

The key point is that this patient initially exhibited severe occlusal disharmony and craniomandibular dysfunction. This can be the case in many of our patients, and much effort should be spent in proper diagnosis and treatment planning.22 I did not prepare 28 teeth in one visit and deliver them a few weeks later. Instead, I conducted a series of diagnostic tests using computerized instrumentation, which provided me with objective data that I was able to use in my treatment planning. Not until the patient’s new vertical dimension position was tested for several months did I dare touch a single tooth with a handpiece. Once I did, however, it was with great confidence, because I knew in which direction I was headed (Figs 20 & 21).

It is well accepted that there is more than one philosophy or method that can be utilized to arrive at a physiologic bite position. A discussion of these different philosophies— whether centric relation, centric occlusion, or neuromuscular—is beyond the scope of this article.23 However, as responsible clinicians, we should study the different treatment modalities available to our profession before making a decision as to which one suits us. Whichever method you apply in your practice, the most important factor is that it must be in your patients’ best interests.24 Before proceeding to final restorations, it is imperative to establish a comfortable, stable bite derived f r o m verifiable, objective clinical data (Figs 22-29).

Acknowledgments
The author thanks Duckee Lee, CDT (Protech Dental Studio, Sterling, VA), for his passion, talent, and technical excellence in creating the beautiful restorations in this case. A debt of gratitude also goes to the American Academy of Cosmetic Dentistry for 13 years of excellent continuing education, camaraderie, and a remarkable credentialing program, in which he learned during his Accreditation journey that, “your hand can only perform what your eyes have been trained to see and comprehend”; and to the Las Vegas Institute for Advanced Dental Studies for its dedication to postgraduate education. Finally, thanks, appreciation, and best wishes goto Erica, the patient in this case, for her patience, kind spirit, and courage.

References

1. Okeson JP. Management of Temporomandibular Disorders and Occlusion (3rd ed.). St. Louis, MO: Mosby; 1985.

2. Coy RE, Flocken JE, Adib F. Musculoskeletal etiology and therapy of craniomandibular pain and dysfunction. Cranio Clin Int 1(2):163-173, 1991.

3. Jankelson RR. Neuromuscular Dental Diagnosis and Treatment. Volume 1 (2nd ed.). Tokyo: Ishiyaku EuroAmerica; 2005.

4. Naeije M, Hansson TL. Short-term effect of the stabilization appliance on masticatory muscle activity in myogenous craniomandibular disorder patients. J Craniomand Disord Facial Oral Pain 5:245-250, 1991.

5. Ormianer Z, Gross M. A 2-year follow-up of mandibular posture following an increase in occlusal vertical dimension beyond the clinical rest position with fixed restorations. J Oral Rehab 11:877-883, 1998.

6. Liu ZJ, Yamagata K, Ito G. Electromyographic examination of jaw muscles in relation to symptoms and occlusion of patients with TMJ disorders. J Oral Rehab 26(1):33-47, 1999.

7. Neill DJ, Howell P. Computerized kinesiography in the study of mastication in dentate subjects. J Prosthet Dent 55(5):629-638, 1986.

8. Mongini F, Tepia-Valenta G, Conserva E. Habitual mastication in dysfunction: A computer-based analysis. J Prosthet Dent 1:484-494, 1989.

9. Jankelson B. Three dimensional orthodontic diagnosis and treatment: a neuromuscular approach. J Clin Orthod 18(9):627-636, 1984.

10. Ow RK, Carlsson GE, Jemt T. Craniomandibular disorders and masticatory mandibular movements. J Craniomand Disord Facial Oral Pain 2(2):96-100, 1988.

11. George J, Boone M. A clinical study of rest position using the kinesiograph and myomonitor. J Prosthet Dent 41(4):456-462, 1999.

12. Konchak P, Thomas N, Lanigan D, Devon R. Freeway space using mandibular kinesiography and EMG before and after TENS. Angle Orthod 58(4):343-350, 1988.

13. Balciunas BA, Stahling LM, Parente FJ. Quantitative electromyographic response to therapy for myo-oral facial pain: A pilot study. J Prosthet Dent 58:366-369, 1987.

14. Isberg A, Widmalm S, Ivarsson R. Clinical, radiographic, and electromyographic study of patients with internal derangement of the temporomandibular joint. Am J Ortho 88(6)453-460, 1985.

15. Griffin JD. How to build a great relationship with the laboratory technician: Simplified and effective laboratory communications. Contemp Esthet 10(7):26-34, 2006.

16. Colonna M. Crown and veneer preparations using the Er,Cr:YSGG Waterlase hard and soft tissue laser. Contemp Esthet Rest Pract 10:80-86, 2002. 17. Bengel W. Mastering Dental Photography Hanover Park, IL: Quintessence Pub.;2002.

18. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach. Hanover Park, IL: Quintessence Pub.; 2002.

