Dr. Konig's Blog

Center for Cosmetic & Comprehensive Dentistry

Archive for September, 2010

Tetracycline Stained Teeth: Conservative Porcelain Veneers to Create a Beautiful Smile

Thursday, September 30th, 2010

Stained and Misproportioned Teeth

Prepless Porcelain Veneers for Stained Teeth

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Cosmetic Dentistry and Orthodontic Treatment

Monday, September 27th, 2010

Interdisciplinarian Dentistry (working together with different specialties of dentists),  is an area I believe best benefits paitents. Whether we are involved in cosmetic dentistry issues, single implants, or complex dental implant cases, some of the best overall care comes from working together. 

The photo below shows a 14 year old who had some undersized anterior teeth.  If the orthodontist would have tried to “squeeze” all the teeth together, two scenarios could have happened:

1)  Poor Esthetics due to disproportionate tooth sizes

2)  Relapse of the front teeth with spaces opening up after completion of orthodontic treatment.

Spaces after completion of orthodontic treatment

Spaces closed with bonding, note the nice proportions and sizes of the teeth

We had been working in tandem with her orthodontist to decide the best position for the teeth to be placed from a cosmetic and functional standpoint.   Even though there was more space on the left side than the right, everything else lined up.  After the brackets were removed, the teeth whitening was completed and dental bonding artistically completed on the lateral incisors and cuspids.  The space was shared so as to allow for better tooth proportions and cosmetics.

This is a very conservative way to bond teeth, no grinding on the natural teeth was done and the dental bonding was layered with different shades to blend in with the natural teeth.   Both the patient and parents were very pleased with the results of this Houston Cosmetic Dentistry.

In overview, not all orthodontic cases can be made perfect. In these types of cases, close collaboration with the houston cosmetic dentist and orthodontist allows the patient the best possible treatment under the circumstances.  Additionally, the same principles apply to other disciplines and complex cases in Houston implant dentistry,  periodontal cosmetic cases, and for TMJ pain.

If you have any questions about Houston Cosmetic Dentistry or Houston TMJ treatment, please feel free to contact our office as welcome the opportunity to assist you, Houston Dentist, Ronald W. Konig DDS, FAGD, LVIF, 713-668-2289

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Porcelain Veneers vs Dental Bonding for Gum recession

Thursday, September 23rd, 2010

I have written in the past about the advantages and disadvantages of porcelain veneers and dental bonding.  There are many indications for both.  Bonding can be conservatively used to close spaces and for defects or notching of the teeth at the gumline. 

The bicuspids have had severe recession and root wear, grafts were completed to cover as much as possible

Porcelain veneers were completed on the bicuspids to stabilize the gum tissue and cover the eroded part of the teeth

This photo reveals a case in which the bonding would not hold at the gumline due to functional stresses of the bite.  The gum recession was severe and gum grafts were completed  to gain some root coverage.  After the grafts, the area around the bicuspids was difficult to keep clean and bonding still would not hold even after the bite was adjusted or equilibrated.

To solve the problem, dental porcelain veneers were then used to obtain full coverage of the check side of the teeth.  It is easy to see how nicely the Houston porcelain veneers integrate at the gumline home care very easy and stabilizing the grafts and gum recession that had been occurring.

This clearly shows a functional case in which porcelain veneers were indicated over bonding.  On the other hand, porcelain veneers are much more conservative than doing porcelain crowns and are much kinder to the teeth and gums as well.  A keen understanding of function, the bite, gum issues, and restorative dental options truly allows us to render stabile and conservative treatment for our patients.

If you have any questions about Houston Cosmetic Dentistry or Houston TMJ treatment, please feel free to call our office, Houston dentist, Ronald W. Konig DDS, FAGD, LVIF  713-668-2289

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Xylimelts: A New Treatment for Dry Mouth

Wednesday, September 22nd, 2010

Xerostomia, which is simply the name for dry mouth syndrome, has long been a problem for patients on certain medications, Sjogren’s syndrome, some radiation treatment, mouth breathers, and often just from aging.  Besides being somewhat uncomfortable, it causes a host of oral dental problems ranging from root decay and tooth loss.

Many methods have been tried to help patients prevent these debilitating problems. The newest is calle Xylimelts which is designed  to help stimulate saliva and moisturize the mouth.  These are discs that adhere to the cheek or gums and dissolve slowly over six hours and can be used at bedtime as well.

Xylimelts are comprised of Xylitol which has been proven to reduce decay and is even found in certain sugarless chewing gum.  These are available directly from the company online, www.orahealth.com

As a Houston Cosmetic Dentist and Houston TMJ dentist, I have seen the destruction that dry mouth can cause in many patients and am always looking for ways to help patients manage this problem.  Another product that seems to help as well as called Biotene toothpaste and rinse and can be found in drugstores.

