Risk Category IV: Esthetics:

     People whose smiles demonstrate the entire front teeth, along with the gum level above, are more challenging to make dentistry in the front look indistinguishable. Some show next to nothing when we smile, the low risk situation. The condition, location, size, shape of teeth, the gumline presence, as well as an individual’s expectations can also influence the risk factor for this category, raising the level of risk.

     Our initial examination includes a series of photographs of not only teeth, but how much is displayed at various smile positions, and angles. This is essential in determining and influencing the outcome of our final restorations.     

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      2008 has been a tremendous year for us, having improved the dental health of many people, this being yet another. This gentleman was referred to us by our periodontist, with the ‘upper right lateral incisor’ failing. It is the narrower tooth with the crown on it. The middle two teeth had existing crowns on them as well, and the gum had risen up over years, allowing the shadowed appearance of the root to be visible. This happens as gum recession occurs, and the type of crown does not permit sufficient light to transmit.

      Our treatment consisted of removing the infected tooth, placement of a dental implant, and immediately attaching his existing crown to the implant. This was accomplished by Dr. Brien Harvey  He left the same day looking almost no different at all!!!  After sufficient healing, we began whitening his teeth, with some cosmetic recontouring for the right side eye tooth. Final restorations include a dental implant with custom abutment, replacement of the center two crowns, and a porcelain veneer on the next tooth to his left.

Risk Category III:   Bite and Chewing:

One of our goals is to help people keep their teeth functioning, for their life. Looking good is a plus too. But functioning can be a challenge.

All of us are built differently, and a combination of the geometry of our jaw structure, teeth, and muscles, along with our muscular habits, can contribute to an accelerated breakdown of teeth or dental restorations, sore muscles, or jaw joint issues.

Our first evaluation includes documenting a screening of the condition of your jaw joints (TMJ’s–by the way, ‘TMJ’ is not the name of a disease, it is a body part), how your teeth are aligned when in contact, how they rub together, checking the muscles which move your jaw around, and degrees of tooth wear as well as the location and pattern of the wear.

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Risk Category II:    Tooth Structure:

Some people still get ‘cavities’, while others do not, regardless of diet, and how well we clean our teeth. Some people have many teeth, ‘heavily restored’ with large silver amalgams, crowns, posts, and root canals, while others, do not. These combine to give me an evaluation of the likelihood of your teeth lasting your lifetime, based on tooth structure.

During our initial examination we document the size and condition of existing restorations, decay (cavities) that may be present, and the evidence of weakening of remaining tooth structure. A consistent part of my initial exam includes the loss of tooth from a rubbing together contact, brushing, erosion, and bite forces. I also try to determine how or why, teeth may have been lost in the past from these factors. This can be accomplished by visual examination, viewing x-rays and dental photography, and a thorough review of one’s dental history.
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The various types of risk and how we determine them, and consider them in our practice are key to successful dental treatment planning. There are a total of 4 categories of risk I consider:

Risk Category I: Gums and Bone:

     Some people are susceptible to gum disease (gingivitis), or perhaps more importantly, bone disease (periodontitis), and thus lose a greater amount of bone in a shorter time than do other people. This can start and stop during a person’s life, and it does not always continue at the same rate. If enough bone is lost around a tooth, it will become loose and fall out, which can happen with a person never feeling pain at all!

     Our initial examination process evaluates the current risk level by measuring for inflammation around the gum of each tooth, assessing for loosening of the teeth, and viewing of the bone level, which is seen on dental x-rays. This is also periodically evaluated during your appointments with our hygienist, Ramona.

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     In September, I spent 6 days learning about the latest research and developments in the use of implants for dentistry. Dr. John Kois, founder of the Kois Center in Seattle, Washington has continual programs which I attend, and the focus for these six 9 to 10 hour days was both on the use of implants to replace missing teeth, and the indications and best methods for using them to help stabilize and retain removable dentures.

The format is an intimate environment, limited to 25 doctors, who were from the United States, Canada, England and Poland. I feel Dr. Kois is absolutely on the forefront of what is happening in dentistry, and holds a program which is not only enlightening and most current, but at the same time highly dedicated for long term success of the services we provide.

