Patient Stories Archives - Eggert Family Dentistry Blog

“Can I Get a New Night Guard?” – Sleep Questions Addressed with the Seattle Protocol and a New Splint – Ann’s Story

By: Dr. Elizabeth Eggert

How did this start?

Ann returned to Eggert Family Dentistry a few years ago after concerns arose at her previous dental office, where she often felt she was being “up-sold” on dental recommendations. In addition, her husband and mom have been patients at Eggert Family Dentistry for years and have been very happy with their experiences. Ann made it very clear from the start that her main concern is overall tooth health, and while she wants a beautiful smile, she is happy with her smile, so she didn’t feel the need to discuss cosmetic options. Ann mentioned at her new patient appointment that she had undergone a sleep study and she was told she didn’t have sleep apnea, but she has been told she snores so she wonders if she is as rested as she could be. She was also told by her previous dentist that she had “TMJ” or Temporal Mandibular Joint Disorder (TMD) and wanted Dr. Elizabeth’s opinion on that. Ann really didn’t have many symptoms of TMD and she wanted to better understand what the previous dentist was seeing.

What was revealed during the records process?

Dr. Elizabeth invited Ann to come back for The Records Process in order to help Ann understand her current dental conditions, including the status of her potential TMD. In the Records Process, we used models, photos, and x-rays, as well as results from an extensive analysis of how Ann’s teeth function. The details of The Records Process revealed that Ann had some evidence of an unstable bite and while it wasn’t causing Ann day-to-day problems, it has the potential to cause faster breakdown of her jaw joints, muscles, and teeth. In addition, with her snoring, Ann had the option of working through the Seattle Protocol, an innovative approach to treating sleep disordered breathing with dental resources, like dental splints. Even though Ann did have evidence of TMD (without current symptoms), she wasn’t interested in pursuing treatment for that, which may have included orthodontics, but she was interested in helping her snoring, so she elected to undergo the Seattle Protocol.

What was involved?

The Seattle Protocol helps us determine the jaw position that best alleviates the patient’s likely airway compromise. The protocol moves the patient through a series of diagnostic steps and treatments using various trial splints (using the myTap system) to find the most effective solution specific to each individual patient. The goal is to move through incremental vertical and horizontal increases to the jaw position. Each step builds upon the last, but patients don’t necessarily need to complete the entire process as the purpose of the protocol is to determine the phase that provides the best relief of the patient’s symptoms.

Seattle Protocol Six Steps

1. Nasal breathing therapy

2. Lower jaw orthotic trial splint

3. Lower jaw anterior repositioning trial splint

4. Dual arch trial splint

5. Dual arch repositioning trial splint

6. Dual arch repositioning trial splint in more forward position.

For Ann, like all patients starting with the Seattle Protocol, we started with Nose Clearing and Mouth Taping, with the goal of rerouting Ann’s breathing through her nose. Ann ended up moving through the first 4 stages and found relief from her snoring and reported sleeping better with stage 3.

What does Ann think?

We asked Ann what she thought about the process of undergoing the Seattle Protocol. She told us she found it very easy and the time went pretty quickly. “Both Dr. Eggert and Tracy helped me move fast through the treatment and my appointments always went smoothly and started on time.” She also found it to be really helpful and that the mouth taping was very beneficial, she even recommended it to some of her friends that she felt it would help.

Ann liked the different options of oral appliances and finding the right one for her after going through all the Seattle Protocol. We asked Ann what she would tell a friend or family member if they were having similar symptoms or issues and she said that she would highly recommend the treatment and working with Eggert Family Dentistry. “You really have to sleep on it! Literally, you have to sleep with the different splints as it is not possible to know how they will benefit you until you try them out. If one version does not work for you, you will know it.”

Congratulations Ann! Thank you for letting us be part of your journey. We’re happy to have found a conservative treatment option that addresses your goals and current conditions. We look forward to working with you and your family for many more years to come!

My Lifetime of Dentistry for an Amazing Smile – W’s Story

By: Dr. Elizabeth Eggert

How did this start?

W (patient name and face photos withheld at patient’s request) has been working with Dr. Elizabeth since she took the practice over from Dr. Jensen in 2005. Prior to that, W had been working with Dr. Jensen since the early 1990’s! In the 20 years Dr. Elizabeth has been working with W, he has undergone various dental treatments, including multiple implants, a bridge, and crowns. W has also undergone some periodontal therapy to help maintain his bone and gum tissues in their healthiest state. While working with Dr. Jensen, W did have anterior veneers placed. Unfortunately, W’s veneers were starting to decay and he was opening up space between his teeth due to heavy forces his bite was putting on his teeth. Dr. Elizabeth talked to W about replacing the veneers, but because of the heavy forces, she recommended the records process first.

