Instant Orthodontics — Correcting Overlapped Teeth With Porcelain Veneers

This article showcases the  treatment of a female patient who sought the help of Tampa Cosmetic Dentist Dr. Saylor for Instant Orthodontics. She has overlapped & rotated front teeth and wanted a quick, attractive, and predictable solution. With Dr. Saylor’s expertise, they developed and accomplished a minimally invasive treatment plan for Instant Orthodontics.

Braces Vs. Porcelain Veneers

Traditional orthodontics (braces) take at least 12-18 months to achieve results like these (see photo below). Besides the lengthy treatment time, another downside to consider is the fact that both upper and lower arches need to have braces placed on them. Instant Orthodontics, which is utilizing veneers and/or crowns to achieve the illusion that the teeth are straight, allows a patient to have straight teeth in a few weeks, with no wires, brackets, or retainers involved! This particular patient decided to have 10 upper veneers bonded to give her the dazzling, movie star smile she always wanted!

A Lesson In Instant Orthodontics: How It’s Done!

These types of dental prostheses are extremely thin and delicate until bonded to the tooth structure. Even dropping them at the delivery appointment can be disastrous. The vacuum in the preceding photo is a great instrument for handling these tiny pieces of porcelain.

Instant Orthodontics requires great skill and an eye for natural esthetics on the part of the doctor. Color choice, shaping the teeth just right during preparation, and communicating how the finished veneers should look and fit to the dental laboratory are what determines the success of the case. Once these veneers are chemically bonded in the mouth, you will not be able to tell they are not the patient’s natural teeth.

The Results Are In — Instant Orthodontics Wins!

Accomplishing these veneers and achieving the esthetic we desired was very fulfilling for the patient and the dental team. This patient has waited a long time to upgrade her teeth and she hasn’t stopped smiling since she left the office! There are many solutions for correcting cosmetic dental problems. Consult Dr. Saylor or another reliable dentist for answers to your dental questions, specifically Instant Orthodontics!

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Do you love drinking soda? Most Americans do like soft drinks–we did invent them!

     Well, it may taste great, but it’s certainly not great for your teeth! Heavy soda consumption has been linked to rampant tooth decay in all age groups, but is the primary reason adults develop cavities. Check out just a few of the reasons why:

• One 12-ounce can of soda contains between 10-12 teaspoons of sugar!
• Acids in soft drinks begin to dissolve tooth enamel after only 20 minutes!
• “Sugar free” or diet sodas also contain acid that can damage your teeth.

     So…how can you minimize your risk for cavity formation? Avoid sugars and acids. The easiest way is to learn to drink water instead – it may take a while to get used to if you’re a soda junkie, but is the most effective way to reduce your risk. If you cannot give up sodas, at least drink the entire can of soda in 20 minutes or less. If you are sipping on these drinks over a few hours, every gulp is re-exposing your teeth to a wash of acids and sugars. After drinking, rinse with some water or brush your teeth to get the film of cavity-causing agents off your teeth.

     Some other positive effects of kicking the soda to the curb are weight loss, as you are not imbibing extra carbohydrates and empty calories regularly. Your kidneys and excretory sytem will have a much easier time filtering fluids without all those additives, preservatives, dyes, and acids. Lets not forget the tangible effects of not buying sodas anymore: each can of soda is approximately 75 cents; if you were drinking 3 per day, then you are saving yourself $2.25  a day by not buying sodas anymore. In no time you’ll be feeling better and your mouth, body, and bank account will be loving you for it!

The following photos are the end result for this case. The veneers turned out beautifully and look so natural it’s a little scary. Dr. Saylor & team and the patient were glad they decided to go forward. Without the mock-up preview, this patient may have been too apprehensive to proceed with treatment. We know now that sometimes the previews are as important as the feature!