19. Ludwig K. Studies on the ultimate strength of all-ceramic crowns. Dent Laboratory 39:647-651, 1991.

20. Kanca J. Improving bond strength through acid etching of dentin and bonding to wet dentin surfaces. JADA 123:35-44, 1992.

21. Garg AK. Practical Implant Dentistry (1st ed.). Dallas, TX: Taylor Publishing; 2007.

22. Tingey EM, Buschang PH, Throckmorton GS. Mandibular rest position: A reliable position influenced by head support and body posture. Am J Orthod Dentofac Orthop 120(6):614-622, 2001.

23. Pully ML, Carr S. Solving the pain puzzle: Myofascial pain dysfunction (3rd ed.). Albuquerque, NM: TMData Resources; 1997. 24. Shankland WE . Temporomandibular disorders: Standard treatment options. Gen Dent 52(4):349-355, 2004.

 

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I Have Never Seen A Smile Gallery As Extensive As Smile South Florida’s And Where The Final Result Of Every Case Is Of Such A High Standard

Want to see the results produced by the professionals at Smile South Florida Cosmetic Dentistry? The proof is on the walls.

Congenially Missing TeethNothing seems to show what a dental procedure can do for an individual like before-and-after photos.

With that in mind, Smile South Florida Cosmetic Dentistry in Fort Lauderdale created a Smile Gallery to show patients the great results that can be achieved through cosmetic dentistry.

“It’s one thing to tell patients what we can do for them,” said Dr. Charles Nottingham, a cosmetic dentist who is the senior partner at Smile South Florida Cosmetic Dentistry. “It’s another thing to show them.”

Nestled within each elegant bronze frame that lines the newly renovated hallways, are two (8-inch x 10-inch) photos of patients’ smiles- one before photograph displaying their dental procedure and one after.

Missing and Misaligned Teeth“The patients love it,” said Office Manager Marianne Taylor. “This was the best thing to ever happen because patients see these photos and seem to feel encouraged that they are going to leave here with their desired results.”

When Taylor discusses procedures such as laminates orporcelain veneers with patients, she can walk them through the hallway and point to a visual of how the completed procedures look.

Several types of procedures are featured in the Smile Gallery.

Congenital Malformation

It is not uncommon for people to be born without certain teeth. More than five percent of people lack upper second incisors or second premolars. One example of this in the Smile Gallery shows how a patient’s missing anterior teeth were restored using two fixed porcelain Lava Bridges. The premolars were restored with porcelain veneers.

Overlapped, Crowded and Crooked Teeth

Teeth that are overlapped, crowded or crooked can cause oral health problems, such as periodontal disease, cavities and uneven wear. One example pictured in the Smile Gallery shows how a patient’s smile was restored by placing porcelain crowns on the upper teeth to give the patient a straighter, wider smile than her original upper arch, which was too narrow and tilted inward.

Poorly Shaped Teeth

Photos in the Smile Gallery show how natural teeth that are oddly shaped and pointed in different directions can be improved with porcelain restorations.

Reverse Smile and Small Teeth

An imaginary line around the incisal edges of the upper front teeth should follow the superior border of the lower lip. This is called the “smile line.” When the centrals appear shorter than the canines, this is referred to as the “reverse smile line.” Smile Gallery photos show how this problem can be corrected by using porcelain veneers and crowns to create longer central teeth, a wider arch and improve the shape of the teeth.

Spaces, Stains and Failed Fillings

One dramatic Smile Gallery photo shows how proper fitting and anatomically correct porcelain crowns were used to close the spaces between teeth, decrease the flair of upper anterior teeth and re-contour the teeth.

“The Smile Gallery not only shows patients various types of dental improvements achieved through cosmetic dentistry, it gives patients confidence to follow through with suggested procedures”, Taylor said.

Taylor recalled a recent patient who was so self-conscious about her teeth; she feared showing them to the dentist. Once Taylor walked the patient through the smile gallery and showed her the ‘before’ pictures of several other patients, the woman felt less self-conscious.

“This woman thought she was going to be the absolute worst case the doctors had ever seen,” Taylor noted. “One trip through the Smile Gallery showed her this was not true.”

About Smile South Florida Cosmetic Dentistry

The dentists at Smile South Florida Cosmetic Dentistry have offices in Broward County and West Palm Beach and serve patients from Boca Raton to Fort Lauderdale and Miami. The dentists specialize in dental aesthetics including porcelain veneers, dental implants, extreme makeovers, Invisalign, and sedation dentistry.

About Dr. Charles Nottingham

South Florida Dentist & Dentist in Florida, Charles Nottingham, D.D.S., Fellow in the Academy of General Dentistry, is an internationally and nationally renowned cosmetic dentist. He has been creating dazzling, healthy smiles for his patients since 1974.

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Lumineers: Some Common Misconceptions

We, at Smile South Florida Cosmetic Dentistry, pride ourselves on giving you the highest level of customer service and latest technology in dentistry offered today. We are always upfront with our patients and treat them as if they are all a part of our dental family.