What was recommended?

Back in 2011, W went through the records process with Dr. Elizabeth because his teeth were moving and because he started losing posterior teeth from root cracks. At that time, she recommended orthodontic treatment for W along with a plan to replace the veneers on his front teeth. At that time, W chose not to proceed with treatment. Fast forward to 2023 and W had decay that was causing the need to replace his veneers so W went through the records process again.

W has always had a “deep bite.” This means that his front and back teeth, especially for his lower arch are not at the same and even level (it is like there is a “step-down” from the anterior teeth to the posterior teeth). This deep bite causes excessive forces on his teeth, putting them at risk for breaking. Since 2011, W has lost more posterior teeth due to root cracks so again Dr. Elizabeth discussed the benefits of orthodontics to help even out W’s bite forces. However, we now have the option to do this for W with Invisalign. It was recommended that W undergo Invisalign with Dr. Elizabeth before replacing his upper and lower veneers.

What did he want?

W understood the benefits of moving his teeth to improve the forces. He wasn’t excited about the prospect of orthodontics, but agreed that he wanted his new veneers to last as long as possible and he understood that moving his teeth with Invisalign was a good way to help make that happen. He also noted he wanted to maintain his natural teeth for a lifetime and did not want any more missing teeth. He also was very sure that he did not want dentures, ever! After deep consideration and after putting his trust in Dr. Elizabeth, W agreed to move forward with Invisalign before replacing his veneers for his anterior teeth.

What was involved?

W’s Invisalign treatment required 30 aligners and was expected to take up to 15 months. However, W was so compliant with using his aligners as directed and keeping them in for 22 hours per day, that Dr. Elizabeth was able to recommend more frequent aligner changes and he was able to finish his Invisalign treatment in only seven months! Invisalign works wonders with motivated and compliant patients. The goals of Invisalign for W were to improve his deep bite, even out the spacing for his upper anterior teeth, and create symmetry for his gum tissue levels.

The photos show W’s smile after Invisalign. It is possible to see more of W’s lower anterior teeth now because his deep bite was addressed. Due to the wear on W’s teeth and their original positioning, there is still a “step” in his bite until the restorations are done.

After Invisalign was completed, W and Dr. Elizabeth went through the planning stages for his new veneers. She was able to plan for veneers for W’s lower anterior teeth, but the upper teeth would now be porcelain crowns to help fill in the spaces between W’s upper teeth. Twelve all porcelain restorations were planned for W.

W elected to sit through a full day with Dr. Elizabeth to prepare all twelve teeth for his new restorations. It was a tiring day, but he was a trooper! Two days later, Dr. Elizabeth had him back to finalize his temporaries and zero-in on his bite. Since W was fatigued and numb on the prep day, it was nice to be able to address the bite at the later time. At that time, W reported he was doing very well and was happy with how everything looked in the temporary phase.

Three weeks later, W’s restorations were ready and Dr. Elizabeth cemented them in and final scans were taken to fabricate W’s Invisalign retainers.

What does he think?

W was very open and honest about how he felt about the plan and process throughout the course of treatment. He admitted that he was very reluctant to do it all but glad that he did move forward. He especially was hesitant to do Invisalign treatment, but admitted, “It actually was not as bad as I thought it would be. Once I got used to the aligners it was ok. I was dreading the treatment time for Invisalign, but it went really well.”

We asked W what he would tell a friend or family member that was considering the same or similar treatment he said, “You need to trust your dentist and if you believe that it’s a good thing, then do it. You are not the professional! Have faith and trust your dentist.”

After W’s final bite and reevaluation appointment, he sent a very kind letter to Dr. Elizabeth. It really meant a lot to her to hear what W had to say. He noted “You had suggested this several years ago and I declined. What changed my mind was your professional opinion that this was necessary for my oral health. I have faith and trust in you as a professional and I realized not to follow your advice would be foolish on my part…As it turned out, the experience was not as dreadful as I expected it to be. Through this process, you and your team were wonderful. You were careful and made sure every step of the process was done exactly right, checking and rechecking as necessary. That made me feel very confident and ensured the success of the process. Thank you for the excellent work you did and please thank your team. They too should be proud of the excellent work they do for the patients of Eggert Family Dentistry.”

Thank you, W for trusting us with your smile! Also, thank you for your kind words. We treasure when patients are happy and it feels good to be recognized for the help we can provide! We look forward to working with you for many more years to come.

“I Want a Bright and Beautiful Smile!” – Shelley’s Story

By: Dr. Elizabeth Eggert

How did this start?

