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Family Dentistry

The core of any dental practice, Dr. Nick Yiannios has provided personalized dental care to thousands of families.  We pride ourselves in utilizing the most modern equipment and methods available, with the primary goal of identifying any issues before they manifest as expensive and unwanted problems. Consequently, regular and thorough cleaning and examination appointments are quite possibly the most important services that we provide, since this offers us the opportunity to preserve your families most valuable asset, their smile!

In order to provide nothing but the best to our patients, our office uses state-of-the-art technologies with all of our procedures. These new technologies coupled with Dr. Nick’s vast experience allows us to detect any dental concerns at the earliest stages, allowing our practice to treat your families dental issues with comfortable precision, so that you and yours may return to doing what you do best!  Routinely, our practice is committed to always providing stunning and customized mercury-free dental restorations.  Of note:  Dr. Nick never places mercury amalgam fillings!

Family dental services performed:

  • Cleanings/hygiene
  • Examinations
  • White, metal-free bonded fillings
  • Dental Sealants
  • Metal-free ceramic inlays and onlays
  • Orthodontic screenings
  • TMJ screenings and treatments
  • Oral cancer screenings
  • Gum/periodontal  disease screenings and treatments
  • Metal-free, all-ceramic crowns-on site, the same day!
  • Root canals, microscope-aided
  • Professional teeth whitening/bleaching
  • Bridges
  • Laser gum recontouring
  • Apthus ulcer laser treatments
  • Dental Implants, 3D-aided placement
  • Extractions
  • Full mouth rehabilitations
  • Porcelain veneers-on site, the same day!
  • Cosmetic & Esthetic Dentistry
  • Children’s dentistry

And much, much more…!

In regards to children, we typically treat children from the age of 5 and older, suggesting that the parents bring their child along during the adults checkup appointment to observe how easily and comfortably a dental cleaning and examination are accomplished in our practice, so that at their own subsequent appointment, that child will not be apprehensive.  Many children under the age of 5 are generally best treated at a specialty pediatric dental practice geared up for the toddlers.  Our primary goal for the young new patient is to not have them experience a negative dental visit which they may psychologically carry on with them for the rest of their life!

Please click here for an explanation of dental treatment at the various stages of life:  CLICK HERE for DDS Talks

Rest assured, when you or your family make an checkup appointment at Dr. Nick’s, you will see the doctor, and not just a subordinate for the examination.  In his 20+ years of dental practice experience, the one rule that Dr. Nick always follows is taking the time to perform a thorough dental, oral cancer, “TMJ”, periodontal (gum) and orofacial pain examination and screening, because, after all, signs precede symptoms, and thoroughness is always paramount in oral health matters!

 

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Dental Emergency and Emergency Dental Services

Dental Emergency. Life happens, inevitably.  A slip or fall, an auto accident, an abscessed tooth; Dr. Yiannios has seen and treated most all of the following scenarios in his 20+ years of dental practice, and has systems in place to expedite emergency dental treatment.  In most situations, our practice will accommodate at least an evaluation of the issue within a days time, and if there exists time in the days schedule, definitive or palliative treatment to resolve the issue.

Dental Emergency

  • chipped or broken teeth
  • abscessing teeth in need of extraction or root canal therapy
  • crowns or fillings that have fallen or broken off
  • avulsed (knocked out) teeth
  • infection of the peri-oral/facial tissues
  • TMJ’s that are locking up and painful
  • non-specific pain in and around the oral cavity
  • wisdom tooth issues

Many technologies are in play with a dental emergency that allow the expeditious treatment of maladies such as the above listed issues including:

Many patients that present with a dental emergency issue such as those listed above are often not regularly visiting a dental health professional.  We strongly advise those patients to schedule a comprehensive examination and cleaning after palliative emergency treatment has been rendered, to stave off the elevated chances of a recurring emergency situation in the future.

CALL US NOW:

479-876-8000 in Rogers

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Meet Dr. Nick Yiannios D.D.S.

Dr. Nick Yiannios D.D.S. Biography

Why NWA?

Born in New Haven, Connecticut, Nick Yiannios was the first born of a Greek immigrant who traveled to the U.S. to seeking his PhD in Organic Chemistry.  Sharing his father’s passion for the arts and sciences, after high school, Nick traveled to Texas seeking an education in microbiology, that branch of science that deals with microorganisms.  After obtaining his B.S. in microbiology from Texas A&M University, his passions naturally led him into the dental profession.  In 1993, Dr. Nickgraduated from the University of Texas Health Science Center at San Antonio Dental School with his D.D.S. degree, and subsequently moved to Dallas, Texas.

