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Air Abrasion Technology

Fillings without a drill?  Air Abrasion technology in minimally invasive dental medicine

No More Drill?  I’m thrilled!

Many people fear the sound of the dental drill (technically called a handpiece) when they visit the dentist.  These drills are used to remove cavities, old fillings, prepare teeth for crowns, veneers, etc.  What if I told you that there exists a technology that doesn’t require the whining drill to accomplish some of these procedures?  No, I’m not talking lasers, though they do exist and can circumvent the drill sometimes.  I’m referring to a technology known as air abrasion.

Air abrasion is basically a tiny little wand that propels miniscule particles of a substance known as aluminum oxide (27 microns in diameter; 27/1,000 of a millimeter wide) under high pressure.   These particles use kinetic energy rather than mechanical energy (as a bur spun by a drill does) to gently “blast away” small cavities.  The neatest thing of all is that many smaller cavities can be removed painlessly with no local anesthetic!  This is possible because the particles generate very little friction when they gently remove the decayed tooth structure.  Burs generate huge amounts of friction, which heats up the tooth structure.   This is why local anesthetic is usually required when a conventional drill and bur are used.  Less friction with air abrasion spells no pain and no anesthetic the majority of the time!

No Drill

Air abrasion technology being used to gently “puff away” a small cavity of a permanent molar tooth.  Kinetic rather than mechanical energy is utilized to remove the problem, usually without the need for anesthesia or a drill.

Air abrasion is akin to a sandblaster.  If you have ever watched some one sandblasting wood or stone, there is no cracking along the perimeter of the cut.  This is possible due to the kinetic energy produced by the sandblaster, which generates much less friction than a drill.  The normal drill and bur are akin to an electric drill and a screw.   Have you ever carefully watched a drill sink a screw into a piece of wood?  Numerous cracks radiate out from the center of the hole that the screw is creating as it is drilled into place.  This is what happens when burs hit teeth.  They tend to radiate cracks outward from the center, which can turn into problems for the tooth over the years as the cracks weaken what is left of the tooth.

Air abrasion is typically used to remove small cavities.  Anything medium to large generally requires the use of the dental handpiece and the burs as the softer, larger cavities are not amenable to removal via the tiny particles under pressure.

White or composite fillings are bonded into these very small and conservative holes.  This bonding process is typically painless and only takes a few minutes.

Advantages of Air Abrasion:

  • Allows us to treat multiple areas of the mouth in the same visit since little to no anesthesia is required
  • Greatly reduces the need for anesthesia for smaller fillings
  • No pressure, sound, heat or vibration is generated
  • Minimally invasive; less tooth structure is removed than with normal conventional drilling
  • Reduces chipping and micro-fracturing of tooth structure, preserving more healthy tooth structure
  • Allows the dentist to penetrate porcelain crowns as needed without destroying the old crown, as oftentimes happens with the conventional drill bit
  • Can remove old composite white fillings, often without any anesthesia

Disadvantages of Air Abrasion:

  • Larger, softer cavities are not amenable to this modality as the powder will not remove grossly softened tooth structure
  • Reserved for the use of smaller cavities
  • Will not remove old silver amalgam fillings

Air abrasion is particularly well suited for children who have new, smaller cavities on permanent teeth, since the process is so conservative.  Adults too can benefit from the minimally invasive nature of this modality. A dental patient who religiously sees their dentist for regular checkups and presents with a tiny new cavity is the perfect candidate for air abrasion.  In addition, the metal-free white fillings that are placed in these smaller holes tend to outlast the more invasive, larger fillings necessary after the use of the drill.   This is due to the smaller surface area of filling being exposed to chewing over time.

Do all dentists use air abrasion in their practices?  No, but they should!

Because oral health matters,

Dr. Nick Yiannios

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A Passion for Dental Medicine

The human psyche universally yearns for a purpose, a reason for being, a feeling of completeness – no matter the culture or continent.  Religion, the arts, science, philosophy, literature, physical prowess…  For millennia endeavors such as these have provided challenges for mankind.  A relatively famous quote by an unknown author states, “The richest man is not he who has the most, but he who needs the least.”  I respectfully disagree.  In my life’s experience, The richest man is not he who has the most, but he who loves his career.”  I state this from true experience, as I love the practice of dental medicine.

I am aware that one would question why an individual who glares into the human oral cavity day after day might find the pink and white, the plaque and tartar, the blood and uppermost part of the guts…appealing.  There can be much more to dental medicine than this, trust me.  Let me explain…

Let me form an analogy.  Imagine a large forest, filled with literally hundreds of trees.  Each of these trees represents a possible condition relating to the oral cavity (or the mouth and surrounding structures).  Imagine that most dentists see and are familiar with the center of the forest, those trees that they were introduced to them in dental school.  Let us say that those trees in the forest epicenter represent procedures relating to the teeth, the gums, and the bone surrounding the teeth.  This sounds reasonable, right?  Perhaps one tree represents pharmacology, or the drugs pertinent to the practice of dental medicine such as antibiotics, antifungals, and painkillers.  Yet another represents x-rays, so that we can see between the teeth and in the bone around the teeth.  Sounds reasonable.  And that one over there represents how we perform surgery on the teeth and the gums…  Ok.  Let us now focus on the perimeter of the forest and begin to study many of the unfamiliar trees that we never really learned what to do with in dental school… Perhaps there are several relating to muscle.  What does muscle have to do with dentistry?  All dentists studied muscle in anatomy and physiology alongside the medical students, but once we hit the clinics, there was little mention of them anymore.  Most simply forget about that muscle thing, right?  When was the last time your dentist mentioned muscle to you?  Well, the muscles move the lower jaw and with the help of the brain and Central Nervous System, empowers us with the ability to chew, drink, talk, sing, sneeze and much, much more.  The tongue, for example, is a conglomeration of three different muscles that aid in the process of chewing, talking, singing, breathing, whistling, and tasting…as well as touch, or proprioception.  Muscles that connect the lower jaw to the skull are directly affected by how the teeth relate to one another, and if imbalanced, can actually manifest as headaches.  How about that other tree way off to the side?  The one that represents how we can stop many types of painful muscular headaches?  Well THAT was never mentioned in dental school!  What about that one way off to the side representing ceramic/white fillings, not that ugly tree in the center that represents amalgam, or the toxic mercury-containing dark fillings in the center?  How about that other one that tells us to NOT cut that tooth down to a nub to do a crown, like they taught us in school.  Why that will never work, because… they said it wouldn’t in school…  That large tree over there that represents the TMJ’s and the cartilage around these joints?  But all they taught us to do in dental school with the TMJ’s was tell the patient that they are “stressed” and that we need to make them a splint to wear at night.  How about that tree way over to the side?  The one that represents ways to treat “TMJ” problems without splints, predictably and effectively.  It has been repeatedly proven in the scientific literature, even though in school they said, and still to this day say, that it could never work…  And that B I G tree W A Y out to the side that represents the brain and nervous system?  Well, most dentists don’t want anything to do with that neurology thing.  Too bad, because that control center is responsible for everything that the patient feels, and understanding how the brain senses pain through the dynamic interactions between joints, muscles, teeth and cartilage can actually empower a dental practitioner with protocols to stop that nasty pain!

So what’s the bottom line?  Most dentists see only the center of the forest, and never focus much on the perimeter.  That tunnel vision is not particularly exciting I must admit.  The reality is that the entire forest which represents the entire head and neck is intricately connected to the rest of the human body makes practicing dental medicine a full time and very exciting career!  I will say it again, “The richest man is not he who has the most, but he who loves his career.”

To you and your families oral health,

Dr. Nick Yiannios

Patients have traveled to see Dr. Nick  from the above locations between July 2015 – July 2017.

 

 

 

 

 

 

 

 

 

 

 

 

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Bridges

The life expectancy of a fixed bridge is typically 10 -15 years, although with proper care these devices can last much longer. Bridges are usually laboratory made, permanently cemented crowns that help replace missing teeth. Adjacent teeth act as supporting structures to “bridge the gap” as false teeth are fused permanently to these adjacent teeth, or implants, restoring the mouth to full function and esthetics. Bridges also help teeth surrounding missing teeth maintain their position, helping to maintain the structure of your face and jaw. Just as laboratory made crowns, bridges usually require 2 visits to complete and build-ups are done as needed.