Shelley has been a long-time patient of Eggert Family Dentistry and was interested in Invisalign treatment as she felt that her teeth were crooked and she wanted to have a smile that she felt good about in family pictures. Dr. Elizabeth Eggert recommended that she go through the complete Records Process to analyze her bite and airway as well. Dr. Elizabeth wondered if there was more at play due to information that Shelley has shared with us over the years. Shelley also wanted to learn more about sleep appliances as she uses a CPAP.

What did she want?

Shelley wanted to have a white, bright, and beautiful smile. She wanted to feel good about her smile in family pictures, and with the many moments in the future that would be captured, she wanted to be confident about her smile and be able to enjoy and cherish these memories.

What was recommended?

Through the records process and with information from her doctor, it was determined that the position of Shelley’s front teeth and the existing wear likely are at least partially due to airway compromises, both at night and during the day. To correct the crowding, it was recommended that Shelley start with Invisalign. Through this process, Dr. Elizabeth would be able to unravel the crowding. However, it was noted Shelley’s tongue and arch form needed more space than her teeth would allow, so Invisalign would create spacing between her teeth. Dr. Elizabeth talked with Shelley about restoring her upper front teeth with crowns or veneers after Invisalign to account for the space discrepancy and to help protect the enamel that Shelley has worn away over the years.

What was involved?

Once the Invisalign was completed, Shelley did some whitening to brighten her smile and prepare for her restorations. Impressions were taken to develop a wax-up or “blue print.” It was only necessary to do restorations for Shelley’s upper front six teeth to help with the spacing issue and to better protect her enamel. Shelley was happy with the wax-up and so Dr. Elizabeth Eggert prepared her teeth and the restorations were fabricated. It was necessary to do more extensive porcelain restorations for Shelley – crowns that covered the whole tooth, because of existing fillings in those teeth. Zirconia crowns were done. Zirconia is a very strong all-porcelain material that has become very esthetic as well. More and more, it is being chosen for even front teeth.

What does she think?

We asked Shelley what she thought once the Invisalign and restorations were all completed and what she thought about the whole process. She said, “This is awesome and I’ve gotten a lot of compliments.” “Everything was great and went very smoothly – you guys were perfect!” When asked what advice she would offer a friend or family member thinking of changing their smile, she said, “Prepare and be patient, but I’m so happy I did this!” Congratulations Shelley! We love working with patients like you! If you’ve been thinking about improving your smile, contact us today to learn more about what Eggert Family Dentistry can do for you! 651-482-8412.

Unlocking A Brighter Smile with Zoom Whitening – Kimberly’s Story

By: Dr. Elizabeth Eggert

At Eggert Family Dentistry we find that a lot of our patients are interested in professional teeth whitening and want to know the options that we offer. They are often looking for quick results, lower chances of sensitivity, longevity, and an affordable cost for the treatment. One of our most popular options that checks all of these boxes is the Zoom Whitening System. This procedure includes an in-office whitening treatment, which can brighten your teeth up to 8 shades, as well as take-home bleaching trays, which help to set and maintain the color. Using a special whitening gel and a blue LED light, in just 2 hours you will have a brighter smile.

Where did Kimberly start?

Kimberly and her family have been loyal patients of Eggert Family Dentistry for a very long time, always consistent with recare appointments and they follow through with recommended treatment by Dr. Elizabeth. Recently, Kimberly decided that she wanted to brighten her smile and set-up an appointment for the Zoom Whitening procedure.

What did Kimberly want?

Kimberly, like so many of us, had staining to her teeth and noticed that in the last few years, her teeth were getting darker and more yellow. She wanted to whiten them quickly and decided that the Zoom Whitening procedure was perfect for her needs. She was afraid that the over-the-counter whitening strip options would cause sensitivity. She also had heard from friends that the white strips can take numerous applications for very minimal improvements.

What was involved?

Kimberly came to our office for a 2-hour appointment. The Zoom Whitening procedure is performed in the office and starts with photographs, obtaining an initial shade, and taking impressions to create custom bleaching trays. After these initial steps, Kimberly relaxed in the dental chair as our assistant, Heather, applied a barrier layer for her gum tissues before the bleach was applied. Kimberly sat through four 15-minute sessions where the Zoom LED light shined onto her teeth with the bleaching gel. Zoom uses this light to activate the gel, which in turn accelerates the bleaching process. Essentially, the light energy speeds up the chemical reaction that whitens the teeth. While the LED light is bright and blue, some people mistakenly think it emits UV rays, but this is not the case at all. The blue light is perfectly safe!

While Kimberly was enjoying time to herself, Heather was busy fabricating her at-home bleaching trays so she could have them as soon as possible to help set the color at home. These trays can also be used to apply a desensitizing gel, if necessary.