After a 2-year stent of practicing in a group setting in Dallas, Dr. Nick found that he missed the four seasons, and subsequently moved himself and his new family north to the Ozarks and opened a dental practice in the safe, and family-oriented town of Branson, Missouri.  Over the next 20 years, he nurtured both his practice and his clinical skills in the heart of the Midwest, rekindling his childhood hobby of fishing the lakes and rivers of the region as time permitted.

On a professional level over these formative years, Dr. Nick found that much of the tradition and analog dogma that pervaded his chosen profession were a hindrance to the predictable practice of general/cosmetic/esthetic dentistry and other aspects of dental medicine, and systematically introduced a highly unique combination of objective digital protocols, one by one, into his practice.  In the mid-2000’s, Dr. Nick integrated digital robotic CEREC CAD/CAM dental technology into his practice, allowing him to eliminate the need for the error-ridden molds, temporaries, and dental laboratories that most dentists rely completely upon, vastly increasing the conservatism, efficacy, accuracy, efficiency of production, and placement of his esthetic crowns, veneers, inlays and onlays.  A few years later, the decision was made to eliminate the paper in the practice, and his office went completely digital, vastly increasing efficiency and accuracy.  In 2009, after earning a fellowship in the organization, Dr. Nick was asked to serve on the Board of the Academy of CAD/CAM Dentistry, an international organization mandated to disseminate the efficient and ethical practice of digital CAD/CAM dentistry.  A year later, Dr. Nick began integrating digital bite T-Scan® technology into his dental practice to complement and improve upon his dental treatment outcomes.  Other unique and highly specialized technologies soon followed, each intentionally integrated to yield more beautiful, functional, and healthier outcomes.

In 2012, while treating his patients with a combination of these specialized technologies, Dr. Nick observed something that no other dental professional had ever statistically documented; a predictable correlation between hypersensitive teeth and painful chewing muscles (dental hypersensitivity and muscular TMD issues), treatable via a digitally directed, single dental treatment visit protocol.  A few months later, he was asked to author a chapter in a dental textbook describing this phenomenon (that he labeled Frictional Dental Hypersensitivity or FDH) to the dental profession.  Simultaneously, Dr. Nick began uploading live patient video case studies to the World Wide Web displaying patient responses to his one visit treatment protocol.  Over time, patients and other doctors began contacting the practice from afar, some from countries far outside of the U.S..

Though highly successful in his burgeoning Branson general and cosmetic dentistry practice, in late 2013, Dr. Nick and his beautiful wife and partner in life Valana, made the decision to open a new, state-of-the-art dental practice in NWA, where others in their family now reside.  With one of their sons (who is a U of A law school graduate and practicing attorney in NWA) settling down in NWA, and with yet another son slated to attend U of A, it simply made sense to make a mid-career move.  The thought of treating patients who are also transplants from other regions of the country sounded appealing to Dr. Nick, since he too had followed this type of geographic path himself.  Bringing many general, TMD, esthetic and cosmetic dental treatments that do not presently exist in NWA, coupled with his passion for clinical dentistry and Valanas vast experience in efficiency of systems gleaned from her many years in the business world; this combination will nicely serve the families of the progressive NWA metroplex.  Intuitively, a dental practice that respects the patient’s time, desires, and important regard for optimum oral health will quickly earn the respect of NWA residents.  Additionally, a larger airport that could assist in connecting those patients who travel from afar to seek treatment in the practice was just what Dr. Nick ordered!

Experience the FUTURE of Dental Medicine,

Dr. Nick Yiannios D.D.S.

 

 

Dr. Nick’s Affiliations

Academy of CAD/CAM Dentistry (ACCD) Status: Fellow & Accredited member

American Academy of Cosmetic Dentistry (AACD) Status: Accreditation candidate

IAOMT (International Association of Oral Medicine & Toxicology) Status: SMART Member

American Dental Association (ADA) Status: Member

Arkansas Dental Association

Arkansas Dental Association Status: Member

1988 Graduate Texas A&M University; B.S. Microbiology

1993 Graduate: The University of Texas Health Science Center at San Antonio Dental School

Center for Neural Occlusion (CNO)

Status:  Master, Center for Neural Occlusion (MCNO)

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Dental Technology

Dr. Nick 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.