Just as bridges connect proximal land masses separated by rivers, valleys, creeks or what-have-you, dental bridges too connect adjacent teeth, hanging whatever teeth are missing between two or more teeth that are still present. These permanently cemented, artificial appliances used to be the high end fix for missing teeth until the advent of dental implants. Even today, there are times that a fixed bridge is an excellent alternative to replacing missing teeth.

In recent years, tooth-colored bridges without any metal content whatsoever have become available for use in times where bridge cosmetics are important, as in front teeth.

Please Note: bad habits such as not using floss threaders to pass dental floss underneath the connected teeth on a daily basis can severely decrease a fixed bridges life expectancy as decay can develop along the edge where the tooth structure meets the artificial.

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T-Scan, JVA, and EMG Technologies

Why is the GETTING THE BITE RIGHT important?

The importance of bite relation (occlusal analysis) cannot be over-emphasized in the dental practice setting. The placement of fillings, crowns, bridges, bite splints, implants, veneers, onlays, inlays, dentures; just about anything we do in dental medicine demands a proper spatial relationship between the temporomandibular joints (TMJ’s) and the oral cavity, not to mention a proper relationship between the maxilla and the mandible. Ignorance to the occlusion, or bite, can create havoc for the patient, creating problems ranging from sensitive teeth, to root canal therapy, to temporomandibular disorder (TMD or “TMJ”as it’s known widely), and even certain types of chronic headaches.  Traditionally, a colored ribbon of paper known as articulating paper is used by the dentist to check the bite. The use of this thin paper is problematic though, as it only qualifies where the bite is “high”, doing nothing to quantify/show how much or how hard…

Bite ribbon that most dentists use exclusively is highly inaccurate statistically per research conducted repeatedly in the dental scientific literature.

T-Scan®

An instrument borrowed from the world of engineering known as the T-Scan® allows a dentist to do just that, QUANTIFY how hard or how much the teeth touch, in 3/1,000 second increments (IN TIME).

The Tekscan T-Scan® handle which is connected to a software program which tracks force/time in 3/1,000 of a second increments.

T-Scan data of a patients bite. An interactive movie is created which displays the force/time data in 2-D (top left), 3-D (top right), and graphical formats (lower).

The T-Scan® digital occlusal analysis is used in Dr. Nick’s office as needed to augment treatment relating to CEREC® insertions, fillings, implant restorations, and in particular, to assist in the novel Occlusal Adjustment procedure known as ICAGD to accomplish DTR for muscular TMD treatments.

JVA

Joint vibration analysis is a painless, digital screening tool to measure the health of the TMJ’s. It resembles a headset that is placed over the patients’ temporomandibular joints that “listens” for vibrations that might be emanating from the joints, which are characteristic of joint pathology, or lack thereof. These vibrations can be correlated against known vibrations from the scientific literature to give Dr. Nick a rapid assessment of the state of health of that patient’s TMJ cartilage that is ~90% accurate, in minutes!  This is significant, because the cartilaginous disk that sits between the lower jaw bone and skull bone (the TMJ-we have a right and a left TMJ located just in front of our ears), when damaged, can have a devastating effect upon dental treatment.  Damaged TM disks can be directly related not only to the bite, but potentially painful muscular manifestations, leading to unpredictable dental treatment outcomes.  Most in dental medicine do not have a true understanding of this fact.  Having a full appreciation for this fact, Dr. Nick uses the JVA on all of his regular patients. Akin to a blood pressure reading in your physician’s physical exam, we track your JVA readings over time at every dental checkup, which helps to identify problems before they manifest themselves. Read more>>

The Joint Vibration Analysis headset which detects frictional interactions between internal cartilaginous surfaces in the TMJ’s and converts the information into quantifiable data in software which can be cross-referenced and used as an indicator of TMJ health.

JVA software data.

EMG 

Electromyography is a painless, highly accurate, and objective digital tool that Dr. Nick uses to measure muscular activity in the chewing muscles. Surface electrodes are placed over the target muscles so that the tiny little currents that muscles create can be measured, allowing us to analyze chewing sequences and patterns just like neurologists and researchers do.  This is a totally painless and safe procedure.  Why are muscles important in dental medicine?  For multiple reasons; muscles:

  • Break teeth
  • Can cause pain in the orofacial region, such as headaches
  • Can damage the cartilaginous TMJ disks
  • Must be in a balanced state or problems will potentially arise over time

EMG allows us to measure certain chewing muscles accurately in microsecond increments, allowing us to accomplish evaluations of oral-facial pain that normal dentists can only dream of!

Placement of EMG skin-surface electrodes over pertinent muscles of mastication. No current is generated. The tape electrodes simply sense for minuscule changes in microvoltage outputs generated in the target muscles as they change during function as the lower jaw functions.

An EMG readout in the software.

Tscan/EMG Link

Tscan technology synchs with EMG (muscle electromyography) technology down to the microsecond enabling Dr. Nick to measure instantaneously changes in muscular output relative to miniscule changes in the bite. This combination of technologies is the ultimate TMD treatment aid when the cause of the joint problem is muscular in origin, which it usually is… Click here to watch YouTube videos that Dr. Nick has created about the use of the Tscan/EMG link for the treatment of TMD patients in our practice.

The T-Scan (left) & EMG (right) linked in real-time. The bite forces are measured on the left, while simultaneously whatever is happening to the muscles at that instant is displayed on the right.

The T-Scan (left) & EMG (right) linked in real-time.  The bite forces are objectively measured on the left, while simultaneously displaying whatever is happening to the muscles at that instant, objectively, on the right.

Watch Videos

RESOLVING TMJ! Watch a grown man cry with relief!:

http://youtu.be/9x_iyZ28g_s?list=PLrsyoxXDGZ4YxS3ThCRSd-kVJAJ4kCCXS

Her 45 minute TMJ Cure:

http://youtu.be/vs9RznhH3zs

3 months after DTR.  No more headaches!:

http://youtu.be/dRiTxJlIFc0?list=UUPoIDjjCFzKZbvQnX3BYlJw

There are many more related videos that exist on Dr. Nick’s channel on YouTube: drnickdds.

So what is DTR, ICAGD, and NEURAL OCCLUSION?

These are treatments for muscular TMD issues that DO NOT rely upon traditional splints and acrylic appliances. These treatments are a new, more definitive way of addressing TMD issues by creating a permanent physiological change in patients with confirmed stable and adapted joints (via digital metrics such as JVA and 3-D imaging), rather than the temporary change that splint appliances create. Dr. Nick rarely makes acrylic splints that the vast majority of dentists do, but rather relies on the following protocols when indicated for muscular based TMD issues, in a patient with a pair of objectively confirmed stable and adapted TMJ’s.

DTR stands for Disclusion Time Reduction. This is the process whereby “interferences” or “speed bumps” in the way the back teeth from the top jaw interact with the opposing teeth from the lower jaw, during function, are precisely removed with data gleaned from the Tscan/EMG link. This process decreases muscular output, relaxing the muscles of mastication (via instantaneous confirmation with EMG), which typically alleviates many TMD symptoms. Years ago, Dr. Nick was personally trained by the creator of this new process, researcher Dr. Robert Kerstein of Tufts University, and is considered an expert in this process. Dr. Nick is also a beta tester for Tekscan, the company that created the T-scan technology.

ICAGD stands for Immediate Complete Anterior Guidance Development. Basically, the human chewing system is more efficient the faster the back teeth separate when chewing side to side, as we all naturally do. Hence our front teeth should cause a separation QUICKLY (via measurement w/ the Tscan or Tscan/EMG link) of our back teeth based on known values. Sometimes bonding materials are added to front teeth to help assist in a more “immediate” separation than the patient can based on the shape, condition, or position of their natural dentition. This creates huge advantages for TMD sufferers because the muscles of mastication are made more efficient and do not produce excess lactic acid as a result of being overworked and chronically fatigued. It is this excess lactic acid buildup that at least partially creates many TMD symptoms, such as tension headaches, painful and stiff jaw muscles, neck tension, clenching and grinding of teeth, etc. ICAGD is not a mainstream treatment as of 2015, so this is not something that you can find in just any dental practice. In just the past  year, there are a growing number of TMD experts who are beginning to see the advantages and effectiveness of this process. Dr. Nick expects that over the next 20 years this novel protocol will become more practiced and available, but presently, his practice is one of the only places where a patient can have this therapy done. From his experience with this process dating back to 2008, it simply changes the lives of muscular TMD sufferers almost every time!

