Dr. Gangwisch - Hello I’m Doctor Richard Gangwisch and today we’re going to perform an extreme smile makeover. We’re going to take six teeth that are extremely worn and we’re going to prepare and place six beautiful porcelain crowns. So let’s get started with David’s story. David Hall - Hi I’m David Hall and I’m here this morning at Gangwisch Dental Group with Doctor Gangwisch himself. He is going to do a total mouth restoration with porcelain caps. I’m here because I’ve had a great amount of wear and tear on my teeth over the past couple of decades and they’re now shells and I am ready to, number one, get it medically treated, and, number two, to get a new look. Before Pictures - Here is the tremendous amount of wear that is the reason for David’s extreme smile makeover. Dr. Gangwisch - We’re here today with David and David has to come to us with the problem of severe wear on his teeth. So what we plan on doing is an extreme smile makeover for him. Now, this is not merely for cosmetic purpose. What we have to do is to protect his teeth from continuing to wear away and eventually crumbling on him. However, one nice thing about this is he’ll end up with a stunning smile after this. Well David’s been sedated. And David how are you doing today? David Hall - I’m doing very well thank you. Dr. Gangwisch - Well, that’s great! Well, we’re going to have some fun today David and you know the nice thing is you’re going to end up walking out with a fantastic smile. So, let’s get started. David Hall - That’s great. Thank you. Dr. Gangwisch - To do an extreme smile makeover, we have to go ahead and prepare the teeth to accept the crowns. That means we have to remove the enamel surface from the teeth so we can go ahead and be able to have some room to put the porcelain in. You’ll notice here, we’re making depth cuts in the enamel. It’s very important to make sure we’ve got enough enamel that’s removed and no more than that. We have to have enough depth of porcelain to make them look beautiful. We like to have that inner translucence and we can’t just do it by layering a thin layer of porcelain over that. So now we go ahead and strip away the rest of the enamel. Now, everyone thinks at this point that we’re grinding these teeth down to little pegs but that’s really not the case, although they certainly do look small. But we’re only taking away a millimeter and a half of tooth enamel. So that still leaves quite a bit of tooth left. Now we’ll go ahead and continue this process. We’ve got six teeth that we’re going to take care of today so that will end up working out real well for him. He’ll end up with a beautiful smile after this. Now you’ll notice one thing, the patient doesn’t feel a thing. That’s extremely important. We want to make sure that they are very comfortable. This is the number one priority in our office. So we continue to go down the line. We’ve got six teeth that we need to do. We’ll go down and refine each preparation and make sure every single tooth is perfectly done before we can consider taking any kind of impression of that. So we’ll go through and get all the edges smooth right around the margins. That’s the extremely important part of the preparation of the teeth. And we’ll round all the corners here at the end, make sure that there are no internal stresses that we’ll put on the porcelain that could cause some premature fracture. Now we’re going to pack some cord along the gums. What that’s going to do is going to get the gums out of the way so we can take an impression of that. That’s what we’ll make a mold of and we’ll send that off to the lab and that’s what they’ll use to construct the crowns. So here we are going to squirt some of that impression material in and then we’ll go ahead and make a mold of that and we’ll wait until that sets and that’s what we’ll use to construct those crowns. Now in the interim, the patient is going to wear a temporary and notice we’ve got a liquid plastic that we place in the mouth and we’ll let that set for a little bit and we’ll take that out and we’ll show what that looks like on the inside. There we go. In the interim, we are also going to do a face bow transfer. What that does is relate the patient’s mouth to a machine that will reproduce jaw movements. They’ll do that doing the lab process. So we’ve made a temporary set of teeth here, so this will be a good indication of what we’re going to be able to put in in the permanent basis. So David, open for me a little bit and we’ll try that in. Now let’s go ahead and focus in on that and we’ll go ahead and see how that is. David will wear his temporaries for a couple of weeks. That will give the lab time to construct his permanent crowns. It will also give David time to make sure that the temporary smile we made is the right one for him. Now the moment has come when we’ll cement his new crowns and complete his brilliant smile. Well the big day has come and we’ve taken his temporaries off and we’re going to go ahead and try in those new crowns. And at that point we want to make sure they look good before we consider cementing them in. Looks like they are coming along quite well there. We want to make sure that every single one of these fit perfectly before we consider cementation. Also want to take into account contours and colors and make sure everything looks good and that the patient approves. Check the margins around the edge and make sure there are no edges that are fitting. So it’s cementation time, we’ll go ahead and put a bonding agent over the teeth. Now go ahead and cement that in with a resin cement. It has a little bit of adhesive properties but mainly has to be held on by the friction of the preparation. That’s why the preparations have to be done the way they are. They are reasonably parallel but not exactly. We’ve got to make sure that when we cement, it’s got to be perfect before we let that cement set. Now this cement can be light cured so we’re able to get it to cure for just a little bit, just enough so we can get the excess cement off easily. Then we’ll go ahead and cure it fully once we have everything in good shape on that. All right. Well we’ve finished our appointment for today. We’ve gotten all six of David’s crowns in and let’s have you take a look there David. Let’s see what you think. Ok let’s see the big surprise. David Hall - Oh they look wonderful. I think that’s a spectacular smile there. A hundred percent better. Dr. Gangwisch - You’ve got to go show those off now. David Hall - I’ll be standing on the corner all weekend. Dr. Gangwisch - Well David, you did great there my man. David Hall - Well great. Thank you. I’m David Hall. I’ve had Doctor G and his staff redo my smile, my teeth, my entire set of teeth and I’ve got to tell you I’ve been extremely pleased with them, as have my immediate family and some people I even run into every now and then that don’t even know me have commented on how white my teeth are and what a brilliant smile I have and it’s made me a lot more confident. If this was a procedure I had to repeat again, I wouldn’t think twice about it. I would highly recommend it for those individuals who want to have a change in their life and have the opportunity to do so.