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S: Smile 2011

BC: "There are hundreds of languages in the world, but a smile speaks them all." -Anonymous "Every time you smile at someone, it is an action of love, a gift to that person, a beautiful thing." -Mother Teresa "You're never fully dressed without a smile." -Bud Cort "Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy." -Thich Nhat Hanh

1: Throughout this book you will find some of our recently completed cases. You will also find information and photographs of some of the most common dental problems we encounter in our practice daily. We hope that these serve not only to educate but also to showcase and inspire what could be accomplished for you. In the healthy mouth, modern dentistry knows very few limits. Whether it is creating a beautiful smile, improving function, or eliminating pain, it is our hope and passion to take this journey with you! | Dr. Jones

2: The healthy mouth is a mouth free of any form of disease, including diseases of the teeth (decay), periodontium (gum disease), and occlusal disease (TMJ/TMD and clenching/grinding). The healthy mouth is not only attainable in each and every person, but also the ultimate goal for every patient in our practice. Without a healthy mouth you cannot have a healthy body or a healthy smile. | The Healthy Mouth

3: Occlusal disease is not only one of the most common dental problems seen in our practice but also the most under and misdiagnosed condition in medicine and dentistry. Occlusal disease encompasses the health and function of the temporomandibular joint (TMJ), and the way the teeth and musculature fit together and relate to each other (occlusion). Untreated occlusal disease, clenching, and grinding can lead to broken and lost teeth, excessive wear and shortening of teeth, widening or formation of gaps between the teeth, and unnecessary suffering in the form of headaches, muscle pain, and jaw pain. Headaches are one of the most common symptoms of occlusal disease. Even in patients unaware of clenching and grinding many report weekly and even daily headaches. In particular, headaches at the base of the skull and temporal region on the sides of the face are an extremely common sign of occlusal disease, and often easily treated. If you are suffering from or noticed any of the following dental conditions you likely are suffering from occlusal disease. | Occlusal Disease (TMD/TMJ)

4: Aside from headaches worn teeth are the most noticed sign of clenching and grinding. | Occlusal Disease (TMD/TMJ)

5: Fractured teeth, broken crowns and fillings are commonly seen in patients that clench and grind. | Abfractions are a less obvious sign of occlusal disease but arise from the excessive bending of teeth while grinding.

6: Periodontal Disease (Gum Disease) | Periodontal disease is a condition affecting the supporting structures of the teeth. In early periodontal disease the gingiva initially becomes very inflamed and irritated (gingivitis). This can progress to periodontal disease where the supporting bone around the teeth is actually lost. During this process loose teeth, bad breath and a bad taste in the mouth may be noticed. Untreated periodontal disease will result in eventual tooth loss. | In this photo the inflammation and redness in the gums around the teeth can be seen.

7: In this picture the calculus (tartar) buildup around the teeth has resulted in inflamed gums. | In the x-ray to the left the resulting bone loss from severe periodontal disease can be seen. The red line indicates the level at which the bone should be, with the red arrows highlighting the current bone level. This results in very loose teeth as can be imagined.

8: Decay (Cavities) | Dental decay results from the softening of tooth structure due to repeated exposure to bacterial acids. These bacterial acids are byproducts of our natural bacteria consuming sugar in our diet. There are three types of decay commonly seen in our practice. This includes new decay in the grooves of teeth or between the teeth, root decay, and decay under existing fillings and crowns. | Decay under fillings and Crowns | This is one of the most common forms of decay seen in adults. Over time all amalgam (silver-mercury) fillings begin to leak. Much like a leaky roof on your house the damage may go unnoticed from the outside, but much damage is caused on the inside. Often times this decay is difficult to detect on x-rays, especially under crowns, and the decay can become very close or into the dental pulp (nerve). This means that in many untreated teeth a root canal is eventually needed.

9: Decay under fillings and Crowns | In both the above cases it can be seen how the extent of the decay cannot be fully evaluated until the old fillings or crowns are removed.

10: Decay (Cavities) | Decay under fillings and Crowns | In the case to the left, several old amalgam filings had decay underneath them. This can be seen by the 'blue-ish' appearance of several of the teeth. In the middle photo, the old fillings and all decay has been removed. Due to the extent of the decay you can visualize how much tooth had to be removed. The three right-most teeth required crowns, as little healthy tooth structure was remaining following removal of the old amalgams.

11: Decay under fillings and Crowns | Above more decay under fillings can be seen. In both of these cases the decay was so deep that root canal therapy was first necessary, as the decay entered into the pulp (nerve) of the tooth. Once decay reaches the pulp the tooth must have root canal therapy or be removed.

12: Decay (Cavities) | New Decay | New decay occurs in one of two ways. Decay in the grooves of teeth, known as pit and fissure decay, is very common. Pit and fissure decay can be prevented by doing sealants. This type of decay can get very deep and sometimes involve the nerve of the tooth. | In the case to the right an example of pit and fissure decay can be seen. As seen in the middle picture the severity is often much worse than it appears. In this case due to the depth of the decay root canal therapy had to be performed.