So what is Neural Occlusion?  Neural Occlusion is a novel TMD screening protocol that Dr. Nick created to help him decide whether or not a particular TMD patient might predictably benefit from ICAGD Occlusal Adjustment to accomplish DTR.  It involves a combination of numerous technologies (CT, JVA, EMG, TScan®, and sometimes MRI) combined with a thorough history, examination, and FDH screening.  As of 2015, there is no other place that a TMD patient might go for this particular type of screening.  Dozens of video examples of the Neural Occlusion protocol and DTR via the ICAGD occlusal adjustment process may be found on the practices YouTube homepage:

https://www.youtube.com/user/drnickdds

Dr. Nick Yiannios and Dr. Robert Kerstein discussing the utility and usefulness of DTR for the muscular TMD treatment:

http://youtu.be/Q0xkJNF0l_E?list=PLrsyoxXDGZ4YxS3ThCRSd-kVJAJ4kCCXS

FOR MORE INFORMATION:

TMJ Pearls

NOTE

Dr. Nick Yiannios has contributed original research to the dental scientific literature with acute relevance to the above technologies:

http://www.igi-global.com/chapter/occlusal-considerations-in-the-hypersensitive-dentition/122077

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Cosmetic & Esthetic Dentistry

A beautiful, youthful smile!  We all want it, but what does it take to get it?  Common sense dictates that there are different ways of doing things, some better than others, right?  So what should the discerning dental patient know about cosmetic dentistry, especially if our only problem is solely for appearances sake, and we possess a totally pain free set of teeth but simply want some “sprucing up”?  This section will address various procedures, tips, techniques, and downfalls of what cosmetic dentistry can and cannot do for the dental patient, including several virtually unknown aspects, which should always be respected when trying to improve the appearance of our “pearly whites”.

Click the topic of interest:

First of all, some pertinent definitions are in order:

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance (though not necessarily the function) of a person’s teeth, gums and/or bite. Many dentists refer to themselves as “cosmetic dentists” regardless of their specific education, specialty, training, and experience in this field. Though the American Dental Association does not recognize cosmetic dentistry as a formal specialty of dentistry, there are dentists that promote themselves as cosmetic dentists.   Most notably, the American Academy of Cosmetic Dentistry (AACD), with its 20,000+ members, is the world’s largest international dental organization, with a charter designed to provide its dental professional constituents with the latest advances in the application of cosmetic dentistry technologies, techniques, and ethical practices via conferences, lectures, workshops and publications.  A member who participates in this organization, tends to qualify as a doctor who is at least introduced to the concepts required to classify ones practice as not only cosmetic in nature, but esthetic as well. There will be more on this distinction shortly.  The AACD offers a very challenging credentialing process, which very few of their constituent members have earned.  An individual who has earned this status in the AACD is known as an Accredited member of the AACD.  There exist approximately 400 dentists on the planet with accredited status in the AACD.

Esthetic dentistry encompasses cosmetic dentistry and much more.  It is a much more complex and lofty undertaking.  Esthetic dentistry actually includes the myriad intricacies involved in the harmonious function and appearance of the masticatory/chewing systemand not just the appearance of the teeth and gums.  Muscles, joints, bone, cartilage, ligaments, neurology, anatomy, biochemistry, physiology; all of these aspects come into play when a dental professional truly strives to create an esthetic, pain free, and functional (and not just a cosmetic) solution for their patients.

In other words, the cosmetic dentist is concerned primarily with “covering up” something ugly, with little emphasis placed upon form and function.  The esthetic dentist, is concerned not only with how it all looks cosmetically, but how it functions as well, trying to ensure that the end result will function harmoniously within the miraculous stomatognathic/chewing system which we all take for granted, until something goes wrong.  Obviously, the concept of esthetic dentistry is much more complex than cosmetic dentistry.  In summary, cosmetic and esthetic dentistry are different in definition, concept, and execution.  Now that this distinction is out of the way, what types of services do patients concerned with improving their appearance desire and what do they need to know prior to implementing “cosmetic dentistry”?

White: Whitening Teeth

Whitening teeth:  professional bleaching/whitening agents very effectively lighten stained, yellowing, and unsightly teeth, with basically two limitations:

  • Artificial fillings, crowns or veneers do not change shade with these chemicals so be wary of this fact
  • Intrinsic (deep within the tooth) developmentally darkened teeth do not completely respond to bleaching agents and often need to be covered with opacious porcelains to whiten them completely

In-office prescription bleaching methods are certainly the most effective and quickest options for whitening.  Brand names such as Zoom® will effectively bleach the patient in less than 90 minutes as several 20 minute sessions are performed in a single dental visit on the patient after the gums are protected and special lights are used to catalyze the bleaching chemicals.  This is the fastest and quite possibly most effective method of bleaching.  Take-home prescription bleaching agents are almost as effective, but take several days to accomplish the same change that the in-office bleaching does.  Custom trays are made for the patient into which the take home bleaching chemistry is dispensed, effectively ensuring an even distribution and even whitening of all their teeth.  The least effective bleaching methods are over the counter as they are non-prescription, weak, and potentially dangerous as some of these products actually use acidic chemistry that can etch tooth enamel in an uncontrolled manner.  Before bleaching, it is always best to ensure that no cavities are present, a dental cleaning has been performed, and that there are no leaking fillings or other restorative materials in that patients dentition.

 Straighten Teeth

Straightening teeth/closing gaps:  orthodontic movements with braces, bridges or implants can be used to correct misaligned teeth in the jawbones.  Every case is different and should be properly evaluated by an experienced dental practitioner before the patient undergoes any of the above three options.  Special consideration should always be given to the implications that closing spaces via the above 3 modalities will have on:

  • The gum tissues
  • The bone in both the maxilla and the mandible (upper and lower jaws respectively)
  • The effect that tooth movements have on:
    1. the bite
    2. the TMJ’s

Beware the cosmetic dentist ignoring the effects that straightening teeth have upon the bite and the TMJ’s.  Most ignore this critical interaction between the bite and TMJ health.  They are each interrelated.  Violating these 2 parameters can lead to chronic issues such as headaches, hypersensitive teeth, and chronic “TMJ” dysfunction.

Before and After Dr. Nick

Reshape Teeth

Reshaping teeth:  for a “prettier smile” seems relatively innocuous, but beware…  The alteration of the shapes of top or bottom front teeth, in particular on the edges of either upper or lower teeth, and on the inside of the upper and outside of the lower front teeth, can trigger neurological consequences relative to timing of the “chewing machine” which can readily lead to “TMJ” problems such as headaches, hypersensitive teeth, and “TMJ” pains.  A doctor who has a handle on the intricacies of “TMJ” issues should only perform these types of alterations.  Quite simply put, altering the shapes of teeth indiscriminately for cosmetic reasons only will most likely lead to esthetic compromises with potentially painful consequences.

Reshaping Gums

Reshaping gums:  too much gum or not enough gum, recession, root exposure, blunting of the pointed gum tissue between teeth…  These are all intricately related to the beauty and youthfulness of a smile.  Sadly, as we age, these sorts of gum issues can take hold.  Think of the gums like a frame encircling a piece of art, which is the tooth.  If the frame is cheap and defective looking, it will take away from the beauty of the tooth, no matter how pretty it may appear.  An attention to periodontics, that discipline in dentistry that is specifically concerned with the gum, bone and ligaments surrounding the teeth, is paramount for successful esthetic outcomes.  An enlightened practitioner will always avoid having the edges of crowns, veneers or fillings buried too deeply beneath the gum line and too close to the bone that lies beneath, and if this is necessary, measures to implement to negate the harmful consequences.  Such a physical spatial violation of the artificial prosthesis can readily lead to an invasion of what is known as “biological width”, with a subsequent inflammatory response that can cause ugly recession and attendant bone loss to occur.