What does Kimberly think?

“I was curious of how the process worked and wondered if it would work for me?” Kimberly found it to be very easy and she told us she was very pleased with the results. She would tell her friends that it was an easy process! Now with the trays that were designed especially for her and included in the treatment, she can continue to brighten her smile at home for even whiter results or she can use the trays when her teeth start taking on some discoloration again, therefore allowing her to keep her confident with her beautiful new smile for many years to come!

“All I Want for Christmas is My Two Front Teeth” – Connor’s Story

By: Dr. Elizabeth Eggert

How did this start?

Connor started seeing Dr. Elizabeth in the fall of 2020. Connor was born without two lower teeth. The teeth were congenitally missing, a condition often known as hypodontia. To mask this, Connor had been wearing a metal wire retainer (Hawley retainer) with two teeth attached to it since his braces were removed many years prior. Why some people are born without certain teeth is unknown. While there are often genetic or heredity links, it isn’t always that parents pass this condition on to their children, in fact, it is often found to skip a generation. Treatments for congenitally missing teeth usually include bridges, dentures, or dental implants. Often orthodontic treatment is also necessary to make sure the spacing available is adequate.

What was recommended?

Dr. Elizabeth talked with Connor about treatment options for the future, should he ever decide that wearing a retainer full time wasn’t for him. In an ideal world, implants can replace congenitally missing teeth without altering any other teeth in the area. Connor did go for a consult with the oral surgeon, hoping to hear that he could undergo implant treatment whenever he was tired of wearing his retainer. Unfortunately, Connor doesn’t have enough space for implants.

What this means is that Connor will have to undergo orthodontic treatment (again) before any implant surgery can be done. Connor and his mom and dad weren’t excited about that option and wanted to know what alternative treatment options he has. Connor goes to college and does not feel that orthodontic treatment at this point in his life is what he wants.

Connor could choose traditional bridges, but Dr. Elizabeth was not in favor of this option because the bridges would be built on small anchor teeth. Initially, Connor planned to keep wearing his wire retainer, but then last summer, his retainer finally broke. Connor was tired of wearing a retainer so Dr. Elizabeth Eggert suggested Connor consider having bonded composite “bridges” completed. She talked with Connor about how conservative the preparation could be for the anchor teeth and was confident that the results could look good. Another advantage of the composite bonded “bridges” was that if Connor does decide to move forward with orthodontics and implants later in life, his neighboring teeth will still be in good shape.

What did he want?

After discussing the pros and cons with Dr. Elizabeth, Connor and his parents decided on composite bonded “bridges,” which is a type of fixed dental prosthesis for the replacement of a single missing tooth. The design of the bonded bridge consists of an artificial tooth made out of plastic filling material with a wing-like extension, which is bonded to the neighboring tooth or teeth. The tooth which supports the resin bonded bridge is called an abutment. The tooth which is replaced by the bonded bridge is called a pontic. Usually only minimal preparation is done to the abutment tooth and this treatment is considered minimally invasive.

What was involved?

After deciding to move forward with the composite bonded “bridge,” Dr. Elizabeth took impressions to get a model of Connor’s teeth so she could design the new restorations. Connor also wanted his teeth to be whiter so he did over-the-counter Crest White Strips to bleach his teeth. Connor then had an appointment with Dr. Elizabeth and in one day, he left the office with two new teeth as part of his composite bonded “bridges.”

What does he think?

Once the treatment was completed Connor was very happy with the esthetics and his bite. When we asked him some questions following treatment he said that he did not think much about having the procedure done, but just that it may take a while. He was surprised at how quick and easy the procedure appointment was and notes “I actually fell asleep for awhile I think!” Connor says “I love them! They’re super easy and they feel pretty normal already! It’s been great.” He would tell anyone that needed the same procedure to definitely do it! “It’s totally worth it.”

Thank you, Connor, for trusting us with your smile, we look forward to working with you for many years to come.

Thankful For My New Partials – Bob’s Story

By: Dr. Elizabeth Eggert

How did this start?

Bob initially was a long-time patient of Dr. Furey before Dr. Elizabeth came on the scene. Bob has autism and requires special care at his visits as he is often non-verbal, making it tricky to communicate or understand his needs. Bob comes to appointments with his mom, Marlene, who does what she can to help communicate Bob’s needs.

Autism Spectrum Disorders (ASD) is a general term used to describe a group of complex developmental brain disorders. Autistic disorders include Asperger Syndrome, Rett Syndrome, and Childhood Disintegrative Disorder. The number of children with autism is on the rise according to the Centers for Disease Control.

