Paul D., is a 56 year old male, sales executive for a large multi-national well known optics company. The firm fabricates optical machines which are used in healthcare both for clinical and research purposes. He often makes presentations to small as well as large groups. Personal appearance as well as speaking ability is very important. So when he presented to our office with his desire to “makeover” his smile, it was important that whatever physical improvements and changes that might be made, they could not interfere with his functional speaking ability.
In his youth Paul D., was very active; he participated in many sports. Physically, he absorbed some significant “hits” during these contact sports activities in which he was engaged. Besides the worn physical appearance of his dentition secondary to his sports activities, it was felt that the patient also would clench and grind is his teeth. His dentition suffered as a result. The images below reflect his dentition at his initial presentation.
Our approach is the same as all previously reported cases. After gathering all our clinical data, and having taken the necessary x-ray films, ral photography, diagnostic impressions were taken for study models. The models were then sent to the laboratory for a wax “mock-up” version of what the final case would look like. However, this time the waxing process was completed by CAD-CAM, which stands for “Computer Aided Design-Computer Aided Manufacture”. The images below represent the wax-up version.
The wax-up models were then shown to the patient. He liked the size and shape of the teeth very much and wanted to proceed. From the models it is apparent, however, that in order to make the teeth longer in appearance, the patient would have to undergo “Periodontal Plastic Surgery” to reshape the periodontal soft tissues and give the teeth a longer profile.
With that said, however, preliminarily the third molars were extracted and after sufficient healing the teeth were bleached using an in-office “Zoom Bleaching” Procedure. This is the same technique used on the ABC Television show ‘Extreme Makeover”. With the initial phase completed, the patient then underwent Periodontal Plastic Surgery, which lengthened the teeth . After sufficient healing the teeth were then prepared for Porcelain Jackets. Using the the wax-up version, a matrix was fabricated and the matrix was then used to fabricate the temporary restorations. Beneath this paragraph the upper image is that of the initial temporary restoration in place. Wearing the temporary restoration, the patient encountered difficulty phonetically forming his words. With that said, the temporary restoration was adjusted by shortening the length of the temporary teeth. The patient was then able to speak without difficulty and phonetically sound out his words without hindrance. An impression was taken intraorally of the adjusted temporary restoration that the patient liked and functioned well. The model retrieved from the impression was then sent to the laboratory. The model was scanned in the laboratory by computer and the parameters of size, width and length of teeth were incorporated into the computer fabricated Porcelain Jacket Crowns. The lower image is that of the adjusted temporary restoration.
Images of the completed case are found below. Prior to the completion of care an Occlusal Guard was fabricated to protect his dentition and the new restorations.
If you would like to discuss this case presented or any other case previously presented in this blog please feel free to contact Dr.Mitchell Indictor, at eastboyntondental.com. He would be glad to speak with you.
My neighbor Al, and I have been friends, since I moved into our neighborhood. Initially he lived with his family directly across the street from me. He was always friendly to me from the first day that I met him as was his “artistic” family. More recently Al, had expressed a desire to esthetically improve the look of his front teeth. He had them bonded a long time ago and while the bonding served its function well for many years, it was now beginning to show “wear and tear”. Moreover, his wife was, for want of a better way of stating it, urging Al, to hit the “refresh” button. Below are images of Al B., prior to treatment. Note the large gap between the front teeth as well as their yellow color. Also note that his teeth in the right posterior segment, which is shown on the left side of the respective image shown below that is just left of center.
Our approach was to initially bleach his teeth. And while he was whitening them at home, we took impressions of his dentition and sent the models retrieved from the impressions to the laboratory to wax up. The waxed up version is a “mock up” of the final shape and length of the “completed” veneers, so that AL, could visually see what was possible and what we at East Boynton Dental envisioned and were working towards. Below is the image showing his teeth prior to wax up which is on the left. The image on the right is the wax up version.
Now with Al’s review, approval and consent, we then proceeded. The teeth were prepared for Porcelain Veneers and an impression was taken. The teeth were subsequently temporized. The impression was sent to the laboratory, along with other records. The laboratory fabricated the eMax Veneers.
Below are the images of the Porcelain Veneers inserted and the case upon completion.
If you would like to discuss this case or any others, please feel free to contact us at www.eastboyntondental.com. Schedule your appointment today.
Maury S., is 65 year old disabled male who lives locally. He was previously a Materials Technician by vocation. As his life progressed, however, he found himself in worsening financial position and progressing health and mental disorder including a debilitating kidney disease as well as Bi-polar Disorder.
Included with his physical health issues, his dentition also suffered from a lack of care. He lacked the finances to repair and maintain his dentition. With his dentition in disrepair, his concept of himself also was effected and he became more depressed. Moreover, he wasn’t able to eat a diet that would foster controlling his diabetes.
However, through social services, with the help of affiliated Dentists and Dental Laboratories, Donated Dental Services under the auspices of the Florida Board of Dentistry, Maury, was able to get his dentition rehabilitated.
It was our pleasure to assist Maury, at this time. We at East Boynton Dental wish him well and hope that the changes we gave him will also change his perspective and outlook on life. We know we gave Maury, something to smile about!
Christopher F., is a 58 year old Financial Advisor with a large local bank. Personal appearance and presentation is very important to a man that works one to one with clients. His teeth are in good condition. However, he has a predilection for chipping the upper incisors. They had been repaired with direct fill composite resin bonding material two times in a four year span. Also the front surface of the incisor teeth are developmentally concave in shape.