Advanced Technology used by Dr. nick includes the following:

 

Complete Digital Dentistry. The advantages to the patient are enormous in the digitized dental practice.  Modern dental practice management software programs are amazingly complex.  Emails and/or text messaging reminders of your appointment, instantaneous encrypted transmission of x-rays and other information to referring specialists and vice versa, storage of all clinical notes ready for instant recall, x-rays and 3-D imaging integrated to compare instantly with other relevant clinical data, tracking images of the teeth or oral pathology over time, archiving digital bite analysis and EMG over time for future comparison, imaging the anatomy of a particular tooth to recall should damage and prosthetic replication ever need to occur, using MRI to track the health of the TMJ disks, for diagnosis, or for predicting treatment efficacy;  the list is endless.

Dental practice management software and 2-D digital x-rays.

Force/time data left, concurrent muscular activity right, slaved to each other in 3/1,000 of a second increments. A permanent and precise snapshot of that patients bite in time, forever part of that patient’s digital dental record.

A digital collage of the kinds of data that we look at daily in the digital patient record.

Paper charts, written notes, chemically processed x-rays; these were the standard when I first started my solo practice in 1995.  Slow, analog, archaic, fraught with error-this is what I remember about the “olden days”.  Comparing the paper chart to the digital chart is akin to comparing an old typewriter to a word processing program like Microsoft Word!

Today, it is a different story.  What are the two biggest advantages for this paperless integration in a dental practice for the patient?  Efficiency coupled with predictability, so that you can receive the best possible care in the shortest amount of time so that you may return to doing what you do best, whatever that might be (aside from waiting around for your dental work)!  Rest assured that your personal, medical, financial and dental histories are safe with us.  Our encryption algorithms on our servers are state of the art and we never transfer data of any kind without your written permission.

Welcome to the future of dental medicine!

 

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

CEREC® 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 reach the office before the permanent prosthesis is put in place. With CAD/CAM, a special digital camera is used to take a picture of the tooth in need of repair, and then computer software is used 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 are both subsequently permanently fused to the restoration in a high temperature glazing oven. The final restoration is then bonded to the tooth with tooth colored materials and matches beautifully! Dr. Nick is an expert in CAD/CAM Technology. He has written a book which you can view here for more information:

Dr. Nick's Book

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 and you are 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 made by a technician who has never 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 present!
  • 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.
  • 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.
  • No gray edges at the gum line: because there is no metal in these restorations, 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 practice 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 often not restorable with a crown in a normal dental practice 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 on front teeth 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!
  • More conservative onlays and Inlays can be created that very day for your tooth: A dentist without CAD/CAM is bound to prescribe a crown to fix a broken tooth because it is less likely that your temporary will fall off when more natural tooth structure is removed. A crown removes far more tooth structure than does an onlay for example. Common sense dictates, the less of mother nature removed in a surgery, the better. An onlay or inlay is preferable to a crown as less tooth structure is removed to resolve the problem.  Dr. Nick always removes the least amount of nature possible in a given situation.
  • X-rays can visualize underneath the all-porcelain CAD/CAM restoration: Most lab crowns have metal underneath. X-rays cannot 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 porcelain restoration over time.
  • Getting the bite right!  Since we are creating the restoration(s) on-site using ultra-accurate digital imaging rather than molds, control of the occlusion (the bite) is far more accurate.  This is extremely important because bite issues can readily lead to sensitivity, trouble chewing, a subsequently broken restoration, headaches, and even “TMJ” problems 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 CAD/CAM restorations are all-porcelain and translucent, the darkness can show-through.  In this circumstance, we might need to send off for a laboratory-made restoration that has an opaque substructure which will definitively hide the darkness underneath.

 

Fillings without a drill?  Solea C02 Laser & Air Abrasion technology in minimally invasive dental medicine

Air Abrasion. 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 technologies that typically circumvent the whining drill to accomplish many filling procedures?  We use two such technologies: A hard tissue Solea dental laser, and air abrasion.   Both of these techs are used in our practice daily to “poof away” decay, typically without the need for numbing or a drill!