Patients with ASD often have difficulties with social interactions, communication, and repetitive behavior. They process sensation atypically and may be overly sensitive to bright lights, loud sounds, touch, strong odors, or taste which can make dental visits a challenge for all involved.

Bob also has a severe gag reflex, which makes it difficult for restorations to be done on his teeth without being sedated for the procedures.

What did Bob and his mom want?

Initially, Bob wanted his severe toothache addressed. It had been awhile since Bob had seen a dentist before Dr. Elizabeth saw him at Eggert Family Dentistry. Bob wore a flipper partial for his upper teeth that was breaking down. Bob also had evidence of the start of periodontal disease, as well as some teeth with severe cavities that needed attention. Bob was having intense pain with these teeth and it seemed like extractions were Bob’s best option, partially because he was unable to take good care of teeth so far back in his mouth due to his autistic disease, as well as his gag reflex.

Bob and his mom wanted Bob to be healthy and set up well since he was planning to move to a group home in the near future, as his mom was finding it more difficult to fully care for him as she gets older too.

It was decided to try to save as many teeth as possible for Bob, without extensive dental heroics and to make him partial dentures that would help him chew and “feel more complete.”

What is involved?

After extensive gathering of information and research, Dr. Elizabeth had a plan in place for Bob that was approved by Bob and his mom. Bob had his teeth extracted with an oral surgeon and after some healing time, they began working through the partials. Since Bob had such a severe gag reflex, Dr. Elizabeth was able to use the intraoral scanner to send images of Bob’s teeth to the dental lab to design his partial dentures.

Dr. Elizabeth worked with the lab and over the course of a few weeks, Bob was able to see his partials come to life. First, there was a try-in of the plastic frame for the partial denture. Then, Bob got to see what the teeth would look like before they were set in hard plastic. The dental lab sends denture teeth set-up in wax so changes can easily be made if desired. Bob and his mom liked the process and couldn’t wait to get Bob’s final partial dentures!

Unlike conventional metal based partial dentures which rely on metal clasps to provide stability on the teeth, flexible dentures are thinner and more lightweight and rest comfortably in the mouth secured with clasps that blend in better with natural teeth. Flexible partial dentures are designed to be comfortable and functional and should not restrict the ability to eat or speak. Bob’s partial dentures were made from a special, very strong plastic, called acetal. The dental lab suggested that acetal be used for Bob since it can be made very thin (to help with his gag reflex) and it is very strong (to help with Bob’s habit of grinding his teeth).

What do they think?

Bob was excited to get his partials and Marlene reports that he eats better with his new partials and he even is able to communicate verbally with her. When Dr. Elizabeth saw Bob for his follow-up denture adjustment appointments, he actually answered direct questions. He was so excited about his partials that he was more open to communicating with others! Bob hates to be without his partials and keeps a close eye on them during his teeth cleanings when he has to take them out. It was exciting to see such a transformation for him. Bob also started a job in a school cafeteria, we like to think at least partially because of increased confidence! Congratulations on your new partials Bob. It was our pleasure to be able to work closely with you on this project.

Avoiding “Spooky” Front Teeth- Mary Kay’s Story

By: Dr. Elizabeth Eggert

How did this start?

Mary Kay is a longtime patient of Dr. Elizabeth. She noted at her first appointment that she had “TMJ” and her right side was experiencing clicking and she was seeking therapy for the condition. TMJ disorders (or TMD) can manifest with different signs or symptoms for different people and encompass a wide variety of diagnoses. Typically, people with TMD experience pain in the jaw joint and/or in the muscles that control jaw movement. Dr. Elizabeth suspected that Mary Kay’s TMD could be related to how her teeth fit together and talked to Mary Kay about the benefits of orthodontics for her. Mary Kay wasn’t ready at that time, but after a few more sessions with Dr. Elizabeth and realizing that the cracking occurring on her teeth and the fact that she had already lost a few teeth at a relatively young age, Mary Kay did want to hear more.

Mary Kay’s Panoramic Image 2021, note the implant and some missing teeth.

Mary Kay suffered for years with TMD. Her bite put uneven forces on the teeth, she had crowding, and when she went into her chewing movements, her back teeth hit very hard. Luckily, orthodontics can improve a number of the issues Mary Kay had. When Mary Kay was ready, she went for a consult with Dr. DeVoe of DeVoe Orthodontics. Dr. Elizabeth works closely with Dr. DeVoe and she had confidence that he could help improve Mary Kay’s bite and therefore, her TMD symptoms. During the course of treatment, Dr. DeVoe discussed options with Dr. Elizabeth for Mary Kay’s front two teeth. Originally, Mary Kay had one existing porcelain-fused-to-metal crown on her right central incisor. With the wear pattern Mary Kay had on her other teeth, this crowned tooth no longer matched its neighbor in either color or size and shape.

