Dental IQ and mental IQ do not always go hand-in-hand. Undoubtedly one of thee most intelligent and interesting human beings I have ever met, Robert is a high-level professional and spends a significant amount of time in the public eye. His chaotic and stressful schedule were a key factor in the long-term breakdown and degradation of his natural dentition. Often, the process is so glacial that we never really notice until our family and friends mention it to us.
Robert was in desperate need of a full-mouth rehabilitation, which is the bread and butter of what we do here at Nuance. Working in collaboration with a board-certified oral surgeon, all of Robert's teeth were extracted and replaced with a hyper-realistic immediate denture. The teeth that we used are a resin-porcelain hybrid that blend gorgeous aesthetics with unparalleled function to stand up to the high stress demands of a challenging career.
Interesting Case Notes: The American College of Prosthodontists (ACP) fell in love with this case and have it posted on their nation-wide website as a patient resource, demonstrating the dramatic before and after results that are possible by visiting a well-trained prosthodontist. The case can be seen on online by clicking on this link, https://www.gotoapro.org/complete-denture/.
Implants are a challenging business. They are very difficult to get right, and a large part of what I do is finding a solution to implant complications when they don't go so well. These solutions sometimes extend to other specialists in the field. For Cookie's case, it was noted that the original implant that she had placed by another provider on her upper left lateral incisor was not healing properly and had begun to perforate through the bone and gingival soft tissue (circular dotted line in the photos). She was referred to a Periodontists for a gum graft to correct this problem. Beyond the obvious biological issues we wanted to solve, there were cosmetic concerns regarding the crowns on her front four teeth. The two central incisors were shorter than the lateral incisors creating an unpleasing look, and the porcelain did not match her natural dentition.
Interesting Case Notes: On the surface, this particular case appears straight forward enough, but it required three different specialists to complete, including an Endodontist (root canal specialist), a Periodontist (gum and implant specialist), and of course, a Prosthodontist to restore aesthetics and function.
Have you ever seen someone with a single artificial tooth in the front of their mouth that stands out from the others because it doesn’t look the same? This was Kim’s situation when she came into the clinic for her first visit. She suffered a traumatic fracture and repair of her top front right incisor, and wanted a restoration that would match her adjacent teeth. We used a highly aesthetic glass ceramic crown to seamlessly reproduce the exact texture, contour, anatomy, and color of the surrounding dentition.
Interesting Case Notes: Replacing a single central incisor is THEE MOST DIFFICULT procedure for a dentist to get just right. For Kim’s case, we had to develop a unique and novel method to analyzing the texture and details of the tooth surface. This technique was subsequently published by myself along with me ceramist in the Journal of Prosthetic Dentistry. Click on the link to download and read the article.
This is Jeff. When he was a child, he suffered trauma to his upper left incisors. After 40+ years of feeling self-conscious about his smile, Jeff made the decision to have his appearance enhanced prior to his wedding day. To see some of the behind the scenes action that takes place for a case like this, please click on this link (https://youtu.be/SFKXaA68R04) to see the video that was put together for the final stages of treatment (This video features my ceramist and very good friend, Lucas Lammott, and was filmed by another excellent friend and collaborator, Angelo Rombley).
Interesting Case Notes: Often times patients such as Jeff are good candidates for orthodontics (braces), however, they are unwilling or unable to have this type of treatment. It is not uncommon for us to correct malpositioned teeth with the use of porcelain laminate veneers, crowns or other prosthetics.
Most everybody who has ever worn a denture knows what it feels like to worry about having their teeth fall out at the wrong time, or to miss eating and tasting the foods that they like. Also, many denture wearers don’t like the “bubble gum” pink plastic, or Chiclets appearance of the artificial teeth. Jen knows this story very well because this was her situation when she first came to us. Jen had ten dental implants placed (six on top, four on the bottom), and we completed a full-mouth rehabilitation utilizing screw-in titanium bars and resin/glass hybrid teeth. Because the teeth are attached to implants, the prosthesis is only able to be removed by a dentist.
Interesting Case Notes: Many people think that a denture is only about the teeth. It is also crucial to evaluate the shade of the gingiva (gums) so that the prosthesis can look as natural as possible. For this case we looked at three different pink shade variations (34,35,36), and created a mix of each to accurately reproduce the look of Jen’s actual soft-tissue profile.
There is currently no prosthetic replacement that can truly match our natural healthy teeth, so whenever possible, we try everything in our abilities to save our patient’s dentition. Occasionally, complete tooth replacement is necessary. This case study outlines the procedure of having several teeth removed and immediately replaced with a temporary partial denture on the same day. In the first photo showing all the teeth, the surgical site is still visible under the partial denture. We put great efforts into getting these plastic teeth and gums to look exactly like the patient’s real teeth and soft-tissue. These extra steps help ensure that the final implant restoration blends in flawlessly with the oral environment.
Interesting Case Notes: Although all-ceramic restorations are a hot trend in dentistry today, there is still a place for metal-ceramic prosthetics. The underlying high-noble gold alloy ensures strength, durability and a favorable soft-tissue response where the polished metal contacts the gingiva. This restoration is screwed in place and is only able to be removed by a dentist.
There is a growing trend in the dental field to make teeth whiter and straighter. There are many patients, however, for whom whiter and straighter is not a good option. This is Joan. She wanted an implant to replace her missing upper right canine. A temporary partial denture was made for her to wear after her surgery. With every case, we have an uncompromising desire to make sure that nobody can tell which teeth are not real. All of these efforts contribute to the beautiful final result. The color and contour of this metal-ceramic implant crown create a true chameleon effect in the mouth.
Interesting Case Notes: Even the top aesthetic dentists can struggle with shade matching and analysis. Click Here to read the full-article that I wrote with my very talented friend, Daniel Hardy, about the methods and materials that we use to get the perfect color every time.