 The following case was a very interesting one with a few hurdles and difficult choices to make. This female teenage patient presented to the office with congenitally missing lateral incisors, meaning she was born without these teeth. Her canines had drifted toward the midline to fill the spaces, so the treatment plan took some time and serious consideration to develop. There are many ways to approach this issue, but Dr. Saylor had 2 plans of action in mind:

1. We could move the canines back into natural,optimally functional position with orthodontics and “build” new lateral incisors on top of implants. Moving these teeth towards the posterior would leave a thin ridge of bone where the laterals needed to be implanted, so a periodontist would perform a bone augmentation procedure to have a foundation in which to place titanium dental implants. (Longer, more involved treatment.)

2.  We could pull everything forward with braces to close the spaces and recontour the canines to look like the missing lateral incisors. (Easier of the two plans.)

-Dr. Saylor collectively decided along with the patient, an orthodontist and a periodontist to go with Treament Plan #1.                                                                                                             -Reason being: This course of treatment was definitely the best for the patient in the long run. The canine teeth are the sentries of the masticatory process. That is, the canines are the teeth that provide guidance for the function of the jaws in the chewing motion. If the canines are moved or have drifted out of position, the function may be compromised and cause the temperomandibular joint (TMJ) to become stressed and develop lifelong issues.

 The next photo is the patient after having the dental implants placed. The implant is left to integrate into the bone for 90-120 days and then the abutment screw is placed. An impression is taken of these abutments so that custom implant crowns can be fabricated. This picture looks a little scary, but illustrates quite a scientific advancement for the dental field.

  The following photo showcases the multi-purpose functions of today’s composite resin. Instead of a traditional temporary crown or veneer that is made out of acrylic from an impression of the original tooth structure, Dr. Saylor had to sculpt temporary crowns to cover the abutment screws, as we had no impression of the original missing teeth! These temporaries look pretty good and give us an idea of how to shape and prescribe the laboratory fabrication specifications. They are not nearly as perfect as the porcelain implant crowns will be, but are definitely easier to look at than the preceding photo!

  The photo below is of the porcelain crowns in place. One of the most difficult challenges to overcome when creating teeth for a patient is matching the angulation or “flare” of the natural teeth. What most people do not realize is that the shape, size, and angle of protrusion of the teeth has a huge impact on the “wideness” of the smile and also the formation and fullness of the lips. Most patients who are missing front teeth congenitally cannot pinpoint exactly why they are displeased with their smile. Usually, it’s because the smile is not a bright, wide smile and has the appearance of a child’s smile in an adult face. This case also presented a challenge to the dental team because the patient began treatment as a teenager and still had some physical maturing to do. Dr. Saylor had to account for this factor and try to foresee the end results in an adult face and frame.  The patient was extremely pleased with the results and has a beautiful, natural, and healthy-looking smile!

Yet another happy patient of Dr. Saylor’s!

  How does your dentist know if you are a heavy soda drinker or if you have an acid reflux problem like GERD (GastroEsophageal Reflux Disease)? Many dental patients are being overexposed to acid in their diets and are experiencing the negative effects of this overexposure in their teeth…and your dentist will know!

     Believe it or not, this irreversible, accelerated wearing away of tooth enamel is quite common and on the rise, especially in patients ages 5-17.  This age group’s increased susceptibility is due mostly to the frequent consumption of acidic drinks to include: fruit juices, lemonades, sweet teas, sodas, and energy drinks, as well as candies that are in the mouth frequently or for extended periods of time. All of these liquids contain citric acids and the sodas have carbonic and phosphoric acids, which have a severely detrimental effect on the tooth enamel. In older patient populations, sodas, bottled teas, and wine are more commonly the culprits, but some internal factors to be considered are GERD and Bulimia. The erosion with GERD and Bulimia can be devastating as the stomach bile, which is extremely acidic, comes in contact with tooth enamel regularly and for longer periods of time…just eating away.

     If you have noticed the edges of your front teeth looking thinner or the back of the teeth having a rough, not pearlescent texture to them, you probably have some erosion occuring. There is also a discoloring effect with the thinning of the enamel, as the yellowish layer of dentin becomes exposed and more visible. Once this dentin is exposed, patients usually experience a great deal of sensitivity to cold and sweets.