What was involved?

Mary Kay completed her orthodontics with Dr. DeVoe. Mary Kay noticed an improvement to her bite and her TMD symptoms did improve as well. Mary Kay was also lucky enough to address a deviated nasal septum with nasal surgery. This also helped improve her breathing and helped her sleep improve. Improvements in sleep always help underlying pain issues with not only TMD, but other chronic pain conditions. To fine tune the bite, Dr. DeVoe asked Dr. Elizabeth to complete equilibration for Mary Kay in order to sync her tooth bite with her jaw bite. This also helped solidify a better bite for Mary Kay.

For her front teeth, Dr. Elizabeth discussed options with Mary Kay. Mary Kay had many options, including doing nothing. She could also have chosen to bleach all her natural teeth and leave her existing crown as is. Dr. Elizabeth recommended, for best color match and to be most conservative, that Mary Kay bleach her natural teeth and then replace her crown on her right central and also complete a crown for her left central to gain symmetry in shape, color, and contour. Mary Kay underwent Zoom in-office bleaching and then her new crowns were completed.

What does Mary Kay think?

Before having the procedures done, Mary Kay was just hoping her teeth would look better when all the treatment was completed. She said that the process of braces hurt at first, but noted that she got used to it and it was less intense the longer she had the braces on. “All of the steps from braces to replacing the front teeth went very smoothly. I am very happy with the outcome. My teeth look much better.” Mary Kay would highly recommend to anyone considering treatment with Dr. Elizabeth to do so because all the steps Dr. Elizabeth works through creates a great outcome as everything comes together!

Mary Kay – we are so happy that you are pleased with your results, thank you for your commitment and the trust you put into the treatment as well! Congratulations on your new smile! We look forward to treating you and your friends and family for many years to come!

Now, Getting Ready for College – Elena’s Story

By: Dr. Elizabeth Eggert

How did this start?

Elena came to Eggert Family Dentistry at the age of 15 as a referral from our orthodontic colleague, Dr. DeVoe. Dr. DeVoe wanted Dr. Elizabeth Eggert to evaluate restorative options for Elena because she is congenitally missing (was born without) one of her lateral front teeth and her lateral incisor on the other size is undersized. Dr. DeVoe anticipated that Elena would want a solution for her smile after her braces were removed.

A congenitally missing tooth is one of the most common dental developmental abnormalities. In fact, roughly 20% of adults have at least one tooth that never developed. Why is that number so high? Well, we’ve all heard of that person who didn’t develop all, if any, wisdom teeth. If you take wisdom teeth out of the picture, the percentage of adults with congenitally missing teeth drops to only 5%. Other permanent teeth we often see missing are second premolars, upper lateral incisors, and lower central incisors.

A wisdom tooth that never develops would typically be thought of as a good thing – one less tooth to remove! However, being a person with a missing front tooth can be quite a different story. Teenage years are difficult enough without having to worry about your smile. With the emotional roller coaster of being a teen, we need to give our children any excuse to smile and no reason not to!

What was recommended?

Dr. Elizabeth had some options for Elena for replacing her missing tooth. One option was to use a “flipper,” which is a removable partial denture that contains one or more artificial teeth. A flipper is often made from denture acrylic and can blend in well with your smile. The flipper is custom made using an impression or digital scan of your mouth. Flippers can be uncomfortable to wear and they do come in and out of the mouth, which can be inconvenient.

To replace missing teeth, you can also consider a bridge. A traditional bridge uses the neighboring teeth as anchors to “fill in the gap.” Since Elena was still growing and developing, a traditional bridge wasn’t Dr. Elizabeth’s first choice. A more conservative option for Elena’s age was to consider a composite bonded bridge, which still stays fixed in the mouth like a traditional bridge, but is much more conservative for neighboring teeth and can more easily be altered with growth, if needed.

Another common method to replace missing teeth is to use a dental implant. With a dental implant, a small post, usually made of titanium, is placed into the jaw bone and serves as a substitute for the root of the tooth. Then, through a series of attachments, a tooth is added to the implant. Again, because of Elena’s age, a dental implant wasn’t indicated…yet, anyway.

Dr. Elizabeth discussed pros and cons with Elena and her mom of these options and emphasized that something would have to be done to last through Elena’s teenage and early adulthood, even though a dental implant may be the best long-term approach.

What did Elena want?

For the undersized lateral on her right side, composite bonding was done to change the shape and size of the tooth. A porcelain veneer could have been done, but with Elena’s age, the composite material can more easily be changed, if needed, for future growth and development. As an adult, Elena could choose to convert her composite bonding to a porcelain veneer for ideal color match. After much discussion, Elena and her mom decided that for her missing tooth on her left side, Elena would use a flipper during the day and an orthodontic retainer at night.