Replace Missing Teeth

Replacing missing teeth:  implants, bridges, or dentures are used for this scenario.  Implants are typically the best of the 3 choices, dentures are most certainly the worst, while bridges are a decent “fix” but they involve not only cutting down the adjacent teeth to the missing tooth/teeth space, but tend to have a limited life span of approximately 10 years.  It depends on the situation.  Bridges also require the usage of stiff floss threaders to floss underneath the connected bridge, while free-standing implants do not.  With the implant, special attention needs to be given to the gum and bone tissue.  Typically, the wavy interdental papilla, or pointy gum between front teeth, tends to melt away after a tooth is extracted.  This papilla can almost never be recovered, even with the most intricate of gum surgeries, because the papilla’s presence is highly dependent upon the presence of a thin pointy peak of bone underneath.  This peak is typically lost in an extraction of the tooth unless meticulous attention is given to an atraumatic extraction protocol coupled with appropriate bone grafting procedures.  Bottom line:  if you are faced with the unpleasant necessity of losing an esthetically important tooth and desire an implant, have your surgeon or dentist take great measures to ensure that the bone and gum tissues are not “roughed up”.  Anyone can pull a tooth.  Few in dental medicine can atraumatically extract a tooth and preserve the delicate surrounding bone and gum tissues.  Remember this before having a key esthetic front tooth extracted.   Lastly, also remember that one typically has only about a years time to place an implant to restore a missing tooth as over time, what bone and gum tissue does remain, tends to blunt/flatten out and recede, regardless of whether or not bone or gum tissue grafting was performed at the time of the atraumatic extraction or not.

Bonding Teeth

Bonding teeth:  composite/white filling materials are typically used for esthetic bonding of front teeth.  In the right hands, these various tooth colored materials can imperceptively mimic mother nature, even to a trained dental professional, IF a laundry list of steps are followed and high quality materials are utilized, in a bone-dry isolation field.  If your dentist does not routinely use a rubber dam or a vacuum apparatus known as an Isodry® to thoroughly dry the area to receive composite bonding, do not use this dentist.  Truth be told, many of these white fillings are not created equal.  Some are designed for lifelike appearance, while some are designed for strength.  Some are cheaper and stain or break off readily, while others are far more expensive and tend to last longer while looking better, longer, as well.  The white composite fillings are typically composed of synthetic resins, a photoinitiator (light sensitive component catalyst which cures when exposed to certain wavelengths of light), and a silica filler.  All of these materials shrink slightly when hardened.  The key is to ensure that one drops these materials in place and then harden them with light in a certain direction, applying the inevitable ~1% shrinkage back towards the particular wall of the tooth that it is covering (rather than across the entire void of missing tooth structure), taking advantage of the shrinkage consequence.  Ignoring this technique can readily lead to “debonds”, or the bonded filling falling off.  Many dentists are either unaware of this fact or chose not to spend the time to initiate this practice.  Additionally, most dentists use only one type of material for all of their bonding.  This is ludicrous.  An esthetic dentist should have at his/her disposal a variety of different materials for different applications to truly provide the best service for his/her patients.  Additionally, there is most certainly more than science behind effective bonding.  The doctor either has an innate artistic ability or doesn’t.  Another little pearl in regards to composites.  The outer most layer of the bonding composite material has what is known as an oxygen-inhibited layer on it which does not fully cure/harden.  The dentist MUST apply a layer of glycerin over the material at the end stages of the bonding to effectively eliminate the oxygen by creating a vacuum with the glycerin, effectively curing the outermost layer of composite material.  Ignorance to this practice will always result in the tacky outermost layer (which is readily seen by the patient) staining and pitting in short order.  There is little cosmetic or esthetic about a recently bonded front tooth that picks up stain within a few months of placement…!

Veneering Teeth

Veneering teeth:  the “Hollywood smile” is typically associated with thin ceramic works of art that are made of beautiful porcelains which very effectively emulate natural enamel, and are bonded in place on front teeth.  In most dental practices, the veneering process requires that the dentist reduces small amounts of natural enamel, applies temporaries to the treated teeth, takes a mold of his/her work, and then sends the mold off to a dental laboratory while the patient walks with the temporaries in place for several weeks.   Several weeks later, the patient returns to have the dentist try in the porcelain veneers which the laboratory has fabricated, hoping that the laboratory has effectively created an esthetic situation in regards to the cosmetics and that particular patients bite.  Sometimes, dental practices purport to providing their patients with “no prep” veneers, whereby the patients teeth are very minimally or even not at all prepared/ground down.  Beware the no prep veneers.  A requirement of esthetic outcomes is that they imperceptively emulate nature and do not cause problems with the gums.  Natural white enamel on human teeth has a certain thickness and translucency that absorbs, bends, and refracts light to various degrees.  This requires a thickness of enamel, which is typically between 1-2 millimeters thick.  Porcelains need a similar thickness to esthetically emulate nature as well.  The “no prep” veneer concept sounds appealing in that less tooth structure is removed, but understand that the refractive properties cannot be accurately emulated without a corresponding porcelain thickness.  Additionally, these no prep veneers can lead to chronic gum inflammation resultant of an overcontoured “emergence profile”/excessive thickness, not to mention the fact that they also require time for a laboratory to fabricate these veneers.

In the past decade, digital dental techniques and procedures have evolved which allow an adept and talented dental practitioner to fabricate and create porcelain veneers on site, the same day, via digital CAD/CAM technology.  With the CEREC® CAD/CAM chairside technology, amazingly natural and esthetic veneers can be created while the patient waits!  No temporaries to fall off, no distorted molds, no laboratory mix ups or delays, no sensitivity issues, less bacterial contamination with subsequent complications, less time away from school, family or work; these are but a few of the advantages of this technology.  Though there are very few contraindications for this process, most in dentistry will not even consider this option due to the enormous expense, training, and skill required to provide this service, not to mention the time crunch placed upon the practitioner as the patient waits anesthetized for the end result, THAT day.   And quite notably, the array of robotically millable ceramics and manual porcelains that are available for truly customized porcelain veneer chariside fabrication are mind-boggling and as good or superior to what laboratory fabricated porcelains can provide.  A final critical and often overlooked point that should be made in regards to porcelain veneer treatment involves the final bonding of the beautiful ceramic works of art.  An absolutely dry field needs to be created, involving not only controlling the minuscule crevicular fluids that leach from within the periodontal/gum pocket surrounding the front teeth to be treated, but also the very humid breath of the patient and the potential weakening this contamination may have upon the final bonded result.  A rubber dam, fluid control for the periodontal sulcus, and/or an Isodry® dry field vacuum isolation system, plus a high quality composite resin bonding agent must be used to ensure a strong, esthetic, and lasting result.  In summary, consideration of minimally invasive porcelain veneers should include:

  • How much tooth reduction is necessary for an esthetic end result
  • Whether or not temporaries are to be dealt with
  • The experience and knowledge of the dental practitioner who is to provide the service
  • Whether or not a dental laboratory will be utilized for veneer fabrication
  • The final bonding procedure including fluid control and quality bonding agents
  • Whether or not the patient wants full input as to the final outcome-with chairside CAD/CAM, the patient watches the virtual design of the final veneer, obliterating the need to communicate with an outside lab source

Step into the future of dentistry…! See Video

Fillings Fillings

Fillings:  Replacing metal fillings/crowns with naturally appearing alternatives:  Esthetic dentists no longer need to rely on unsightly metals to replace tooth structure lost to decay, but use high density, state-of-the-art plastic (composite resins) and porcelain materials instead. These materials more naturally mimic the look, feel, and function of natural teeth and actually bond directly to the remaining enamel and dentin. This means that new fillings preserve more of the natural tooth so less repair work is necessary immediately and in the future. These modern filling materials are also more natural in appearance; it’s almost impossible to tell that your tooth has a filling.  Dentists are using more tooth-like materials (composite resins and porcelains) that are both safe and predictable. The most important feature, for many people, is that they look and react more like natural teeth than do the older metallic materials of old.  An amazingly accurate, esthetic, and long-lasting option for larger fillings are known as onlays.  These ceramic restorations can be created while the patient waits in about an hour using CAD/CAM technology and robotic milling of solid ceramic blocks.  The blocks fit the missing prepared tooth structure to within microns tolerance, and are bonded/fused to the remaining tooth structure, disallowing leakage, and additionally, they are virtually imperceptible to the patient.  These ceramic alternatives are the best option for larger filling situations when the patient desires a natural looking, esthetic restoration, which actually helps fuse the tooth together to an almost virgin state.  Smaller filling situations are less susceptible to shrinkage issues, and the smaller surface area in need of filling is typically amenable to composite/white filling materials.  Gone are the days of mercury-amalgam fillings in the esthetic dental practice!

Crowns: 1 VISIT ESTHETIC CROWNS

Crowns are inevitable, sooner or later we all hear the words, “…you need a crown”.  Crowns are placed on front or back teeth for many reasons. The purpose of the crown is to hold or “cap” what little is left of the tooth together, allowing the patient to retain a tooth that would not be predictably restorable otherwise.

