Another Beautiful Smile Created on Long Island

Ryan suffers from amelogenesis imperfecta, a hereditary disease in which there is imperfect formation of enamel, resulting in a brownish coloration and fragile teeth. These teeth are weak and tend to decay easily. Unfortunately, Ryan and other members of his family have this condition. All of his teeth were decayed; some were too decayed to be saved, others needed root canal treatment, and also periodontal treatment before we could create a fabulous smile for him with porcelain veneers.  Ryan is thrilled and is getting ready to have his lower arch restored.

 

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Before

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Several months ago I told Jay’s story on a blog post: http://drterryshapiro.com/world-trade-center-hero-teeth/. His teeth had been severely eroded by acid in the air after the World Trade Center attacks. He was a supervisor on the cleanup crew for more than four years.  We fabricated upper and lower anterior porcelain bridges for him and upper and lower precision partial dentures to replace the back teeth. He looks terrific, is comfortable and can eat anything without trouble.

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Severely eroded teeth.

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Porcelain crowns and bridges

Jay is a hero. He was at the World Trade Center on September 11, 2001 – now 14 years ago. He saw horrific images. He then spent the following four years supervising cleanup at the site. Four of his co-workers subsequently passed away from rare cancers contracted from the pollution. Jay had his yearly checkups and was grateful every year that he passed his physical and was healthy.

 

Jay came into my office last month because he wanted a new smile – his teeth had dark black/brown stains and were severely eroded. He was very unhappy with his teeth. We spoke about this and I was very puzzled: what had caused this severe erosion? I had never seen anything quite this severe. Did he have any habits, did he suck on lemons? or anything acidic to cause this destruction of his enamel? My questions had triggered a memory and he lit up – it was the World Trade Center, he said. While he was on the cleanup he had a strong, acidic taste in his mouth that he couldn’t get rid of. He would rinse and brush his teeth but the taste stayed with him. He had never before made the connection but he said that the teeth damage had begun during that time. Before Sept. 11 his teeth were normal. I did some investigation about World Trade disabilities.  There is some data on dental damage but it is not something that has been a focus among so many other disabilities of the survivors and responders.

 

After completing a full dental examination I determined that most of Jay’s teeth could be saved as the roots and gums were healthy. We scheduled two appointments, one to place temporary crowns on the upper teeth and one appointment to place temporary crowns on the lower teeth. He was thrilled with the transformation.  Permanent crowns still to come!

 

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 Severely eroded teeth

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Temporary Crowns

When Andrew was a child he fractured both of his upper front teeth. He had crowns placed on both teeth in the early 1980’s. As you can see below, the crowns are squat and too bright for the surrounding teeth and the gums are uneven. The crowns look very artificial and he was unhappy with the looks.   Not only were the teeth ugly – but they were causing enormous wear of the lower front teeth because the crowns were in the way and he was grinding and clenching his teeth.  Andrew needed a makeover!  We removed the old crowns, placed new all-ceramic crowns on the upper front teeth and placed porcelain veneers on the lower front teeth. Andrew is thrilled – he looks wonderful!

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Before: ugly crowns, worn down lower teeth

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After: new crowns and veneers – very natural looking

This is what Andrew wrote to us after the work was completed:

Thanks to Dr. Terry and her great staff!!  Special thanks to Peter Kouvaris, Master Ceramist for his excellent work on my crowns. Dr. Terry is an absolute professional and she uses only the best Lab. They literally saved my mouth and my smile! Her approach to my problem was the absolute right one. Other dentists could not even handle my problem, but Dr. Terry took the time, she did not rush, she called me after visits to discuss the right plan of action and to see how I was feeling because she really cares.  Dr. Terry and Peter Kouvaris Lab…. THANK YOU!!