Then what happened?

Throughout Elena’s high school career, she found it was inconvenient for her to wear her flipper and she also didn’t wear her retainer much so her teeth moved somewhat. In thinking of her life after high school, Elena wanted to review her options. Elena and her dad came to consult with Dr. Elizabeth she told Dr. Elizabeth, “I am interested in a bridge now.” Once again, Dr. Elizabeth reviewed Elena’s options in regards to how the most conservative approach would still be preferred. Dr. Elizabeth recommended that Elena complete a composite bonded bridge. Dr. Elizabeth would be able to artistically create a “fake” tooth and attach it her surrounding teeth. This choice is good for the esthetics and will buy Elena some time until she is older and can make some alternate decisions, if needed.

What does she think?

When asked how Elena felt about getting the procedures done, she said “I was looking forward to my tooth looking like a normal sized tooth.” She also said that her mom had a bridge done and so she was not worried about it. “I like it a lot and it looks good. It doesn’t feel weird to my bite. It does not feel weird when I chew or eat.” She is really happy to have her palate free! She would recommend that anyone needing the same or similar treatment done go for it. She says, “I like it! It’s nice to have a normal smile where all my teeth are a normal size.”

Congratulations on your amazing results Elena and thank you for putting your trust in us! We are delighted to help you move into your college years!

“I’d Like to Get Some Veneers” – The Dental Journey for Kris

By: Dr. Elizabeth Eggert

How did this start?

Kris came to Eggert Family Dentistry as a new patient in the summer of 2021, looking for a clinic closer to home after she had moved to the area. Kris had been through Invisalign treatment in recent years, but her teeth had relapsed and she wasn’t happy with how things had changed. She also noted that she had a small mouth and a gag reflex that made it difficult for her to tolerate x-rays. Dr. Elizabeth was curious, wondering if Kris might have a compromised airway? At her new patient appointment, Kris asked Dr. Elizabeth, “I’d like to get some veneers, but what would be involved?” Kris told Dr. Elizabeth that previously a different dentist told her she would not be a candidate for veneers due to her bite. Elizabeth believed that Kris would be a candidate for veneers, but suspected that some tooth movement first would be best. So, Dr. Elizabeth welcomed Kris to undergo the records process with her in order to figure out how to get Kris the smile she deserves!

What did Kris want?

Kris’ main objective was to have whiter and bigger teeth. She wanted to be able to eat without any limitations and have her teeth show in her smile. She was sure it would give her so much more confidence. She had friends who had had veneers done on their teeth and she loved the result. What she didn’t know until undergoing the records process was why her teeth had relapsed after her last Invisalign treatment and why she had such a severe gag reflex. Dr. Elizabeth noticed that her tooth positions were putting strain on her tongue and it looked like her tongue craved more space. Dr. Elizabeth believed by addressing this, she could help Kris have a much more stable end result, a better airway, and set her up for beautiful veneers. Therefore, Kris started her treatment with Invisalign.

What was involved?

Kris underwent Invisalign treatment with goals to improve her crowding, expand her arch, create space for porcelain veneers, level her gum tissue, and provide comforting support for her joints and muscles. After less than a year of Invisalign, Kris was then ready to plan for her restorations. Before starting the restorations, Kris underwent Zoom Whitening in-office bleaching at Eggert Family Dentistry for both her upper and lower arches to help achieve the brightness she wanted. A mock-up was done as well, to verify the shape of her future veneers. Once Kris was happy with the color of the teeth that would stay natural and after she approved her mock-up, Kris was ready to prepare the teeth for veneers. She spent part of the day with Dr. Elizabeth Eggert and went through the procedures needed to get her teeth ready for her veneers. After about 3 weeks with temporary veneers, Kris came back to seat her veneers. Kris chose to veneer 8 teeth on her upper arch.

What does Kris think of her results?

Before undergoing procedures to get her veneers, Kris told us “I was really nervous because I didn’t know what to expect. It seemed overwhelming in the beginning.” Yet, she was very confident in Dr. Elizabeth and was excited to start the journey. Kris told us that she didn’t mind the whole process and after undergoing everything, she understands the need for it to take some time.

Kris is very happy with her results. She told us “Thank you! I love it so much! I am super happy with everything!” She also shared, “I think it’s so funny that people at work and my friends can tell something is different but cannot pinpoint what it is!” She would definitely recommend the treatment to others and says, “It is a team effort and you have to do everything that is expected of you for the best results.” Kris feels that having a better smile is fantastic. She would tell anyone thinking of having the treatment done “Do it in a heartbeat! Of course, it is an investment but it’s not as bad as you think and definitely worth it!”

Congratulations Kris – you look fabulous and we appreciate your trust in us to help us live out our motto of providing “Dentistry for a Lifetime of Smiles!”

When the Puzzle Pieces Aren’t Fitting Together, How to Improve Crowded Teeth – Lisa’s Story

By: Dr. Elizabeth Eggert

How did this start?

Dr. Elizabeth Eggert has been working with Lisa since 2016. Initially, Lisa was having issues due to a cracked tooth on her lower right side. After a crown was done for that tooth, it historically and occasionally flares up for Lisa. Dr. Elizabeth noticed that due to Lisa’s crowded teeth, the teeth in her lower jaw sit at an angulation toward her tongue, instead of straight up and down. This puts extra forces on teeth and often will contribute to cracking. Lisa also admitted that she finds herself clenching her teeth together, most of the day and probably at night. This also produces more force than the teeth are prepared to handle. Therefore, the fact that Lisa’s teeth are often sensitive comes as no surprise.

Initially, Lisa thought she would try a standard occlusal guard (or night guard) to help alleviate the pressure she experiences from clenching her teeth. Lisa wore the appliance regularly and she believed it helped, but she still had sensitivity from time to time and when a second tooth started having symptoms of cracked tooth syndrome on her lower right, she knew it was time to take action. She decided she wanted a more permanent solution to her bruxism and that is when the discussion of Invisalign began.

What did Lisa want?

Lisa wanted to straighten her teeth, avoid getting more cracked teeth, and help stop her grinding at night. Lisa didn’t want to have the wires and brackets of traditional braces, so she was excited about the option of Invisalign. When Dr. Elizabeth was planning Lisa’s case, she helped Lisa notice that the small lateral incisors on her upper jaw played a role in why the bottom teeth were crowded. Because of the smaller lateral incisors, the lower teeth had to be more “squished in” and crowded. Dr. Elizabeth talked with Lisa about how after Invisalign treatment, there would be spaces left between her teeth on the upper arch. Luckily, Dr. Elizabeth had a solution, which involved widening those teeth with veneers. Lisa was excited about the prospect of straight teeth and understood why the veneer restorations were necessary so she decided to go forward with treatment.

What was involved?

Lisa underwent the Invisalign records process with Dr. Elizabeth so a treatment simulation could be done. Her treatment was expected to take 10-12 months with the goals of unraveling the crowding, creating space for upper veneers, and providing support for her joints and muscles.

To help with her bruxism, Dr. Elizabeth added bite ramps to Lisa’s Invisalign aligners. These are a way to help keep her muscle more calm because they don’t allow for easy clenching. Despite the bite ramps, Lisa’s strong muscles did continue to clench somewhat, although things were improving for her joints and muscles throughout treatment. Her continuous clenching did slow down her progress and after her initial set of 20 aligners, Lisa’s bite still wasn’t quite perfect. Therefore, Dr. Elizabeth recommended a “refinement” treatment with Invisalign and Lisa’s treatment continued on for another 6 months. During this time, Dr. Elizabeth also gave Lisa exercises to help stretch her jaw muscles so that her clenching wouldn’t continue to impede the progress for her Invisalign treatment.

After 18 months of Invisalign, it was time to plan for Lisa’s veneer restorations. Some simple bite equilibration was also needed for Lisa to finalize her bite position and give her solid stops for her back teeth. Lisa wanted whiter teeth so she decided to try the Opalescence Go! professional white strip whitening system to brighten her smile. Lisa chose to only restore her 2 lateral incisors. Dr. Elizabeth reviewed the pros and cons of completing veneers for her upper 4 front teeth, including better size proportioning, and continued color matching, but Lisa felt that 2 veneers was the right choice for her. So, a laboratory wax-up was done as a blue print for the final restorations and the 2 porcelain veneers were completed for her upper lateral incisors. Lisa was very excited about finishing her treatment after spending the time to move her teeth into a better position!

What does Lisa think of her results?

When we asked Lisa what she thought about undergoing the procedures before she had things done, she said “I kind of knew what Invisalign did – it was going to straighten my teeth and work out problems like cracks in my teeth and help me stop grinding at night.” Lisa didn’t understand that the spacing issues she had were causing her crowding until we started analyzing things.

The process took longer than she was initially expecting, but she understood that her clenching was slowing things down so she worked hard to do her exercises. In the end, she is happy with how everything looks and the outcome. “It looks good!” She really is hoping to slow down any new cracks from forming on her teeth. In talking with anyone considering similar treatment, Lisa would tell them to talk to Dr. Elizabeth because this too may be an option for you and it is definitely a better alternative to brackets!