After reviewing the patient’s teeth clinically and radiographically, it was felt that the best course of action was a treatment plan that included the two central incisors alone, since the other contiguous teeth were in good repair. Images of the patient’s teeth prior to treatment are below.
An impression was taken of the patient’s dental archs. The models retrieved from the impressions were sent to the laboratory for evaluation and “wax-up”. The “waxed up” version was returned from the laboratory and then shown to the patient and after review the patient accepted the treatment plan. In doing so the patient got an opportunity to see a three dimensional version of what the final case should look like before a bur or any changes are made to his dentition.
With the patient’s approval and consent, treatment then commenced and the central incisors were prepared slightly. Definitive impressions were taken of the prepared teeth. The patient’s teeth were temporized.
The model of the upper arch of teeth with the two front teeth slightly prepared were retrieved from the impression. The laboratory then fabricated Porcelain Veneers for the two front teeth.
Approximately two weeks later, the temporary material was removed from the patient’s central incisors and the new Porcelain Veneers, now fabricated and back from the laboratory, were then tried in. After the patient’s review and acceptance, the Porcelain Veneers were cemented in place. The images below reflect the final finished case with new Porcelain Veneers in place.
If you would like to discuss the treatment in this case or any other case listed in the please feel free to contact us at eastboyntondental.com. We would be more that happy to talk to you.
David R., an auto technician with a local automobile sales agency, was blessed with beautiful teeth. As a teenager he was very active. However, one day without provocation, someone took a “cheap shot” at his face. This altercation resulted in avulsing (knocking out) the upper right canine tooth.
To save the tooth from the sustained trauma, it was reset back into the socket from which it came. Subsequently, it was treated with root canal therapy and restored. At the time this treatment was the “standard of care”. The treatment succeeded; the tooth remained and continued to function as a part of his dentition until David R. reached his late thirties. The root of the treated tooth ankylosed (locked onto ) the bone. One day recently, however, David R. heard and felt the tooth crack.
When he presented to the office of East Boynton Dental, clinical review and x-ray film study found that the coronal aspect of the tooth fractured obliquely from the root with the fracture running below the bone level on an angle. Images below show the cracked canine tooth shortly after presentation with the fracture; it is the canine located on the left side of the images.
Since the root was not usable, it was deemed hopeless. To begin correcting the problem with the canine in the esthetic zone, the coronal segment had to be removed. The root was extracted, but in so doing the buccal plate of bone was lost because it was ankylosed to the bone. The socket was then grafted with bone and after 4-5 months of healing, an implant fixture was then placed.
The implant fixture was allowed 4 months to heal. At that point an impression was taken of the implant and its spatial relationship to neighboring teeth. A custom abutment is then fabricated which screws into the implant. A crown is then fabricated, which sits on the implant.
The images below show the completed case. As an observer can you tell that the canine is supported by an implant?
If you would like to discuss this case, or any other case that has been shown in previous posts, please feel free to contact us at East Boynton Dental.
Julianne L., is a “50 something” female engineer, who is employed at a local quasi-public utility. She has been a patient of record for some time.
She had implant fixtures placed in the upper right and left posterior, as well as the lower left posterior. It is evident from the photographs below, however, that the lower arch reflects badly worn teeth in need of reconstruction.
After careful evaluation and review, it was determined that the best course of action was to replace all the crowns in the lower arch at a new increased height to compensate for the worn tooth structure. The lower incisors were prepared for all Porcelain Jacket Crowns. The full cast gold crowns in the lower arch match complementary full cast gold crowns in the upper arch. The completed case is found in the photographs below.
If you would like to discuss the foregoing case or any other case posted here on the eastboyntondental.com website, please feel free to contact us. Our staff is always willing to listen to you.
This 60+ year old female former bank exec, had presented to our office for routine care, for a few years. For sometime she expressed interest in wanting to improve the esthetics of the upper anterior teeth. The teeth in the upper anterior are what is commonly referred to as the “esthetic zone”.
As is evident from her smile, there are a multitude of challenges that present themselves, which will have to be addressed. The above picture does not reflect all the challenges; when the soft tissues of the cheeks are retracted it becomes much more evident as the picture just below reflects.
Even to those less observant, there is an obvious size disparity that is clearly evident. The lateral incisor on the upper left with the crown, displays a very long tooth. While the remaining three incisor teeth as a group are in a different size range. To give the patient contemplating this care a better perspective of what the final case will look like, impressions are taken of their dental arches. The models fabricated from those impressions shown below, were sent to the laboratory to wax up a “mock up” version of what the final case will look like before the cosmetic dental care is begun.
The wax up version or “mock up” is shown below. Now the patient has an opportunity to get a rough idea of what the final treatment will look like.
Initially our approach was to remove the crown on the left lateral incisor; the temporary crown as shown in the picture below was sized so it roughly equaled the size of the other three incisor teeth. This leaves a portion of the root of the tooth exposed. Also, what is not evident is that this tooth was treated with root canal therapy; it has a cast yellow gold post and core as well. A soft tissue graft procedure was then used to move soft tissue from the palate (donor site) to the neck of the tooth displaying the exposed root (recipient site).
Following the graft procedure and 8-10 weeks of healing, the tissues presented as shown below. Now it becomes a straight porcelain bonded veneers and porcelain jacket crown case.
Below is the completed case following an in-office “Zoom” whitening of the teeth and the preparation, insertion and cementation of the bonded porcelain veneers and the porcelain jacket crown.
If you are interested in any aspect of this case and would like to discuss it further or any of the other cases that have been previously presented please feel free to contact us at eastboyntondental.com. We’re always willing to discuss our dental care.