     Enamel is not regenerative, so the only way to correct this erosion is to have composite resin restorations bonded where enamel used to be coupled with the abandonment of your favorite acidic foods and drinks. If GERD is indicated as the source of acid erosion, then you should seek a medical professional who can prescribe medication to help alleviate the overproduction of stomach acids.  Bulimia is extremely tough to conquer for anyone, but awareness is the first step in getting your oral and overall health back. Working with dental, medical, and psychiatric professionals is the way to go in that case.  

      What will happen if this erosion continues over a long period of time? Nothing good, that’s for sure! The health of your teeth depends greatly on the strength of the enamel. This substance keeps the extreme biting forces from wearing the teeth down to nubs, protects a person from experiencing sensitivity, and is the first line of defense against cavity-causing bacteria.  Once this enamel shield is gone, your teeth are sending out an open invitation for dental problems.     

 One way to prevent acid erosion of the enamel is to eliminate or minimize exposure to sugary and acidic food and drink. Another way to help prevent this problem is to utilize a fluoridated mouth rinse and have your hygienist apply a concentrated fluoride treatment at your regular cleaning appointments. Seeing a dentist at least annually or at the onset of any changes in the appearance or texture of your teeth is the ideal way to nip any issues in the bud. Take care of yourself and keep smiling!

In one of the other blog posts, the health risks of amalgam dental restorations was discussed. At Dr. Saylor’s office, there is a very strict amalgam removal protocol that was developed and implemented to prevent mercury exposure to the patient and the dental providers. Below is a pictorial guide to the extensive precautions taken in our office and some of the things you should look for when researching a provider to remove your amalgam fillings.  

 The picture above is a typical amalgam removal set-up for Dr. Saylor.

From a different angle, (photo above) you can see the precautions that are taken to protect the patient and provider alike. The Horton Vacuum is on during removal to reduce mercury vapor and amalgam particles from the ambient air. The patient also has an Isolite Suction Barrier in place. This acts as a safety net in the back of the mouth. It has a continuous flow of high volume evacuation (suction) and protects the patient from swallowing amalgam particulates or mercury vapors. Because mercury can be ingested through the soft tissues, we also have to rinse the oral cavity frequently with cold dental water. The Isolite barrier has a light built into it so that the whole oral cavity is illuminated, allowing Dr. Saylor to identify any stray debris that needs to be removed. 

The photo above illustrates more precautionary measures including Dr. Saylor’s  super filtration mask and the patient’s mask with a constant flow of oxygen to prevent the inhalation of mercury vapors. 

Need a reason NOT to do Meth? If that picture isn’t enough motivation to never start – here are 4 more reasons why you should never even try methamphetamine:

• Meth can contain battery acid, cold medicine, drain cleaner, antifreeze, acetone or lye. (Do you really want to ingest these chemicals?)
• Acidic content causes massive dry mouth, leading to gum disease and extensive tooth decay.
• Teeth are heavily damaged by grinding and clenching.
• Teeth become stained, blackened and rotting- and the person who is using meth is not especially concerned about brushing for days on end. Most teeth fall out within a year of starting to abuse methamphetamine.

     Many advances in dentistry have occurred over the last few years and are continually developing. Dental researchers and providers have formulated upgraded materials and perfected advanced techniques that have optimized dental care. These folks have examined the effect of oral health on overall health and the importance of considering a multitude of factors when placing a restoration. We’re not just “filling a hole” anymore. We are considering all the possibilities and impact that restoration will have on the patient’s whole mouth. Dr. Saylor attends many Continuing Education courses with his peers and leaders in the field of dentistry to stay abreast of all the new developments in the industry. He regularly introduces new and upgraded materials to his practice to ensure the best restorations for his patients. The following article is an example of how upgrading the materials of existing restorations can make a drastic improvement in a smile.  :)

This patient was dissatisfied with the Porcelain Fused To Metal (PFM) bridge that was placed in the front of his mouth. The existing bridge is bulky, monochromatic with little natural anatomy, lacks translucent characteristics, and doesn’t fit very well at the gumline or into the patient’s bite.