Traditionally, crowns are made in an off-site dental laboratory after the dentist grinds down much of the top, and all four sides of the tooth to the gum line, effectively leaving a “stump”.  A mold is then taken, a temporary restoration is placed on the tooth for several weeks, and the mold is sent to the lab.  Some weeks later, the crown is returned to the dental practice at which time the patient is called back in to evaluate the fit, function and cosmetics of the new restoration.  Occasionally, the crown needs to be returned to the lab YET AGAIN, and the temporary replaced. Eventually, the crown is finally cemented in place… Talk about frustrating and inefficient for all of those involved!

In contrast, CAD/CAM crowns constructed in the dental office provide patients with a much more efficient, desirable, and timely alternative, THE SAME DAY.  Since no temporaries are involved, the CAD crown usually requires less tooth removal.  The ALL-CERAMIC restoration is capable of being bonded very strongly in place regardless of the geometry.  This is in contrast to the traditional crown, where the retention of the crown is dependent upon radical removal of tooth structure to allow the crown stay on top of the “stump”.   A special camera is utilized to obtain a digital impression rather than a physical mold.  The experience is much more efficient and comfortable for the patient.  Also, the instantaneous feedback that this digital image produces on the computer monitor for the dentist affords your doctor the opportunity to modify the tooth preparation in the event that things are imperfect.  If imperfect, your dentist may simply re-image moments later.  Since these all-ceramic crowns are bonded directly to the tooth structure within hours, this usually eliminates the need for radical removal of all the walls to the gum line.  This allows the retention of more NATURAL tooth structure. Sensitivity issues relating to bacterial leakage and seal are also reduced, as there is no temporary that will leak over time.  This also decreases the likelihood of a subsequent root canal following the crown procedure.  CAD crowns are made from beautiful porcelains that are not only totally customizable by a knowledgeable operator, but also allow the penetration of x-rays so that your dental professionals can visualize what is underneath the crown over the years.  This again, is in contrast to laboratory crowns, which are usually constructed of core materials that do not allow x-ray pass-through, effectively masking subsequent problems that might arise over time…  And let us not forget that this single visit convenience also allows this procedure to be accomplished with just one anesthetic injection!

And why don’t more dentists take advantage of this amazing technology for their patients? Due to the enormous economic and educational sacrifices necessary for integration of CAD/CAM technology into a dental practice.  In addition, many of the concepts involved in this technology are contrary to concepts of traditional dentistry…

BOTTOM LINE:  WHEN THE PREPARATION AND FABRICATION PRINCIPLES OF SINGLE VISIT, ALL-CERAMIC CAD/CAM CROWNS ARE APPLIED PROPERLY, THE ESTHETIC CAD/CAM CROWN WILL TYPICALLY FIT MORE ACCURATELY OVER A LESS INVASIVELY PREPARED TOOTH THAN A TRADITIONALLY PREPARED CROWN.   ALSO, THESE CAD/CAM CROWNS TYPICALLY PROVIDE A LESS SENSITIVE AND MORE BEAUTIFUL ALTERNATIVE TO LABORATORY FABRICATED CROWNS.

Nick Yiannios DDS-experienced NWA Cosmetic and CEREC Dentist

  • Fellow & Accredited Member, The Academy of CAD/CAM Dentistry
  • Member, International Academy of Oral Medicine and Toxicology
  • Member, International Association of Mercury Free Dentists
  • Accreditation Candidate, the Academy of Cosmetic Dentistry
  • 1993 Graduate The University of Texas Health Science Center at San Antonio Dental School
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World-Class Care

Patients travel from literally all over the globe to see Dr. Yiannios.  Why?  Primarily because of his precise and meticulous attention to detail is known to promote two things:  Health and Beauty. 

  • Mercury safe dentistry: traditional amalgam fillings contain mercury.  Few dentists employ any measures to protect the patient from the toxic mercury vapors released when old “silver amalgam” fillings are removed, which happens many times daily in a typical dental practice.  We always take measures to protect the patient, our staff, and our environment from these toxic byproducts, and always use beautiful, non-mercury containing restorative materials.  Patients travel hundreds of miles to see us for mercury free and mercury SAFE dental services.
  • CEREC® CAD/CAM technology: virtually designed and robotically milled on-site beautiful porcelain crowns/veneers/onlay/inlays;  Dr. Nick has a decades experience with this esthetic, minimally invasive, and unbelievably accurate robotic technology.  He is one of 6 dentists to have ever earned peer-reviewed accreditation in the Academy of CAD/CAM Dentistry, a lofty credential that few were ever able to obtain.  Additionally, many thousands of CEREC restorations later, Dr. Nick can produce more beautiful and more accurate restorations, the same day, than other dentists who rely upon outside dental laboratories can only dream of.  Resultant of this, patients travel from afar for his expertise in same day, metal free, all-ceramic restoration fabrication.
  • Sensitive teeth: Dr. Nick recently published a chapter in a 1st edition, internationally published dental textbook describing a protocol to essentially “cure” sensitive teeth.  For years, he has been involved in cutting edge treatments for “TMJ” pain, and in applying hi-tech instrumentation to provide lasting relief for “TMJ” sufferers; he discovered a novel way to predictably and statistically decrease dental hypersensitivity in a lasting manner!
  • Digital bite analysis and TMD: temporomandibular disorder affects an estimated 20 million in the U.S. alone.  Chronic pain after dental work, braces, and traumatic accidents can often be traced to a defective bite and/or damage to the temporomandibular joints (TMJ’s).   The implications of this TMD subject are pertinent to the normal practice of general dentistry, as Dr. Nick is aware of slight intricacies that can be introduced via normal dental work that can become problematic, and he knows how to prevent this from ever happening!  Nick has been applying novel techniques and principles to effectively resolve these sorts of issues for years now, and has a large number of patients flying in monthly to see him from literally everywhere.  Using objective technologies and 3D imaging including CT and MRI for many of these cases, he is highly sought after in regards to lecturing, teaching, and writing about this subject.
  • Cosmetic/esthetic dentistry: as it relates to beautiful, and healthy smiles!  Dr. Nick is a few steps away from earning the coveted Accreditation credential from the Academy of Cosmetic Dentistry (AACD).  He is working on becoming the first dentist who has ever completed this credentialing process without the help of outside dental laboratories (all the rest have delegated the porcelain work out to laboratories), but rather with chairside CEREC® CAD/CAM technology for creation of the perfect porcelain works of art that must be created for the AACD credential!
  • Digital Bite Analysis: getting the bite right!  Dr. Nick is heavily involved in using the T-Scan® digital bite analysis technology to ensure that his dental work is in a proper place in space relative to each given patients unique bite.  The T-Scan is used routinely in the practice, with little reliance given to the old analog bite ribbon and the famous question asked of the patient after dental work (while they are still numb), “…so how does it feel?”.  T-Scan eliminates guesswork, leading to more predictable and painless dental outcomes.
  • Headaches: and their relation to dental medicine.  Dr. Nick has been involved in research linking headaches in the temple region to the dental bite, and is internationally respected for his work in treating and identifying the relationship between the two.
  • Minimally invasive dentistry: cutting away less is more!  Common sense dictates that the more of nature left in place, the better.  Everything that we do in our practice promotes the retention of more of what mother nature gave us, regardless of the extra time and effort that such a policy might entail (and believe me, it does require more work to remove less)!

Dr. Nick has a strong presence on the web, including hundreds of live patient case studies relating to many of the above aforementioned topics.  On YouTube his channel is:  drnickdds.

https://www.youtube.com/user/drnickdds

Dr. Nick has published in a dental textbook relating to hi-tech research relating to the human bite:

http://www.igi-global.com/chapter/occlusal-considerations-in-the-hypersensitive-dentition/122077

Dr. Nick Yiannios – A Mercury SAFE Dentist

  • Fellow & Accredited Member, The Academy of CAD/CAM Dentistry
  • Member, International Academy of Oral Medicine and Toxicology
  • Member, International Association of Mercury Free Dentists
  • Accreditation Candidate, the Academy of Cosmetic Dentistry
  • 1993 Graduate The University of Texas Health Science Center at San Antonio Dental School

 

Sample Video of an international patient seeking Dr. Nick’s help:

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CEREC CAD/CAM Technology

Dr. Nick Yiannios D.D.S. has provided personalized dental care to thousands of families. Our patients come from near and far to experience the warm, individualized care we provide. We pride ourselves in utilizing the most modern equipment and methods available.