Air abrasion is basically a tiny little wand that propels minuscule 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 does 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, on the other hand, generate huge amounts of friction, which heats up 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 injections 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 someone sandblasting wood or stone, you have observed that 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 does a drill with a bur.  The normal drill and bur are akin to an electric drill and a screw.   Have you ever carefully watched an electric drill sink a screw into a piece of wood?  Numerous cracks radiate out from the center of the hole, which the screw is creating as it is drilled into place.  This can readily happen when burs cut teeth.  They tend to create small cracks outward from the center, which can turn into problems for the tooth over the years as the cracks tend to weaken what is left of the tooth, making them more prone to leakage and fracture.

Air abrasion is typically used to remove small cavities.  Anything medium to large generally does require the use of the dental handpiece (drill) and the burs, as the softer, larger cavities are not amenable to removal via the tiny particles under pressure.  Many times however, Dr. Nick will use air abrasion to at least start the entry into the cavity before commencing with use of the bur, to mitigate the potential damage that the bur might make from the initial penetration into the tooth structure.

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

Advantages of the Solea Hard Tissue Laser & 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 fillings/the vast majority of time no shot is needed!
  • 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
  • Can remove old composite white fillings, typically without any anesthesia

Disadvantages of the Solea Laser & Air Abrasion:

  • Will not remove old silver amalgam fillings
  • Will not remove metal or porcelain crowns
  • Solea and Air Abrasion will not prepare crowns, veneers, or bridges; we need a drill for these procedures

The Solea and Air abrasion technologies are particularly well suited for patients who have new cavities on baby or permanent teeth, and the process is typically far more conservative and minimally invasive in comparison to the usage of the traditional dental drill. A dental patient who religiously sees Dr. Nick for regular checkups and presents with new decay is a prime candidate for this sort of painless and minimally invasive cavity restoration.  In addition, the metal-free white fillings that are placed in these cavities 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 the rigors of chewing over time.

Do all dentists use the Solea or Air Abrasion in their practices?  No, but they should!  As a matter of fact, as of the summer of 2017, Dr. Nick owns the only Solea dental laser in the state of Arkansas, let alone Northwest Arkansas!

 

 

3-D and 2-D 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 a dental 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.  Dr. Nick and Dr. Piper frequently lecture together regarding bite and TMD issues in various conferences and universities, and each own and participate in each others respective teaching institutions, Dr. Nick’s Center for Neural Occlusion, and Dr. Piper’s Piper Education and Research Center.  Quite simply, usage of the MRI is the missing link in the practice of dental medicine!!

 

T-Scan, EMG, and JVA. The importance of bite relation (occlusal analysis) cannot be over-emphasized in the dental practice setting. The placement of fillings, crowns, bridges, bruxism splints, implants, veneers, onlays, inlays, dentures; just about anything we do in dentistry 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 headaches to temporomandibular disorder (TMD). Traditionally, a colored ribbon of paper known as articulating paper is used to allow 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…

An instrument known as the T-Scan® allows the dentist to do just that, QUANTIFY how hard or how much the teeth touch.

 

Please note the PINK spike on the computerized 3D rendering of this patients initial bite, signifying that her bite is heavy towards the front. After Dr. Nick adjusted her bite, another digital occlusal analysis was recorded.

t-scan-5

Notice the distinct improvement in the stability of this patient’s bite as a result of the use of the T-Scan (R), as signified by the even distribution of force/time spikes and the loss of the pink “high spot” on the 3D graph .

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 implementation of Occlusal Adjustments in relation to TMJ disorders.

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 to give Dr. Nick an assessment of the state of health of that patient’s given TMJ that is up to ~90% accurate, in minutes!  The JVA is the “poor man’s MRI” in that it gives us a rapid screening of the health of the important soft tissue cartilaginous TMJ disks.  Short of an expensive MRI, this is the next best way of evaluating the disks.  Dr. Nick uses the JVA on all of his patients at checkups and exams to track this important indicator of dental health, the TMJ disks.

EMG
Electromyography is a tool that Dr. Nick uses to measure muscular activity in the chewing muscles when indicated. Surface electrodes are placed over the target muscles and the tiny little currents that muscles create are measured, allowing us to analyze chewing sequences and patterns, just like neurologists and researchers do! This is a totally painless and safe procedure.