Before Treatment:

Underside of denture, showing attachments:

Bar attached to implants:

Implant supported overdenture in place:

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We make many wonderful improvements for people, but this gentleman really has progressed.

He was quite busy in his career, and work consumed many hours as a dedicated executive. Recent retirement (although he is STILL busy), had given him time to pursue his dental health.

You can see the original teeth were heavily worn, if not missing. With careful planning, and a very patient individual, we have been able to begin restoring his dental health to a far superior level of function and appearance.

Unable to eat effectively before, Ben no longer holds back. He is far more comfortable now, with his new appearance as well. This treatment, which included the use of several dental implants, has got him up and running. I may be little biased, but I think he looks younger!

One of the most rewarding things about being a part of the dental community are the opportunities that we have to help others in a profound way. One of the programs that our office is proud to be a part of is the Give Back a Smile program.

Give Back a Smile is a program sponsored by the American Academy of Cosmetic Dentistry^® (AACD) for victims of domestic violence. Millions of peoples lives are affected by the scars left by domestic violence. These courageous survivors deserve the help from a program like Give Back A Smile that enables them to rejuvenate their lives through the caring hands of a local dentist.

These local volunteers help to heal the effects of domestic violence by providing free consultation and dental treatment to restore the smiles of survivors of domestic violence.

How the program works

• Domestic violence survivors who have suffered dental injuries from abuse from a former intimate partner or spouse can contact GBAS toll-free at: 800.773.GBAS (4227)

• Survivors must make an appointment with a counselor, domestic violence advocate, social worker or therapist to complete the advocate section of the GBAS application.

• GBAS conducts the initial review of the application however the dentist has the final say as to the eligibility of the applicant.

• If eligible, the AACD connects the survivor with a local GBAS volunteer who provides treatment at no charge to the recipient.

October is Domestic Violence Awareness month. If you know someone who is a survivor of domestic violence who can benefit from this program please urge them to contact GBAS.

Through the Give Back A Smile program our office has been thrilled to assist survivors by treating their dental injuries that were sustained from domestic violence, so that they may reclaim their smiles, their self-esteem and, ultimately, their lives.

Want to improve your smile without the unsightliness of metal braces? Invisalign aligners could be the answer. Described as invisible braces, the invisalign system involves using a progressive series of removable teeth aligners made of clear polyurethane. It was developed by Align technology as an alternative to metal braces.

The progressive feature of these aligners means a new teeth alignment tray must be used approx. every 2 weeks. Over the course of treatment an average of 18-30 trays may be used depending on the severity of the case.

We have been offering invisalign to our clients for a number of years now. This system not only provides a more aesthetically pleasing smile but is very helpful in getting teeth into a better position before we begin any restorative dentistry. This makes it possible for our treatments to be more conservative, kinder to the nerves within the teeth. The finished results are more easy to maintain with a good oral hygiene routine, allowing for improved health of gum tissue.

What are the advantages of invisalign braces?

• Cosmetically pleasing-their transparent quality makes them especially appealing to adults

• Removable-for eating, drinking, brushing and flossing

• Use less force- so are generally less painful

What is the treatment process?

1. Dental impressions, x-rays and photographs are made and sent to Align technology

2. A three-dimensional model is made

3. A computer simulation is made of the progressive movement of teeth

4. A plastic aligner is made for each stage of progression

Average treatment time is approximately 1 year depending on the severity of the case.

Our clients who have used invisalign are very happy with the results. Please call our office for a consultation and we would be happy to help you to learn more about how this procedure can help you to achieve a dazzling smile.

You may have noticed that our website has a bit of a ‘cosmetic’ slant to it. Not only is esthetic dentistry becoming more and more popular, but the results can be truly amazing. For the past ten years and more, I have become more focused in what I would call ‘adult restorative and cosmetic’ dentistry. It is not only fun, but very rewarding. Dentistry has really become my passion—just today, our new client, after experiencing the initial examination, described me as such, and made it a point in our discussion. What a compliment!

As a result, you will see a significant amount of photography within our site. My observation when looking at examples of dental websites, was that a very large proportion of the websites for dentistry display ‘before and after’ images, but they were not examples of what was created by that office. This became noticeable after I saw the same cases in many, many offices.

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