In order to provide nothing but the best to our patients, our office uses state-of-the-art technologies in all our procedures. These new technologies allow us to detect dental concerns at early stages, treat your dental issues with precision, and provide stunning and customized restorations and solutions. When you visit our office you can be confident that you are receiving the finest and most advanced in dental care. A flagship example of one of these technologies follows:

CEREC®visually demonstrating the capabilities of this technology by an adept operator (himself) which you can view here for more information. CAD/CAM
This dental CAD/CAM technology allows the creation of high quality all-ceramic crowns, veneers, inlays and onlays ON-SITE the SAME DAY by Dr. Nick. Normally, such restorations take at least 2 weeks to be made in a dental laboratory and at least 2 visits to the office before the permanent prosthesis is put in place permanently. With CAD/CAM, a special infrared camera is used to take a picture of the tooth in need of repair and then computer software is used by Dr. Nick to design the restoration from the picture. Diamonds in a milling chamber carve the restoration out of a solid ceramic block of a color and size that matches your tooth, and then Dr. Nick customizes the final result by applying stains and then a glazing material which is permanently fused to the restoration in a high temperature glazing oven. The final result is then fused to the tooth with bonding materials and matches beautifully! Dr. Nick is an expert in CEREC CAD/CAM Technology. Many years ago he authored a book explaining and visually demonstrating the capabilities of this technology by an adept operator (himself) which you can view here for more information.

 

Advantages of CAD/CAM to the patient:
Single visit procedure: no need to take a 2nd or 3rd day off of work or school. 1 visit is all it takes, typically 90 minutes per tooth, only ~15 of which is spent in your mouth. The rest of the time you are relaxing or watching us create your tooth in the virtual world and then subsequently in the real world…

  • Dr. Nick is in complete control of the final result: because the crown or veneer is designed beside you with the computer software, Dr. Nick has complete control over how it will look and fit, whereas laboratory made restorations are being made by a technician who has not ever even seen the patient. In addition, tiny improvements that mean a world of difference as to the fit of the final result can be made instantly since the patient is still sitting right there!
  • No nasty molds of your teeth: instead, a picture is taken!
  • No temporary restorations: Ever have a crown or veneer done the normal way? Chances were it was lose, leaky, sensitive, looked off, tasted badly, etc. Not any more with CAD/CAM.
  • Less tooth removed in many cases!  No more grinding a tooth away for a crown.  With CAD/CAM, there are far more conservative possibilities, meaning more natural tooth structure is retained!
  • Only one set of local anesthetic injections: Remember, it’s all done in one visit…!
  • VERY accurate seal means less sensitivity: CAD/CAM restorations are typically accurate to within 50 microns, which is 5/100 of a millimeter. A good laboratory crown can achieve a similar fit ONLY IF the mold was accurate and did not distort. Remember, there is no impression or mold or outside laboratory with CAD/CAM.
  • Chairside customization: All CAD/CAM’s in this practice are stained and glazed in the office to beautify and increase their strength.
  • Imperceptible edges: these restorations fit and blend in so well, you will not be able to feel or see the edges!  Dr. Nick often leaves much more of your natural tooth structure than would be possible using conventional methods resultant of the aforementioned statement…!
  • No gray edges at the gum line: because there is no metal in this fix, there is no metal to show through along the edge of the crown at the gum line.
  • Far less breakage: As of April 2015, our office has created over 7,000 CAD/CAM restorations, with only 4 fractured restorations over our 10 years of providing this amazing service.
  • Teeth that are oftentimes not restorable with a crown can sometimes be saved: As long as you have some enamel on your tooth, we can almost flat-top the tooth and expect success with a bonded all-ceramic CAD/CAM crown…
  • Beautiful porcelain veneers can be created the same day: Wow! Not possible otherwise. Not to mention the subtle nuances associated with the looks and shapes of your front teeth that can be tweaked while you watch, interjecting your own input along the way!
  • Onlays and Inlays can be created that same day for your tooth: A dentist without CAD/CAM is bound to prescribe a crown to fix a tooth because it is less likely that your temporary will fall off. A crown removes more tooth structure than say an onlay. Common sense dictates that the less of mother nature that is removed in a surgery, the better. An onlay or inlay is preferable to a crown as less tooth structure is removed.
  • X-rays can visualize underneath the restoration: Most lab crowns have metal underneath. X-rays can not penetrate metal. CAD/CAM restorations have no metal, only porcelain, and X-rays do penetrate porcelain. This allows your dentist to more readily catch a problem underneath your prosthesis over time.

When do we not use CAD/CAM?

  • When what little is left of the tooth is black looking because of an old root canal: Since these are all porcelain and translucent, the darkness can show-through.  Sometimes a lab made restoration with an opaque material under the porcelain to block out the darkness beneath may be indicated in these types of cases.
  • Almost never…!

Dr. Nick Yiannios – An experienced CEREC and Cosmetic Dentist in NWA

  • Fellow & Accredited Member, The Academy of CAD/CAM Dentistry
  • Member, International Academy of Oral Medicine and Toxicology
  • Member, International Association of Mercury Free Dentists
  • Accreditation Candidate, the Academy of Cosmetic Dentistry
  • 1993 Graduate The University of Texas Health Science Center at San Antonio Dental School
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Headaches and Dental Medicine

What could headaches possibly have to do with your mouth, or your jaws for that matter?  Well… Please reference the following virtual image of the human skull:

Human skull and upper jaw/maxilla (transparent) and the lower jawbone (beige mandible), TMJ disks (2 yellow pillows interposed between skull and mandible), upper and lower teeth (lower teeth embedded in lower mandible/jaw bone) and lastly chewing muscles (red and white stringy images throughout).

Human skull and upper jaw/maxilla (transparent) and the lower jawbone (beige mandible), TMJ disks (2 yellow pillows interposed between skull and mandible), upper and lower teeth (lower teeth embedded in lower mandible/jaw bone) and lastly chewing muscles (red and white stringy images throughout).

An increasing amount of data suggests that certain types of headaches are related to malocclusion (a bad bite) and Temporomandibular Disorder (TMD or commonly referred to as “TMJ”).   Despite the fact that mainstream scientific evidence does not definitively corroborate this, an experienced clinician that treats these types of cases knows that an apparent connection exists.   I am just that sort of clinician.  For years I have been treating patients with amazingly accurate instrumentation that allows me to track the forces generated between opposing teeth (upper teeth to lower teeth), the timing involved with how long those opposing teeth frictionally “rub” and interact with one another, and the resultant muscular responses from the aforementioned force and timing interactions.  It sounds confusing, but it really isn’t.  Let me explain as succinctly and quickly as possible:

  • Research has repeatedly shown since the early 90’s that when opposing teeth rub too much frictionally together for too long (in time), chewing muscles become hyperactive
  • Hyperactive muscles produce excess lactic acid biochemically on the cellular level
  • Excessive lactic acid is toxic and potentially painful to all mammals, including humans
  • Precise measurements of timing and force and resultant muscular activity levels can be used to balance out the human bite, making the muscular response more efficient, and less likely to generate excessive lactic acid on the cellular level
  • Decrease muscular lactic acid production and one can decrease myalgic/muscular pain
  • Muscles such as the bilateral (right and left) temporalis muscles (located in the temples) are one example of a set of chewing muscles that can hyperfunction when the bite is not right in regards to timing/force/friction and resultant muscular output
  • Through precise and objective digital measurements of the human bite, in a patient who possesses stable and adapted right and left temporomandibular joints (TMJ’s)-confirmed objectively via digital modalities such as 3-D imaging and electromyography (EMG), one can decrease hyperactive chewing muscles such as the temporalis muscles by minuscule alterations of how opposing teeth interact
  • An example of a common headache that can be related to a spatial and temporal (space and timing) malocclusion (bad bite) is a headache in the temple region

  • This could be due to a bad bite, and adjusting the bite precisely and objectively using amazingly accurate digital metrics can eliminate headaches such as these

  • As a matter of fact, orthodontic movements and dental work can throw the bite out enough to cause muscular hyperfunction-THIS IS A CRITICAL POINT THAT WE RESOLVE OFTEN IN OUR DENTAL PRACTICE!
  • FACT:  the bite ribbon that dentists traditionally use to check the bite is 12% accurate relative to force/time and shows the dentist nothing about what is going on with the chewing muscles
  • FACT:  little known digital instrumentation known as the T-Scan® digital bite analysis technology is 95% accurate in regards to force/time
  • REMEMBER:  through force/time measurements, we can readily control and calm the chewing muscles, thereby reducing lactic acid and myalgic symptomatology