13: New Decay | New decay also commonly occurs between the teeth. This is known as interproximal decay however is often referred to as flossing cavities. Without the regular use of floss these cavities often develop. | In the above x-ray flossing cavities can be seen by the circled areas. Untreated, these can also progress to reach the nerve of the tooth.

14: Root Decay | Decay (Cavities) | Root decay is a type of decay affecting the softer root structure of teeth. These types of cavities can develop very rapidly. Root decay is often caused by the dry mouth side-effects of many medications prescribed today. Fluoride trays are a very effective preventative measure for this type of decay. | On the left early root decay can be seen. Treated early these lesions do not often effect the nerve of the tooth.

15: In the above pictures root decay can be seen underneath two crowns. This type of decay can spread very quickly and get very deep, as seen by the bottom photos. | Root Decay

16: Bridges | Linda came to the practice wanting a way to improve her smile. She had been missing her right lateral incisor which had been replaced some years ago with a bridge. Linda also was very aware of the space on the right side of her mouth, behind her canine.

17: In addition to Linda's missing teeth we noticed the uneven incisal edges of her front teeth. This is due to grinding. While improving Linda's smile is still our goal here, we also must manage the grinding with a nighttime mouth-guard to stop trauma to the teeth and to protect the new dental work. The final goal of her treatment plan included replacing the missing spaces from missing teeth, correcting the wear and inclination of the front teeth, and whitening. Due to time constraints and the patient not being interested in dental implants we decided to make a permanent bridge cemented into place. The final treatment plan included a 5-unit all ceramic bridge, a crown on the central incisor, whitening, and a composite veneer on the lateral incisor. | On the left, Linda's temporary bridge is shown the day she left the office. While not perfect temporaries can still offer a drastic immediate improvement.

18: Bridges | Below the finished case pictures can be seen. Overall, the treatment took 2 main appointments and 4 weeks in the lab.

20: Crowns | Kim came to our office because she noticed the darkening of several of her front teeth. This darkening was due to old, leaking fillings. Our treatment plan for Kim included replacing the leaking fillings with three all-ceramic (no metal) crowns on 3 front teeth, a composite veneer on her right lateral incisor, and a night guard to control clenching and grinding. | In the above photo you can see the leaking fillings and worn, uneven teeth from grinding.

22: Kim's treatment was completed in just two visits. While we only treated the front four teeth, a dramatic change to the smile can still be accomplished. By using all ceramic crowns we were also able to match the shade of her natural teeth well and create crowns that are incredibly life-like.

24: Veneers | Porcelain veneers are thin porcelain restorations that are bonded to the tooth to either improve the appearance of the teeth or restore the teeth. In the case below, Amy came to us concerned about the dark fillings present on her two central incisors. Over two appointments we removed the failing fillings and placed 4 porcelain veneers to close the small gap and improve the appearance of her smile.

27: Veneers | In the case below, we used veneers to repair Margaret's broken front teeth from an accident. In addition we decided to lengthen the teeth and fill out the smile using no-prep Emprethin veneers. All of Margaret's work was completed in two main visits after her initial "trial smile" visit. | In addition to lengthening the teeth and filling out the smile, our goal was also to create a smile that was less "gummy" but still natural. Margaret also decided to slightly whiten the shade of her teeth with the final restorations.

28: In the picture to the right, you can see the result of our "trial smile." This gave the patient a chance to wear the anticipated smile over the weekend to know exactly what to expect. | Above are the 10 cemented Emprethin veneers. As you can see, we not only repaired the fractured teeth but also filled out the smile and made the teeth whiter while still creating a natural result.

31: Single Crown | The single incisor crown has been called the "hardest job in dentistry" with good reason. If you've ever known someone with a crown on a front tooth, you know how hard it can be to create a perfect match. Jane had an accident when she was a child which fractured her front tooth. Since then it had been repaired numerous times (and unsuccessfully) by other dentists. We decided to make Jane a single porcelain crown that would not only look beautiful and natural, but last her a long time as well.

32: As you can see above, thanks to working with a spectacular ceramist and dental lab we were able to recreate nature for Jane. Although only one tooth was restored, the entire smile gained symmetry. For the first time since she was a child, Jane can now smile confidently!

33: Metal-Free Partials | While bridges or implants may not be medically or financially possible for each patient, modern partial dentures can offer an excellent esthetic alternative. In the case below we used a metal-free Valplast partial to replace three missing upper teeth. | In the above picture a metal-free partial was used to replace three missing upper teeth. The same case can be seen below, with the clasps 'disappearing'.

34: Artificial tooth roots, or dental implants, represent the latest technology to replace missing teeth or even to secure dentures. Dental implants are made of medically pure titanium and actually grow to become integrated with the body. Research suggests that implant success rates are in the 90-95% range, with the successful implants expected to last a lifetime. In the below case we used a single implant to replace a missing premolar lost in an accident. An old bridge was originally present at that site so we also placed two crowns beside the implant. | Implants

35: An x-ray can be seen on the right of the previous case. The implant serves as an artificial tooth root which a crown can then be placed on just like a natural tooth. | In the picture below you can see the final crowns delivered. The implant not only looks just like a natural tooth, but also functions like one.

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