Creating a smile that reflects who you truly are. That is the mission of Dr. Mitchell Pohl, an experienced cosmetic dentist in Boca Raton.
A broader range of dental possibilities exists within the field of Reconstructive and Restorative Dentistry. Recent advancements in equipment, ceramic technology, materials and highly specialized training … when coupled with well tenured experience … has established an elite group of Cosmetic Dentistry Artisans.
Drama in South Florida Dentistry
Dr. Mitchell Pohl is considered by many Boca Raton and South Florida residents to be part of this new concept of dramatic dentistry. Dr. Pohl has the artistic eye and talent for creativity in dentistry. To produce the harmony and symmetry that was once thought to be available only to a select few. The Perfect Smile. The accomplished dentist is able to incorporate a variety of procedures and artistic perspective to produce just about any imaginable degree of dazzle, celebrity smile or Hollywood smile desired.
Makeover Success gives patient a new start in life
She needed a confidence boost and wanted to change her smile. Her two main concerns were her gummy smile and square yellow crowns on the front teeth as well as the poorly shaped veneers on the lateral incisors.
Bite – Occlusion Issues
Aside from the aesthetic concerns, she had functional problems.
There was no anterior guidance or canine protection and her lower anterior incisors were extremely worn. Due to wear on the lower incisors, the teeth and bone had extruded coronally (upward).
The maxillary plane of occlusion was not level as seen in the profile picture and the arch was constricted in the bicuspid area.
Gum Shaping – Crown Lengthening
After completing a diagnostic wax-up and a comprehensive examination with x-rays it was determined that we would start with the upper arch and perform crown lengthening of the four incisors.
Utilizing the Waterlase laser in a very comfortable procedure with very little bleeding or discomfort, we removed gum tissue and bone from the facial aspect of the central and lateral incisors. Patients exhibit very little post-op discomfort and quicker healing time with the laser because it is a closed tissue procedure. There are no incisions made.
(In the photo above, one can see where the old crown margins end and exposed tooth structure is revealed. This was an immediate post-op picture. Note the minimal amount of bleeding and lack of swelling.)
After three weeks we prepared her teeth for bonded porcelain jacket crowns on her central incisors, porcelain veneers on the laterals and canines, and onlay veneers on the bicuspids. Temporary veneers were fabricated and modified based upon the diagnostic wax-up.
The patient approved the esthetic appearance of the veneers with regard to length and shape. An impression was made of the temporaries and sent to the lab as a reference.
Choices in Porcelain Materials
Da Vinci Dental Studios, the lab of choice for ABC’s Extreme Makeovers, would fabricate the porcelain restorations.
We (Da Vinci and Dr. Pohl) believe that the best esthetics can be achieved with feldspathic porcelainas opposed to Empress which is an alternative porcelain material touted by the Las Vegas Institute.
(All ABC extreme makeover cases are done by Da Vinci with feldspathic porcelains and the dentists are non LVI graduates contrary to popular advertising.)
Two weeks later we tenaciously bonded the porcelain restorations to her teeth. In the photo at the left the improvement can be seen in the patient’s plane of occlusion (upper and lower teeth are better aligned) and the facial profile.
We created a fuller smile by building out the buccal corridor thus correcting the constriction of her upper arch in the bicuspid area.
Simple and Complex Dental Makeover
The majority of extreme dental makeovers are usually not that complex. Most cases involve correcting crowded or rotated teeth or teeth that are worn and discolored. Perhaps replacing one or two teeth and performing root canal treatment might also be required. These types of cases can be completed within two to four weeks.
More Case Histories: Complex Makeover/ Interdisciplinary
We start with a full mouth reconstruction. The patient in the adjacent photo had a pool side accident. His upper front teeth were introduced to the edge of the pool in an uncoordinated attempt to jump in.
The majority of his front teeth were nonrestorable and needed to be removed during an emergency visit. The patient also suffered from periodontal disease as well as dental neglect. All molars were missing except one that was super-erupted and nonfunctional. His two remaining upper right bicuspids were abscessed and required root canal therapy and apical surgery by an endodontist.
Treatment Plan Complex Makeover
The treatment plan for this patient first involved fabricating a temporary appliance to replace the missing front teeth. Then root canal therapy was performed on all his lower bicuspids and canines.
Stainless steel post and cores were used to build up those teeth after the root canal treatment. (Sometimes when there is an esthetic concern and we are using a bonded porcelain restoration on a root canal tooth, a translucent fiber post is utilized.
Stainless Steel vs. Translucent Implant Posts
Stainless steel does not allow light transmission and can affect the esthetics of the final restoration.) The patient’s lower anterior teeth were removed due to periodontal disease and a one piece temporary bridge was then placed that spanned from bicuspid to bicuspid. The endodontist did the the root canals and root end surgery for the absceses. Root end surgery was necessary because the abscess would not resolve.
The patient was now ready for the periodontist. In one lengthy session the periodontist performed gum surgery on both upper and lower arches and placed seven implants. Replace Select from Nobel Biocare were used for implants.
After the healing phase, the lower teeth were prepared to receive gold telescopic copings. The purpose of the gold copings was twofold. We wanted to design a retrievable appliance. Placing a super structure over the gold copings would make that easier. In addition, it also made it easier to gain parallelism so that it would be easier draw the bridge on and off.
Once the lower bridgework was complete, the implants were ready to be restored. We first fabricated the metal framework that would fit over the implants. Once the fit was confirmed, porcelain was baked onto the metal framework.
The porcelain was in a bisque state. In other words, it was not glazed to a smooth shiny surface. At the bisque try-in we made the necessary esthetic adjustments to the porcelain. The bridge then received its final glaze and was seated. Then patient now had a winning smile to go with his personality.
Simple Smile Makeover
This was a very straight forward case. The patient in this photo was extremely self conscious of the mottled (blotchy) appearance of her teeth which was caused by excessive fluoride and decalcification from wearing orthodontic brackets.
In this after photo, we see the tremendous improvement in the appearance of her teeth. The patient choose to have eight veneers placed from the first bicuspid to first bicuspid.
Incidentally, what you don’t see here is the dramatic positive impact it has made on her self esteem and confidence.
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Creating Beautiful Smiles. Great Teeth, Better Life.
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