Are all headaches related to this sort of bite/occlusal problem?  No.  There are many potential causes of headache pain, including vascular and hormonal issues to name just a few.  However, there are ways to screen patients as to their cases applicability for this sort of treatment after the physicians have ruled out insidious organic causes such as brain tumors and the like.  We call this screening protocol Neural Occlusion.  Neural Occlusion is used to help us decide if a patient’s headaches are likely to respond favorably to an occlusal (bite) adjustment procedure known as ICAGD (Immediate Complete Antierior Guidance Development) which is used to accomplish DTR (Disclusion Time Reduction) therapy.  DTR therapy consistently calms hyperactive chewing muscles through precise and minuscule manipulations of the human bite.  Be aware that there are many times patients who find us have been told that there is nothing that can be definitively done for them, other than medications as needed to help reduce their headache pain, and many of these times we resolve their headaches anyway.  For more information:

TMJ Pearls

To see live patient cases that Dr. Nick has treated via Neural Occlusion/DTR protocols (there are dozens more on the drnickdds channel of YouTube):

 

http://youtu.be/YHPHL2GmnoA?list=PLrsyoxXDGZ4YxS3ThCRSd-kVJAJ4kCCXS

http://youtu.be/dRiTxJlIFc0?list=UUPoIDjjCFzKZbvQnX3BYlJw

http://youtu.be/hgjaK3tcakU

http://youtu.be/a3kY3n3skew

http://youtu.be/vs9RznhH3zs

http://youtu.be/9x_iyZ28g_s?list=PLrsyoxXDGZ4YxS3ThCRSd-kVJAJ4kCCXS

http://youtu.be/VjzngoWVacA?list=UUPoIDjjCFzKZbvQnX3BYlJw

http://youtu.be/AG-VPfJ-95I?list=UUPoIDjjCFzKZbvQnX3BYlJw

http://youtu.be/WNIDjGLpEC0?list=PLrsyoxXDGZ4YxS3ThCRSd-kVJAJ4kCCXS

http://youtu.be/UDWGKDkvkEE?list=PLrsyoxXDGZ4YxS3ThCRSd-kVJAJ4kCCXS

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In the News

Early August 2017  Over the past 2 weeks, Dr. Nick has welcomed foreign patients from 3 different continents seeking answers and for with their dental issues…:  Quebec, Canada; Sydney Australia, and Brussels, Belgium!  Oh, and he also saw close to 100 local patients from around AR, MO and OK during that same time frame as well!

Mid July 2017  Dr. Nick lectures at Marquette University complimenting Dr. Mark Piper’s lecture on the sympathetic nervous systems influence upon dental medicine, occlusion, and TMD.  Dr. Nick’s topic:  Neural Occlusion screening-displaying the supreme importance of 3D imaging to aid in the diagnosis of bite and TMD disorders (MRI and CBCT imaging) plus the importance of arriving at a proper diagnosis prior to the implementation of treatment for TMD patients.

Early July 2017  Dr. Nick adds the only Solea dental laser presently in the state of Arkansas to the practice.  This recently FDA approved tech allows him to do fillings on baby and adult teeth typically without local anesthetic!  Wicked cool tech ? Patients are calling from afar for this one!

Late June 2017  Dr. Nick spends more time with one of the CNO Board Members, Dr. Mark Piper in Florida, so that they may both prepare complimentary lecture material for their upcoming lectures at Marquette University later this month.

Mid June 2017  Dr. Nick gives the second Center for Neural Occlusion course and lecture of the year at his office in Rogers (CNO headquarters).  Of note, a dentist traveled from Japan to train with Dr. Nick this time!

Early June 2017  Dr. Nick is on the podium lecturing to the Mississippi Dental Association during their annual meeting.  The topic:  “Measured Occlusion & Frictional Dental Hypersensitivity”.

Late May 2017  Dr. Nick becomes the first and only dental practitioner to become SMART certified in Arkansas by the International Academy of Oral Medicine and Toxicology (IAOMT) so that he may better provide mercury safe care for those holistic dental patients who seek him out from all over this part of the country.

Mid May 2017  Dr. Nick and two others publish again in The Journal of Craniomandibular Practice about the T-Scan digital bite analyzer.

Early May 2017  Dr. Nick adds a Mercury Vapor Analyzer to his practice.  The same type of instrumentation used in industry to identify and track trace amounts of mercury.  Why?  To better understand and circumvent the dangers associated with the removal of mercury amalgam fillings for his patients, his staff, and himself!

Mid March 2017  A new record!  Patients have traveled as far as 9,000 miles to see Dr. Nick until this month when someone broke the record…  A young woman travels from Perth, Australia to see Dr. Nick in Rogers for an objective and measured opinion on her confounding TMD and bite problems;  10,000+ miles away!

Early March 2017  Dr. Nick continues his Botox and fillers certification earning CME certification from Albert Einstein College of Medicine.

January 2017  Dr. Nick spends a week with Dr. Mark Piper, the world famous TMJ surgeon, in St. Petersburg, Florida.  Dr. Nick and Dr. Piper are working together in regards to both of their respective teaching centers, Dr. Piper’s PERC and Dr. Nick’s CNO.  Additionally, one of Dr. Nick’s patients from Rogers is being operated on by Dr. Piper this week, so Dr. Nick scrubbed in for that TMJ surgery.

Late November 2016  Well. The “Best of the Best” in Northwest AR results are in. We are runner ups/top 2. Funny thing is, the practice that won first place has 6 dentists spread over 5 locations, and the other practice that we tied with has 4 dentists in 1 location. We are just 1 dentist in 1 location. I wonder who really won that one?! Not bad for only having been in AR for a little over a year ?

Mid November 2016  Dr. Nick hosts his CNO Board of Advisors at his office for their first annual meeting.  Docs traveled from as far away as Brazil for this meeting!

Early November 2016  Dr. Nick, Dr. Robert Kerstein, and Mr. John Radke publish the formal paper on the phenomenon that Dr. Nick discovered in The Journal of Craniomandibular Practice.

August 2016  Dr. Nick formally launches his Center for Neural Occlusion (CNO) teaching and training organization. The CNO is designed to teach all sorts of health care providers about the human bite and TMD issues.  Dr. Nick has surrounded himself with some of the most legitimate doctors, engineers, researchers and dentists in the world to help direct the organization.

July 2016  Dr. Nick lectures at the Bioresearch Annual meeting.  The topic on the podium?  “Frictional Dental Hypersensitivity and DTR Therapy”.

July 2015  Dr. Nick opens the doors to his new practice in Rogers, Arkansas…finally – after 2 years of planning!

June 2015  Our new office in Rogers, Arkansas will be opening on July 27, 2015 and the Branson, Missouri office will be closing on July 22, 2015.  Appointments for the Arkansas location are now being accepted!  This month, Dr. Nick lectured alongside Dr. Robert Kerstein at the BioResearch Technologies Annual conference in Milwaukee.  The topic: the efficacy of using DTR to optimize patient care in a general practice setting.  Dr. Nick, as co-author of the recently released 1st edition dental textbook on digital occlusal analysis in dental medicine, was honored for his contribution to the textbook at this same conference.

May 2015  Update on our new Rogers, Arkansas dental office building: we are officially in the dry!  At this rate, the dental practice will be open in NWA by late July 2015…!

April 2015  Dr. Nick has 3 international patients travel to see him this month!  One from Canada, one from England, and one from Malta (a southern European country located between Italy and Africa in the Mediterranean Sea).

March 2015  Dr. Nick uploads the 57th live patient documentation online to our drnickdds YouTube channel!  57 separate patients from all over the country whom we have treated, have volunteered to help spread the word re what we’re doing with our TMD treatments!  Many of these patients no longer have any TMD symptoms to speak of, such as temporal headaches, hypersensitive teeth, upper neck and shoulder tension, etc.  People have flown here from as far away as 8,000 miles to see us to date for our Neural Occlusion/DTR TMD treatment protocols (South Africa is the furthest locale to date).

January 2015  Dr. Nick’s chapter in the first edition dental textbook entitled, “The handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine” is published by IGI Global.

December 2014 Dr. Nick spends several days with Dr. Mark Piper, a world-renowned oral and maxillofacial and TMJ surgeon, learning personally from him MRI 3-D imaging interpretation.  Very few dentists ever delve this far into imaging.  The MRI protocol will be added to Dr. Nick’s current CT protocols that he already uses (as needed).

