Cosmetic Dentistry
"I'd get those California plates off your car as soon as you can." this unsolicited advice was thrown in my direction at the town pump after informing my fueling neighbor of my new arrival to the flathead valley, I was not surprised by this gentleman's sentiment knowing full-well I had somehow snuck my way into the exclusive flathead valley resident's club; a little good-natured ribbing is requisite to eventually claiming oneself a local.
Hi, I'm Dr. John F. Miller DDS. I'm pleased to introduce myself to the lovely women of Northwest Montana. Joining me is my beautiful wife Juli, along with our three amazing children Nayvee (6), Banks (3), and Maxwell (0.85-ish). Juli grew up in Southern Alberta and I hail from Northeast Arizona. I was initiallydrawn-in by her otherworldly physical attractiveness, only to realize shortly after that this was surpassed by her emotional and spiritual intelligence. She is my perfect companion.
After getting married we called Mesa, AZ. home while I completed my Biology degree from Arizona State University (Go Devils) where I graduated Magna Cum Laude in 2007. During that time we welcomed Nayvee Lee into our lives, and the three of us took our show on the road all the way to San Francisco in the summer of 2008, where I began my training at the University of the Pacific School of Dentistry as a recipient of the Dean's scholarship.
Upon arrival in San Francisco, we found our 800 overpriced square feet felt a little too roomy so we bucked conventional wisdom and added Banksy to the mix in 2009. It was around this time that Juli and I had to make the major decision of where to lay down some roots and raise our children. I said, "Julz, we spend all of our vacation time in the Flathead because we love it so much. If we don't move there we'll never experience the rest of the world." It was then that I began my search for employment in the valley and was blessed with an ownership position at the Columbia Falls Family Dental Center alongside Dr. Dean Calderwood. We had fallen in love with our city by the bay and our hearts hurt as we travelled north over the Golden Gate and it's iconic orange bridge with the GPS set for Whitefish, MT.
A year and a half has passed since that road trip and we couldn't be more content. The life we found was a little too relaxed so we added 8 pounds of chaos in the form of Maxwell Jay last spring. Wow, I think that about covers a nutshell's worth of an introduction to the Miller family. I'd like to focus the remainder of this column on a subject I am very passionate about: Teeth and the practice of Cosmetic dentistry. Cosmetic dentistry is defined as a set of elective (not required for health) dental procedures, with the aim of improving the appearance of one's smile. The dental options available for improving one's smile include: whitening(bleaching), replacing discolored or silver fillings with today's highly aesthetic composite, orthodontic treatment, gum surgery, composite bonding to improve the shape of teeth and/or close gaps, implants, crowns, traditional veneers, and minimal prep veneers (lumineers). A standard smile makeover will usually require several of the steps above to achieve the most desirable outcome.
The following case study demonstrates this as we follow Mrs. Patient from the beginning of her smile journey to her dream smile. Upon initial presentation (see Figure 1), my highly motivated patient had the following concerns with her smile:
SHE HAD CHIPPED THE EDGES OF THREE OF HER INCISORS (FRONT TEETH) WHICH HAD TO BE CONTINUALLY FIXED WITH COMPOSITE FILLING MATERIAL THESE FILLINGS ARE VISIBLE IN FIGURE 1.
SHE WAS UNHAPPY WITH THE ALIGNMENT OF HER TEETH WITH HER FOCUS BEING MAINLY ON HER CANINES BEING ANGLED INWARD.
SHE WAS DISSATISFIED WITH THE OVERALL SHAPE OF HER TEETH DESIRING LONGER TEETH.
HER GUMLINE WAS UNEVEN AND THIS SHOWED WHEN SHE SMILED.
SHE DESIRED A WHITER TOOTH SHADE.
This list of concerns can seem overwhelming, but you'll see that all of them were easily addressed with treatments from my list above. The following sequence of treatment was planned for Mrs.Patient:
WHITENING (BLEACHING) TEETH.
ORTHODONTIC TREATMENT TO IMPROVE TOOTH ALIGNMENT.
LASER SURGERY TO EVEN OUT HER GUM LINE.
TRADITIONAL VENEERS.
Considering these treatment modalities individually, whitening is the quickest and easiest way to improve the appearance of one's smile. In the context of this treatment plan it served to lighten the tooth structure underlying her semi-translucent veneers. Also, since her veneers were going to be a lighter shade, bleaching helped bring the remaining teeth into at more complimentary shade.
Orthodontic treatment was required to bring her teeth into a more ideal alignment prior to her veneer restorations. Orthodontics is not always. required to achieve an ideal result. Traditional veneers can fix minor discrepancies in tooth alignment up to 1-1.5 millimeters. For Mrs. Patient who desired a wider smile, orthodontics was necessary. (See figure 2)
As I mentioned earlier, Mrs. Patient is highly motivated and notices things like her gumline being lower on her upper right lateral incisor relative to its left-side counterpart. Normally this is an observation I would bring up with the patient when designing their final smile. Repositioning the gumline is completely dependent on how much movement is desired, and the patient's underlying bone level relative to the gumline. In more advanced cases the bone level is modified to accommodate the desired gumline. In our situation, fortunately, only minor movement was desired on a single tooth and this was easily accomplished using a soft-tissue diode laser.
Traditional veneers consist of removing a small portion of enamel on the facial surface of the tooth, the side of the tooth touching the lip. Since Mrs. Patient had completed orthodontics, and the teeth were in nice alignment, minimal preparation was required to accommodate stunning veneers. Mrs. Patient was in temporary veneers: for approximately 2 weeks while her permanent restorations were being fabricated.
(See Fig. 3) At her final visit, the temporary veneers were removed, the permanent veneers tried in for patient approval, and following approval were bonded on. This is a great example of a patient following through with treatment to achieve not an alright smile, but an amazing smile -the smile of her dreams.
I have been around this country and feel confident that a better place is hard to find. We enjoy unbelievable summers with perfect temperatures, long days, refreshing rivers, and pristine lakes. The winters are equally as enjoyable with easy access to amazing skiing/snowboarding. Year-round we are witness to some of the greatest scenery on god's great earth. There is no reason we should not be smiling, we live in montana. I want you to realize that a nicer, brighter smile is available for you; the smile that matches the enthusiasm and excitement that you feel inside.
*Special thanks to Alan Gibb at Gibb Orthodon- tics in Lethbridge, Alberta and Dave Swanberg, master ceramist at Precision Dental Prosthetics in Helena, MT.
Read Cosmetic Dentistry and other Smile Montana articles by Dr. John F. Miller, DDS, in 406 Woman magazines.