Restorations made of PFM are extremely strong, are tooth-colored, and have been used for many years successfully. Porcelain Fused To Metal material has a couple of drawbacks, though. For one, the opacity of the metal substructure in a PFM crown or bridge reflects most of the light off the restoration, making them appear dull, one color, and unnatural. Certainly another factor to consider with the use of a PFM restoration is the impact of the abrasive porcelain on the natural teeth of the opposing arch.  The before photo clearly illustrates significant wear of the enamel on the lower teeth caused by the bulky porcelain bridge on the upper arch.  This patient’s oral health has actually been compromised by the material used for this restoration.

 Dr. Saylor used all-ceramic e.max  bridge material for this patient and it has improved the appearance of this patient’s smile exponentially! All-ceramic restorations are translucent, like natural tooth enamel. Real enamel allows light to travel through it, leaving subtle shade variations in the appearance of the natural tooth. For example: the incisal edges, or the edges of your front teeth, will look lighter than the portion of the same tooth by the gumline. If this translucency and shade variance is no longer there, it draws the eye to it and makes the tooth/teeth look fake. All-ceramic restorations mimic this translucency, so they are ideal for use on anterior, highly-visible teeth. 

To add to the effect of upgrading the materials, this patient whitened their teeth. Dr. Saylor also restored the worn lower teeth with composite resin and ensured the bite fit together perfectly, so as not to cause anymore attrition. Dr. Saylor chose the e.max System, made of  Lithium Disilicate, for the bridge. This is a new material that combines strength and beauty. The end result is a restoration that is beautiful, natural-looking, and durable. See below for before and after photos.

If you or someone you know has a dental restoration that could be upgraded, search your area for a qualified cosmetic dentist like Dr. Saylor. It may not take a lot of work for your smile to be completely upgraded!

Attrition of tooth structures is basically the premature erosion or wearing of the teeth. This can be caused by dental work that is too bulky on one arch and is wearing against the natural tooth structure on the opposing arch. It could also be caused by clenching and grinding and can be exacerbated by a diet high in acid. This patient had severe wear present on all of his teeth.  It caused a quality of life issue for this person, both socially and physically. This patient was on his way to a full denture, but Dr. Saylor and the patient concurred that the best thing for this patient’s health and well-being was to save all the natural teeth they could.  While waiting for two areas in the back to be prepared for implants, we were able to restore his front teeth with all-ceramic restorations, yielding an incredible result.

Not only did this procedure have a cosmetic impact, but Dr Saylor and team  literally saved this patient’s teeth. Had this issue of attrition not been addressed, it is likely that this patient would have worn his teeth down to the gumline, causing the teeth to become non-restorable. This patient’s treatment has been complete for 3 years and the patient is still completely satisfied with the decision to invest in his dental health as well as his overall health and peace of mind. 

“This is the best money I have ever spent”, says this patient.

If your goal is the same as Dr. Saylor’s, which is to have the least amount of dentistry possible over a lifetime and to maintain your natural teeth until your death at 95 or older, then you should be aware of the amount of wear and tear you are exerting on your teeth. There are many preventive measures you can take, but they all start with the observations and actions of you and your dental professional.

In one of the other blog posts I illustrated how to close diastemas, or enlarged spaces between teeth, with composite resin material. The photos below allow you to see some of the highlights of a veneer procedure. 

There are many ways to improve the appearance of a smile. It may not take a whole lot of dental treatment to get you where you want to be.  A cosmetic consult  with a reliable and knowledgeable dentist who would be able to give treatment options for your personal dental situation would enlighten you. If you have general questions regarding different procedures or options for treatment, feel free to reply to this blog post!