If you have any questions about Houston Cosmetic Dentistry or TMJ treatment, please feel free to call our office, Houston dentist, Roanld W. Konig DDS, FAGD, LVIF, 713-668-2289

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Different Types of Dental Implant Dentures

Monday, September 20th, 2010

Different Types of Dental Implant Dentures

Most patients are not aware that there is more than one type of implant denture that might benefit them. For many patients, the use of an overdenture which clips on to locator abutments , is a really successful way to anchor dentures in place so that they do not move when eating or talking. These are very strong and have received excellent patient acceptance. The primary disadvantage is that they are removable.

A second type is called a hybrid denture. As the name entails, this is a denture, however, it is fixed in the mouth and cannot be removed. It completely resting on the implants and not on the gum tissues. These hybrids also allow me to design the denture to be much smaller as opposed to the overdenture mentioned above.  A common technique for a hybrid is to use what is called All-on-4, Teeth in a Day.  This is excellent for patients who desire something fixed and do not wish to undergo sinus-lifts and bone grafts.  Our Houston dental implant office utilizes both types of implant dentures based on patients desires and needs. 

If you have questions regarding  Houston Dental Implants or Houston Cosmetic Dentistry, please do not hesitate to contact my office as we welcome the opportunity to assist you. Ronald W. Konig DDS, FAGD, LVIF, 713-668-2289(Houston Dentist)

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Interesting Study Comparing Dental Sleep Appliances

Thursday, September 16th, 2010

A recent study that was completed compared the efficiency of two dental sleep apnea appliance or Oral Appliance Therapy.  One type was an Anterior Tongue Postioner  (ATP)  and the other was an Mandibular Advancement Device. 

Briefly, a tongue repositioner is like a bulb in which you stick your tongue into it, it simply holds the tongue forward to keep it from blocking the airway.  A mandibular advancement device holds the jaw more foward using the teeth to position the jaw. This accomplishes the same function of opening the airway.  The study was compared by measuring the AHI, which is simply how many times per hour someone quits breathing for 10 seconds or more during the night.  The results showed similar results for both appliances.  However, the tolerance or acceptance of the appliances highly favored the mandibular advancement device.

There are many studies that compare appliances and new designs are always in the works. Our Houston dental sleep appliance patients seem to like the appliances that are two pieces, such as the Somnomed,  and do not lock the jaw in place.  This is not to say that it is better, only that is more comfortable.  At any rate, dental appliances for snoring are much more tolerable than CPAP machines and are a viable option for those who are CPAP intolerant.

Please feel free to call our office if you have any questions about Houston Dental Sleep Appliances or Houston TMJ problems.  Our office welcomes your calls.  713-668-2289

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Porcelain Veneer Design: It Truly Makes a Difference

Wednesday, September 15th, 2010

Ever wonder how much difference the actual design of porcelain veneers or porcelain crowns makes to the smile?   There is a true difference in what artistic dentistry can and does do to ones smile.  The two cases below look very different, however, they are the same patient.  We made two sets of veneers/crowns with different smile designs:

This design of porcelain veneers has more square tapering and heavier texture

This design of porcelain veneers is more rounded and smoother texture

The difference is substantial. It is easy to see how the veneers on the left create a fuller and wider smile as opposed to the more rounded and softer appearance of the photo on the left.   Although it is harder to see the texture in these photos, the different textures reflect light in different manners.

In our office, we design Houston porcelain veneers based on our patients desires and to fit their faces. The variables that we take into cosideration for Houston Cosmetic Dentistry are numerous.  It is possible to totally change ones arch form, width of smile, length of the teeth and more.  To create the final artistic touch, we almost always perform some recontouring with the veneers in place.  Truly, cosmetic dentistry is artistic and rewarding to be able to create different smiles for different individuals.

If you have questions about Houston Cosmetic Dentistry or Houston TMJ treatment, please do not hesitate to call our office as we welcome your inquiries.  Houston Dentist, Ronald W. Konig DDS, FAGD, LVIF,  713-668-2289

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Sleep Apnea and the Dentists Role

Tuesday, September 14th, 2010

Dentists who are highly trained in sleep apnea are stepping up to the plate to help this growing problem in the United States. The statistics are really overwhelming such as the ones reported in US Today: over 50% of males snore, over 40% of females snore and over a year ago it was reported that over 27% of couples over 40 sleep in separate bedrooms due to snoring.

The reason that dentists can help with this medical issue is that many of the highly trained TMJ dentists recognize the importance of airway.  This is certainly the reason that I have been steered into Houston Dental Sleep Apnea treatment. The study of airway issues, however, is missing in dental schools which is why untrained dentists are not aware of some of the problems that obstructed airways cause.  This is also important in children who have ADD and ADHD, many who have airway problems which cause them not to sleep well and affects their academic and social functions. 