Our goal is to educate patients on some common misconceptions in dental marketing that can be misleading and not give the entire story. One such example is with the popular brand Lumineers by Cerinate.

Lumineers are considered a type of porcelain veneer “smile shaper” that boasts catch phrases such as “no reduction of tooth structure (no filing down of teeth), no shots, 2 easy dental visits, permanently whitens” and many others. While these statements can have some string of truth behind them, in most cases this will not be the situation –not if you ask any top cosmetic dental professional.

While the popular Lumineers can, in very few situations, be completed in 2 easy visits with little to no pain, drilling, and preparation, this is not going to be necessarily true for everyone. It all depends on the condition of the teeth, and what the best treatment scenario would be to give the best aesthetic outcome. If a patient has very bulky teeth and wanted to place even the “contact lense thin” Lumineer shell over the tooth, some preparation and drilling would be necessary for the outcome to have a better, less bulky look. There are other situations where the patient would not be a candidate for Lumineers. It would all need to be determined by a cosmetic dentist.

As far as the color and shade of the Lumineers, there is not a variety of color choiceslike traditional veneers. Veneers colors and shades are specifically selected by the doctor and the patient together so that the best result is achieved. With Lumineers, there is no variation so everyone will get the same result regardless of what the best color/shade would be for each individual person.

If you look at the before and after photos featured on the Lumineers website, you will see some improvements in the look of the teeth after Lumineers have been used. I am not discrediting that they can make a change in people’s dental aesthetics; however, compared to traditional veneers and crowns, the differences are very substantial. If you look at our smile galleries and the before and after pictures, you can compare the dramatic differences in the quality of the aesthetics for our patients.

When you are thinking of a south florida dentist or a dentist in florida for Lumineers treatment, make sure you do your research to make an informed decision, and consult a dental professional that has done extensive quality veneers cases.

The dentists at Smile South Florida Cosmetic Dentistry have offices in Broward County and Boca Raton and provide patients Boca Raton Cosmetic Dentistry, Fort LauderdaleCosmetic Dentistry, and Miami Cosmetic Dentistry. The dentists specialize in porcelain veneersdental implantsextreme makeoversInvisalign, and sedation dentistry.

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Dr. Nelly Silva DMD Is A General Dentist Providing Aesthetic And Reconstructive Dentistry With A Focus On TMD Therapy

TMJ Treatment and Relief Center of Pennsylvania – located in the heart of Collegeville just next to Trappe and Phoenixville. Pennsylvania Dentist Dr. Nelly Silva DMD formally opens their doors and is currently accepting new patients.

Dr. Nelly Silva DMD is a general dentist providing aesthetic and reconstructive dentistry with a focus on TMD therapy. Dr. Silva treats her patients with compassion and skill, taking care to listen to their individual concerns and providing them with a comprehensive approach to their care that includes specific customized solutions utilizing the very best that modern dentistry has to offer. Dr. Silva provides options whenever possible and his guests are asked what they want, not told what they need. In addition to general family dentistry, Dr. Silva has extensive training and experience in comprehensive aesthetic dentistry (including Invisalign, veneers, and smile makeovers) and neuromuscular dentistry (including TMJ treatment, pain relief, and full mouth reconstruction).

What is TMJ?
Temporomandibular joint disorder (also known as TMJ) is a chronic degenerative disease that may take years to develop. People who suffer from TMJ have a structural imbalance in their jaw-to-skull relationship that is caused by poor bite. This condition puts excessive pressure on the joints and surrounding tissues, twisting the jaw into an unnatural position. Often, a popping of clicking sound can actually be heard when a TMJ sufferer chews. Muscles in the face, back, neck, and shoulders may also be affected, leading to symptoms that range from headaches to numbness in the hands.

Symptoms:
You may be a candidate for neuromuscular dentistry if you experience any of the following symptoms on a regular basis:
• Headaches or Migraines
• Pain or soreness around the jaw joints
• Facial pain
• Neck, shoulder or back pain
• Numbness in your fingers and arms
• Congestion or stuffiness of the ears
• Worn, chipped or cracked teeth
• Cracked, chipped or broken dental restorations
• Unexplained loose teeth

Neuromuscular Treatment:
TMJ can now be easily and painlessly detected using state-of-the-art electrical muscle stimulator or TENSing unit and a sophisticated piece of equipment called the Myotronics K7. Your facial muscles will be exercised, built-up toxins will be released and your jaw’s optimum relaxed position will be determined. To correct your bite, Dr. Nelly Silva will most likely use dental restorations to precisely raise or lower areas of your jaw into a more neutral position. In most cases, they can reposition your bite and complete treatment in a few short weeks.

Results:
Following treatment to correct TMJ, most patients experience significant lessening to a complete cessation of symptoms. Imagine living headache free after enduring the pain for years! And as an added bonus, most patients of Dr. Silva also report positive aesthetic results – some are even asked if they’ve had a facelift. Please call today to schedule a consultation or visit us online to learn more: http://www.pennsylvaniatmjdentist.com(610) 400-3040

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