John had a composite filling that was placed several years ago. It had broken and there was decay around the edges. The tooth was in jeopardy of breaking. Repairing it after it broke would have been complex: possible root canal, periodontal surgery, post and core and crown, or even extraction if the fracture was into the tooth root. Instead of waiting, we removed the old composite filling and removed the decay. We took impressions and placed a temporary crown.  The following week we cemented a beautiful ceramic crown. This new tooth will be functional for many years to come!

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 Broken composite filling with marginal decay.

X0102250New porcelain crown.

Rick was born without his permanent lateral incisors (the teeth just to the side of his two front teeth). His other teeth moved over and everything was crooked. When he was nine, it was time for the orthodontist. He wore braces for several years so his teeth could be moved into the proper spaces. Space was left where the missing teeth should have erupted. Rick is now 15 but when his jaw is no longer growing at about age 19 he will have implants placed. Crowns will be placed over the implants in order to fill in the spaces.

In the meantime he needs a temporary solution so he has replacement teeth for the two missing teeth and also to hold the spaces so the teeth don’t drift again. The orthodontist made him a removable retainer, but Rick didn’t like that the retainer was removable. It didn’t look great and it was not comfortable.  Rick asked me what to do.  I recommended a bonded, or Maryland, bridge. This is a fixed bridge that is bonded to the adjacent teeth. It doesn’t require cutting the adjacent teeth and the esthetics can be excellent. It is easily removed when Rick is ready for implants.

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Missing teeth.

X0103013Replaced with a bonded or Maryland bridge.

It always strikes me that people never seem to be as concerned about losing a back tooth as they are about losing a front tooth. But back teeth also count!!  You need your back teeth so you can chew properly. Back teeth also protect the front teeth, and they help to maintain your facial structure. If even one back tooth is missing, the adjacent teeth will drift to close the space; they may loosen and a pocket of infection may form. The opposing teeth may erupt into the open space. Your bite will start to collapse. The front teeth will begin to splay forward.

The following patient was missing all of her back teeth. She was putting a lot of stress on her front teeth because she didn’t have back teeth for chewing. The front teeth were beginning to splay forward. She elected to have implants placed. We placed four implants on the top and two on the bottom and gave her new front crowns – a great result and a very happy patient:

Posterior Implants Picture

 

The following patient lost her lower back teeth, and consequently the top teeth have super-erupted into the space. This weakens the top teeth and they become susceptible to loss. We did some periodontal crown lengthening and placed five crowns on the top teeth in order to restore them to their proper position. Four implants were also placed on the bottom and will soon be uncovered so implant crowns can be placed:

Posterior Implants before and after picture

Carol desperately wanted to have her teeth fixed. They were crooked and discolored and chipped.  Several were decayed. She wanted white, white teeth that were straight, straight. She came to our East Setauket dental office at 9:00 this morning and by noon she had temporary crowns that were white and straight – just like she wanted. She has to have some gum recontouring done, then impressions and cementation of the permanent crowns. We will also whiten her lower back teeth.  The permanent crowns will look even better than the temporary crowns – but for now Carol is thrilled!

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Before placing crowns

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     Temporary Crowns

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Check out the all ceramic e.Max crowns and bridges that I cemented last week for Dorine (photos below).  Dorine has long-standing periodontal issues  and her teeth were drifting apart. One of her front teeth had moved forward and a space had opened up between the two front teeth.  She hated her teeth and avoided smiling for photographs.  She was missing her left canine tooth and had an old bridge that connected three teeth.  She also had individual veneers on the right front teeth.

We placed temporary crowns and Dorine had periodontal treatment to improve the health of her gums and bone.  After healing took place, we took impressions and placed the new crowns and bridge. We used e.max for superior esthetics. A very dramatic improvement.  She looks great and is ready for the holidays!

For more on crowns and bridges that we have placed in our East Setauket dental office, look at our crown and bridge page.

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Before

 

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After

The jury is still out – there is not enough evidence on the long-term durability of the one-visit crown. Check out the article “Are Dental Crowns Made in a day as good as traditionally made ones?” in the Wall Street Journal: