Center for Cosmetic & Comprehensive Dentistry
May 16th, 2012
With the increase in obesity in the United States over the past 20 years there has been a corresponding increase in obstructive sleep apnea (OSA). Worldwide obesity has doubled since 1980. This is why there are so many sleep labs that are around us. Where does dentistry come in to play with this?
Neuromuscular Dentists and those highly trained in TMJ problems can recognize these issues as so many of them stem from the Oral Cavity. Some oral clues are:
-deficient cranio-facial anatomy
-cause: chronic mouth breathing and allergies
-facial development
Another factor that can be recognized is crowded oropharynx. This can be observed when treating patients. Obesity only compounds the problem. Unfortunately, the large majority of dentists are not trained to recognize this OSA which is a life threatening condition.
These OSA patients need help whether by the means of a CPAP or some sort of Dental Sleep Appliance.
If you have questions about Houston TMJ or Houston Dental Sleep Appliance please feel free to call our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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May 8th, 2012
Implant Dentistry continues to evolve and the new technologies allow us to offer patients more cosmetic and convenient treatment. One of the problems and inconveniences that patients do not like is having to wear a “flipper” or removable partial when the implants are healing. This is cumbersome and annoying.
We are now able to extract a single tooth, place a dental implant and a temporary crown on the implant in a single visit. This temporary crown means no flipper. Additionally, it allows us to design the temporary crown to help preserve the gum tissue architecture which will allow for a more cosmetic long term crown. This is futher accomplished with custom zirconium abutments that are computer designed to fit the implant site and continue to maintain the gum tissue contours.
Custom Implant abutment after removing Temporary Crown
Porcelain Implant Crown with excellent gum tissue contours
The above photo shows how the temporary crown was used instead of a flipper and how it preserved the gum tissue contours. The final porcelain crown was custom shaded to blend in with the other teeth.
In overview, there are some excellent techniques that allow us to combine cosmetic dentistry and implant dentistry in a manner that is comfortable for our patients.
If you have any questions about Houston Cosmetic Dentistry or Dental Implants Houston please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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May 6th, 2012
A recent research study that was released this week in the Journal of the American Medical Association, found that Botox injections were not effective for preventing migraine headaches. It goes on to further state that Botox treatment also does not not appear to benefit patients with chronic tension headaches.
The researcher, Jeffrey Jackson MD, states that much better migraine therapies are needed.
In my opinion, this is true. However, it behooves me that so many researchers and those in the medical profession fail to recognize the role that TMJ issues play in causing theses headaches. In prior blogs, I have mentioned that many of my TMJ patients come from ENT’s who have started to recognize that some of these headaches and earaches are indeed from TMJ and that dentists with special interests and training in TMJ can help them.
Personally, this has been a very rewarding area for me as I have been able to help patients who have been suffering from these debilitating headaches for years. In fact, it is even more rewarding to see our patients get off of the medications they have been on for headaches. As for Botox, I have yet to have a patient who has advised that the Botox helps them.
I have been working with others to try and expand the medical and public about the relationship between migraines and TMJ.
If you have any questions about Houston TMJ or TMJ pain Houston, please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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May 3rd, 2012
The symptoms that occur from true TMJ issues are numerous and often outside the range of the jaw and muscles. Everyday patients present with symptoms that vary. A very common TMJ symptom and one that patients want corrected is headaches. These headaches are often a major concern and until we inquire about other symptoms sometimes the patients have not realized that they all stem from TMJ. This can range from neck pain, limited neck rotation, shoulder pain, pain in the sinus area and even tingling of the fingertips.
This morning, we saw a young patient who gets headaches two to three times a week and notices his hearing gets worse on the side that the jaw popping occurs. His CBCT 3d scans also revealed that he was developing a straight neck as opposed to normal lordosis (normal curvature of the neck). Additionally, his front teeth were wearing in an unusual pattern which was caused by his positioning his teeth to where his jaw was comfortable.
Another case from the other day, one of our TMJ patients presented with similar complaints except for the fact that when she starts to get some ear noise or jaw pain she will pop her neck and it feels better but that her jaw will be out of position.
Developing an understanding of symptoms and their relationship to TMJ and the rest of the body has enabled us to assist patients in feeling better in ways that we never could before. The addition of our high tech 3D scan also provides insight to the underlying issues and syptoms.
If you have any questions about Houston TMJ or TMJ treatment Houston please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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April 30th, 2012
This is definitely an art and science! Todays technology allows us, in many cases to remove a front tooth and immediately place a dental implant in the tooth socket the same day. In fact, we can also make a temporary implant crown so that the patient does not have to wear a removable device such as a flipper during the healing phase.
The “art” begins with skilled removal of the bad tooth. This means removing the tooth with no bone or gum damage. It is the surgical responsibilty to preserve this architecture and the restorative dentists responsibilty to create an excellent temporary crown to preserve the gum tissue in six dimensions. The final cosmetic dentistry result will be dependent on these art forms as well as the color and shape of the final dental implant crown. This crown is all ceramic, meaning that absolutely no metal is used.
Dental Implant and Custom Abutment
All ceramic dental implant crown
The additional use of a custom abutment, which is the piece that inserts into the implant is also essential. This custom piece, should be zironium and not a dark metal and the contours of this should be designed to compliment the adjacent tooth.
The photos show a close up view of what can be accomplished when the “art” is carefully planned and completed.
If you have questions about Dental Implants Houston or Cosmetic Dentistry Houston please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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April 26th, 2012
There is a lot more to comprehensive neuromuscular dentistry then what one often sees. Whereas most neuromuscular dentists are trained to look at the muscles, nerves, and teeth, advanced training dictates that the neck, shoulders, posture, and even legs can play a role.
At the very least, a neck and posture exam should be included in TMJ exams as the neck and facial muscles work hand in hand affecting TMJ pain and treatment. A good analogy is that your head is a bowling ball, as long as you balance it on a stick in the middle the stick is fine. If, however, you move the head forward, the stick will be strained and can bend under the stress of trying to support the bowling ball. The same happens with your head and neck.
This can result in loss of lordosis, rotation of C1 and C2, a straight neck and even shoulder drop, sidebending of the head and hip issues. To only correct the jaw and leave the neck issues unattended can lead to long term instability of the TMJ treatment and pain relief.
If you have any questions about Houston TMJ or TMJ treatment Houston please feel free to contact our office, 713-668-2289, Ronald W. Konig DDS, FAGD, LVIF
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April 23rd, 2012
Patients often ask why or how they got TMJ problems. Some have had trauma or accidents, others may not realize it, but a child may have had compromised airways, allergys, or breathing issues which can often lead to TMJ or malocclusions. This is usually results in constriction of the maxillary arch which can contribute to a host of problems from crossbites to retrognathic mandible (retruded). I personally, feel that it is extremely important that these issues be corrected as early as possible to allow proper development and facial symmetry.
Many of these problems can be easily treated in children with orthodontic appliances, however, airway evaluation is essential. If tonsils or adenoids are obstructing the breathing then the problems can re-occur. With adults, treatment is dependant on how much degeneration and change has occurred and what symptoms are still present.
In overview, these functional and skeletal problems do warrant early treatment to help normal facal development and to prevent future TMJ problems as well.
If you have any questions about Houston TMJ or TMJ treatment Houston, please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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April 21st, 2012
It is very common for our TMJ pain patients to have seen an ENT or other medical professionals for the headaches and pain they experience. After all if you have constant headaches and earaches, the most logical thing to do is to see your physician. Many times if no medical problems are found, the symptoms may stem from your bite or rather how your teeth force your muscles and joints into a bad position.
I am often asked how this causes headaches? Simply stated, contracting muscles pull on the periosteum around the skull. This muscle contraction in turn causes decreased blood flow through tissues which can cause the release of vasoactive peptides that directly stimulate the nerve endings. In laymans terms the constant contracting of facial muscles as you eat chew swallow 2500 times a day can cause headaches if the way your teeth meet together is not correct.
What about ear congestion? Your jaw joint or TMJ is right in front of the ear. When the joint is compressed backwards it puts pressure on the middle ear which has a fenestrum. Pressure on the middle ear causes the feeling of congestion. In fact, this compression can also cause vertigo and tinnitus.
In overview, TMJ problems can cause a host of maladies from ear congestion to tingling of the finger tips. The good news is that these can be treated and this is what I personally find so rewarding, helping these patients.
If you have any questions about Houston TMJ or TMJ Houston, please do not hesitate to contact our office, Ronald W. Konig DDS, FAGD, LVIF
713-668-2289.
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April 18th, 2012
This is an interesting case of a patient with missing lateral incisors. His before photos shows an old type of a metal bridge that had decay and unesthetic teeth. Several options were considered and investigated:
1) Use of dental implants for the missing teeth
2) Use of fixed bridges and porcelain veneers
The use of implants was going to entail bone grafts then implant placement with the possibility of using a 3mm diameter implant, which is very small. The adjacent teeth both had decay and were going to need crowns even if the implants were done. Sometimes this is a difficult choice to make.
Decayed and unethstic teeth: Missing Lateral Incisors
Fixed Bridges and Veneers
In this case, the patient elected to forgo the bone grafting and dental implant surgery and proceed with fixed bridges and porcelain veneers. This is not to say that dental implants are not a good choice. The lower teeth were whitened prior to treatment. A natural smile and contour was desired by the patient.
We designed this case accordingly and used what is called “ovate pontics” to create the appearance that the missing teeth are coming out of the gums as opposed to laying on top of the gums. This was accomplished using a laser to contour the gum tissue-no pain associated with this. The strength in these bridges is excellent as we used Emax ceramics.
In overview, the patient was elated and loves his smile.
If you have any questions about Houston Cosmetic Dentistry or Houston Porcelain Veneers, please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF
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April 16th, 2012
Many of you have been hearing about or reading about a dental x-ray report that came out last week. Whereas our office always has our patients interest at heart which is why we invest in the best technology for our patients. In this case, digital x-rays which have minimal radiation.
The report, “Dental Xrays and Risk of Meningioma” published in the Journal Cancer dtd 10 April 2012.http://onlinelibrary.wiley.com/doi/10.1002/cncr.26625/pdf). really seems to be is another in a series of sensationalist, inflammatory articles on therapeutic radiation and in this case, dental radiation. It grabs great headlines but totally lacking in true science!
Rather than elaborate on the context of the report which has many inaccuracies and poor scientific validation, I think there will be many reports and experts that will repudiate the inaccurcies cited. In fact neither Dr. Claus or her colleagues have any dental or radiation physics education.
A few observations:
For comparison, the radiation exposure from an average single film-basedbitewing is approximately 5 uSv, less than the 1 day 8 uSv natural radiation exposure we all receive just being on the planet Earth. How can several bitewings even in a one year or 40 year period result in a meningioma? Astandard Medical CT scan of the mandible is 1400 uSvʼs – the equivalent of 5 months natural radiation exposure! It would take 280 bitewings to equal the patient radiation of just 1 Medical CT scan and who gets just one CT? Why is this study not going after Medical CT s?
The important thing is that any xrays only be taken as needed and with digital films the exposure is way less than conventional. Our office has had digital for over 6 years and will continue to monitor any improvements that benefits our patients.
If you have any questions about TMJ houston or Houston Cosmetic Dentistry please please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF 713-668-2289
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