November 2014  Dr. Nick orders a second CEREC CAD/CAM for the practice to enable him to provide his same day crowns even more efficiently.  One CAD/CAM unit is no longer enough-we’re too busy!

Editorials

An editorial is written about Dr. Nick Yiannios D.D.S. in the Branson Tri-Lakes News.
Click here to view this article.

Dr. Nick explains the importance of dental visits at any age.
Click here to view this article.

An editorial regarding the importance of regular checkups.
Click here to view this article.

Dr. Nick answers the question “What’s wrong with my bite?”
Click here to view this article.

A article Dr. Nick created for other dental professionals.
Click here to view this article.

Dr. Nick explains the usage of joint vibration analysis for TMJ analysis in his dental practice.
Click here to view this article.

Dr. Nick describes the huge advantages of CAD/CAM all-ceramic crowns over traditional crowns.
Click here to view the article.

A Detailed review on the causes and treatments of sensitive teeth.
Click here to view the article.

Dr. Nick brings a safer, more effective type of dental-x-ray machine to Branson.
Click here to view the article.

Accreditation

Dr. Nick has earned fellowship and accredited status in the Academy of CAD/CAM Dentistry.
Click here to view Dr. Nick’s accreditation from the ACCD

Newsletter

January 2014  Dr. Nick begins placing dental implants with the unbelievable precision and predictability afforded him via the 3D CBCT technology/CADCAM digital interface.

December 2013   Another aspiring dental student who spent over a year shadowing Dr. Nick is accepted into UMKC Dental School.  Congratulations to the C of O student Matt Buswell!

October 2013   A dental patient suffering from chronic TMD issues travels all the way from South Africa to Missouri for Dr. Nick to treat him with his unique approaches to dental occlusion and TMD/TMJ problems!  We have seen patients come to us from all over the country for this unique TMD treatment, but never from the other side of the world!

September 2013  Dr. Nick begins aiding Dr. Robert Kerstein, the editor of a soon to be released dental textbook on dental occlusion, by peer reviewing other contributing authors from all over the globe.

August 2013  Dr. Nick finishes his contribution to the new textbook on dental occlusion.  His 70 page long contribution to the 1st edition textbook, Computerized Occlusal Analysis Applications in Dental Medicine, identifies and offers a predictable treatment for a never before documented, routinely seen, and unique dental pathology to the dental profession, Frictional Dental Hypersensitivity.

June 2013  Dr. Nick adds 3D computerized dental imaging, or Cone Beam Technology (CBCT) to the practice.  This technology allows him to see problems and pathology that cannot be gleaned from even the finest, 2D digital dental x-rays, allows for micron-accurate placement of dental implants, and even meshes with his CADCAM technology.  Very amazing stuff!

February 2013 Dr. Nick is asked by Dr. Robert Kerstein, the world’s authority on digital occlusion, to write a chapter in an upcoming dental tetbook to be released in 2014. The topic: Computerized occlusal analysis and the treatment of dental hypersensitivity.

January 2013 Dr. Nick publishes a peer-reviewed dental article on CAD/CAM technology in the Journal of Minimally Invasive Cosmetic Dentistry (MiCD).

September 2012-Dr. Nick brings dental electromyography to Branson. This EMG equipment lets him study and measure muscular force generated by the chewing muscles and compliments his Tscan equipment, letting him more effectively identify and treat muscular related TMJ disorders.

May 2012 Dr Nick adds joint vibration analysis technology to his repertoire of hi-tech diagnostic equipment. This tech uses waveform algorithms to help diagnose problems within the TMJ’s.

November 2011 Dr Nick moves the practice from Ridgedale to Branson over Thanksgiving holiday. We miss our old building but love our new one!

September 2011 – To better serve our patients, our office will be moving from Ridgedale to Branson in November of 2011. The new location will be at Hwy 65 and Bee Creek, on the East side feeder in the Corporate Summit building, next door to Akers and Arney Insurance which is located 1/8 of a mile south of the Branson Jr. High School. We are excited about our move into the new, state of the art facility!

August 2011-Jon Jacoby leaves us to begin dental school at UMKC. Good luck Jon!

July 2011-Dr. Nick welcomes Devin Lindsey, RDH as our new dental hygienist.

August 2010 – Cody Thress begins dental school at UMKC and Dr. Nick welcomes another aspiring dentist, Jon Jacoby to the practice. Good luck with school Cody!

July 1st, 2010 – Congrats to Dr. Nick for having passed the American Academy of Cosmetic Dentistry’s written exam!

April 2010 – Dr. Nick attends the Academy of Cosmetic Dentistry’s annual scientific conference in Texas. He takes the written examination which is the first step in the process to becoming accredited within the Academy. Only 300 Dentist’s in North America hold this distinction.

March 2010 – Dr. Nick places new signage out in front of his office as patients have traditionally had trouble finding his office out in the woods!

February 2010 – Dr. Nick hires a new hygienist, Jill Agre RDH.

January 2010 – Dr. Nick is awarded the distinction of Accredited in the Academy of CAD/CAM Dentistry. He is the 4th dentist in North America to be awarded this distinction which acknowledged proficiency in the fabrication of cosmetically superior dental restorations with the usage of the computerized CAD/CAM technology.

November 2009 – Dr. Nick’s office goes completely digital.

July 2009 – Dr. Richard Steinberg, President of the Academy of CAD/CAM Dentistry, asks Dr. Nick to serve as a voting Board member for the international dental organization.

May 2009 – Dr. Nick is awarded the distinction of Fellowship in the Academy of CAD/CAM Dentistry. He is the 5th dentist in North America to be awarded this distinction.

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2-D and 3-D Digital X-Ray Imaging

2-D digital x-rays

At Dr. Nick’s practice, long gone are the days when chemical processors and relatively high dosage X-ray arms are used to image the tissues of the oral cavity.  Instead, low radiation, handheld digital Nomad’s® are used as the operator stays in the room with the patient as the x-ray images are exposed against a small digital sensor.

Resultant of this, a much quicker and convenient workflow for radiographic imaging is involved.  These 2-D digital x-rays are used for normal tooth and bony tissue imaging typically needed for diagnostic reasons, including assisting in the identification of cavities between the teeth, abscessed tooth roots, faulty dental work, and bone levels as they relate to periodontal/gum disease.

2-D panoramic x-ray imaging

A quick low radiation screening of both jaws, the tooth roots, the TMJ’s, the sinuses and other hard tissue components of the head and neck.  Often used to help with orthodontic diagnosis, simpler wisdom tooth issues, and a generalized screening of any missing or extra teeth in the pediatric dental patient, this type of film is typically indicated in younger patients.

3-D CBCT hard tissue imaging

 See video of 3-D Imaging>>

This amazing in-office technology allows Dr. Nick to visualize, in 3 dimensions, any hard tissue within the digital CBCT sensors range, including bone, teeth, roots, sinuses, etc.  Used as needed to image difficult cases related to: impacted wisdom teeth, the TMJ’s and their associated structures, root canal issues that evade visualization per normal 2-D imaging modalities, future dental implant treatment planning, and any confirmation of aberrant pathology that is detected per history, exam, or preliminary 2-D imaging.  Modern CBCT is a greatly reduced version (in regards to radiation exposure) of medical CT, in that the physics and technology used to generate the image is much simpler than the medical CT imaging counterparts.  For instance, Dr. Nick uses this modality routinely to study the temporomandibular joints in his “TMJ” patients.  Within the 3-D image, Dr. Nick can have an undistorted view of any hard tissue, with the added ability of being able to virtually measure and manipulate the placement of potential implant placement.  Imagine a non-surgical confirmation that there is enough room in the bone for an implant screw, which clears potentially dangerous and problematic anatomical structures such as the sinuses, arteries and nerves of relevance.

3-D MRI soft tissue imaging 

There are times when diagnosis of a “TMJ” patient requires imaging of the soft tissue cartilage within the temporamandibular joints to definitively diagnose a given TMJ patient’s problem(s).  These cases are referred out to an imaging center and involve a radiologist’s interpretation before Dr. Nick can combine the MRI soft tissue results with the CBCT hard tissue results.  Dr. Nick has been personally trained by one of the world’s experts in maxillofacial radiology and TMJ surgery, Dr. Mark Piper in regards to 3-D imaging interpretation of the TMJ’s.

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