These issues should and can be identified by dentists who see patients regularly in their offices.  The dental profession is in a position to really help patients recognize the hazards of snoring and sleep apnea.  The next area where dentist can help these patients is with treatment for those with mild to moderate sleep apnea.  It is not the dentists responsibility to diagnose sleep apnea, only to make patients aware of the potential health problems associated with airway problems. There are many extremely knowledgable sleep physicians whom patients should be referred for complete diagnosis.   If the cases are mild to moderate, then dental sleep appliances can be used to help the patient as opposed to CPAP machines. In fact , American Association for Sleep Medicine states that the first line of treatment for these mild to moderate cases and for those who cannot tolerate the CPAP machine (CPAP intolerant), should be oral dental sleep appliances.

It is essential that dentists treating sleep apnea use amubulatory or home monitors to adjust these appliances to insure that the apneas are controlled.  Just placing an appliance in without following up with proper testing for sleep apnea is a serious error. For all of our Houston dental sleep appliances, we send patients home with these monitors which helps me adjust the appliances for their health. 

All in all, this is an important area of health that the dental profession can be of tremendous assistance to patients. 

If you have any questions regarding Houston Dental Sleep Appliances or Houston TMJ treatment, please do not hesitate to contact our office, Houston dentist,  Ronald W. Konig DDS, FAGD, LVIF, 713-668-2289

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TMJ Surgery

Monday, September 13th, 2010

When patients have as much pain as can be associated with TMJ pain, many are willing to do whatever the treating dentist or surgeon recommends.  Fortunately, almost all TMJ pain patients can be treated non-surgically and should be.   There are numerous surgical procedures ranging from what is called, “arthrocentesis”  to disc removal, to surgically repositioning the disc.

You can find numerous literature on these procedures, good and bad.   As a Houston TMJ dentist, I have seen very few  surgical case that have been successful.  This is not referring to orthognathic surgery cases, which are surgical cases being done for skeletal reasons or major trauma/accident  cases.    In my opinion, part of the reason for the poor success rate is due to the fact that most surgeries are being completed with the teeth and muscles in the same position that caused the probems in the first place.   This is important in idiopathic condylitis cases as well.

If you have clicking or popping jaw joints, headaches, or  facial muscle pain that is being caused by damage to your jaw joint from the way the teeth meet together, simply putting the disc back in place without correcting the problem of the position in which the teeth meet together is asking for failure.  The teeth are dominant. Another factor is that the TMJ is the most complex joint in the body and is the only one that moves in six dimensions.

Neuromuscular Dentistry principles takes into consideration: muscles, joint position, nerves, posture, and many other factors.  It truly allows for a more predictable way to help patients with TMJ problems and to help them on a long term basis as well.

At this time, it saddens me to see patients who have been guided to surgery in the past.  In our practice, over the past 15 years, there are probably less than a handful of TMJ surgical cases that have been necessary.  Regardless of the problem, non-surgical treatment should be tried and implemented prior to any type of surgery.

If you have any questions regarding Houston TMJ treatment, Houston Neuromusuclar Dentistry, or  Houston Dental Sleep Appliances, please feel free to contact our office as welcome your inquiries. Ronald W. Konig DDS, FAGD, LVIF, 713-668-2289

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Mouth Breathing and Health Issues and the relationship to TMJ problems

Friday, September 10th, 2010

This may seem like a complicated title to this article. However, it is necessary for me to tie the pieces together.   There are many medical, physical, and social problems associated with mouth breathing. Unfortunately, this is not currently recognized by most health care professionals, ( according to a study published in the Jan 2010 issue of General Dentistry).   In my own eyes, dentists who are involved in neuromuscular dentistry and are studying TMJ problems and developmental issues are keenly aware of the problems that mouth breathing  causes especially in children.

There are so many allergens, synthetic materials, pollutants, and food additives that cause allergies and upper airway obstruction and mouth breathing.   According to Dr. Yosh Jefferson, “It is an unrecognized epidemic  that touches almost every family in the industrialized countries.”

Orthodontists and houston neuromuscular dentist recognize that childrens mouth breathing that goes untreated can lead to abnormal facial development and dental development ranging from gummy smiles ot high palates and crooked teeth.  If you look at patients who mouth breath, most have swollen tonsils as well.

These issues can lead to poor sleeping habits as these kids cannot breath.  Poor sleep can affect growth and academics.  Why? If kids (and adults) cannot breath at night,  it can lead to decrease in oxygen blood saturation and other medical issues.  Many of these kids are diagnosed with ADD, attention deficit disorder.

What can be done for this?  Dentists, who usually see patients every 3-6 months can observe for swollen tonsils, flared nostrils, high palatal vaults, bags under the eyes, and abnormal tooth eruption patterns. In adults, snoring is a tell tale sign.

In overview, mouth breathing in kids in harmful to the dental, facial, and social development of children. It is my hope that our dental and medical profession will become more aware  and knowledgable of this problem, which in turn will help treat this kids.  Lack of treatment is detrimental to development and can lead to dental malocclusion (bad bite) and TMJ pain down the road as well.

If you have any questions regarding Houston sleep apnea or Houston TMJ problems, please do not hestiate to contact our office as we welcome your questions.  Ronald W. Konig DDS, FAGD, LVIF, Houston Dentist,  713-668-2289

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