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 “TMJ” problem is muscular in origin, which it usually is…

So what is DTR and ICAGD?
These are treatments for muscular TMD issues that DO NOT rely on traditional splints and acrylic appliances. These treatments are a new, more definitive way of addressing TMD issues by creating a permanent physiological change, 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 upon the following two protocols, when indicated, for muscular based TMD issues.


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 are precisely removed with data gleaned from the Tscan/EMG link. This process decreases muscular output, relaxing the muscles of mastication, which typically alleviates many TMD symptoms. Dr. Nick was personally trained by the creator of this new process, Dr. Robert Kerstein of Tufts University, many years ago and is considered an expert in this process.  Dr. Nick in 2015 published a chapter in a first edition dental textbook relating to novel, research-based usage of the T-Scan® and related technologies, and presented the pathology known as Frictional Dental Hypersensitivity (FDH) to the dental profession (Yiannios, DDS, Nick. “Occlusal Considerations in the Hypersensitive Dentition.” In Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine, ed. Robert B. Kerstein, DMD, 358-428 (2015)).  Dr. Nick is also a beta tester for Tekscan, the company that created the Tscan® 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 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 MRI) combined with a thorough history, examination, and FDH screening.  As of July 2017, 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

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The Isolite®-a MUST for modern dental treatments! What is so important about a soft, plastic block that creates a vacuum, pours oodles of fiberoptic light upon the operative field for better visualization, and comfortably fits in your mouth during dental treatment?  Modern dental materials are typically tooth-colored porcelains or composites (white fillings), and they both share one characteristic:  they require a dry field for optimum fusion/bonding to tooth structure.  Even the humidity in ones breath can compromise this dry field requirement, let alone any saliva that might enter the procedural field.  Enter the Isolite®, a single use, disposable, fiber optically lit, dry field technology that helps to ensure predictable modern restorative dental treatment.  The vacuum (which envelopes an entire half of the mouth) also expedites dental treatment by keeping the cheeks and tongue out of the way, so that the dentist can accomplish more treatment per unit time so that the patient spends less time in the dental practice.  Additionally, when old mercury amalgam fillings are removed in the course of dental treatment, the vacuum theoretically helps serve to protect both the patient and dental personnel from the toxic mercury vapors created upon its removal since the powerful vacuum envelopes the entire perimeter of the tooth being worked on.

Dr. Nick uses this technology on just about every patient.  This includes the placement of white/composite fillings, CEREC® CAD/CAM porcelain crowns and veneers, air abrasion procedures, dental implant placements, oral surgical procedures; just about everything he does.  The advantages to the patient are tremendous:  safety, predictability, comfort, and better visualization.  Though this single use technology is quite expensive, Dr. Nick will not perform his dental work without it for two main reasons:

1) he wants everyone protected

2) he wants his work to last!

Step into the future of dentistry!

 

Lasers. We use both a Solea Hard/Soft tissue laser and a soft tissue diode laser to provide dental care for our patients. The benefits of these technologies are tremendous! They can be used to help improve/assist us in our CEREC CAD-CAM dentistry by improving our digital optical impressions, to remove cavities without a shot or a drill, as an adjunct to scaling and root planing (deep cleaning) gum procedures, aphthous ulcer care, gum shaping, control of minor hemorrhage (or bleeding of the gums during surgical procedures), and many other surgical procedures.

Examples of procedures that are routinely performed with these Lasers are:

  • Fillings typically without a shot or a drill
  • Clinical soft tissue crown lengthening
  • Hard tissue crown lengthening
  • Soft tissue debridement
  • Orthodontic tissue control
  • Frenum release
  • Biopsies
  • Cold sore treatment
  • Implant access
  • As an aid in CAD/CAM imaging for crowns and veneers

Imaging. Examples of our Intraoral imaging capabilities abound throughout this entire website… Dr. Yiannios has taken most every photograph here either with a digital SLR camera, or with a digital intraoral camera which is linked to the patient’s digital dental chart. Every patient of Dr. Nick’s has the opportunity to see any clinically apparent problem on the computer monitors in each treatment room… as a matter of fact, he insists on showing his patients what is going on every chance he gets!

Fiber-optic Intraoral Camera
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Lasers

Dr. Nick Yiannios uses two types of lasers to provide state-of-the-art laser care in our practice.  A “doped” CO2 hard and soft tissue laser known as a Solea (operating at 9.3 µm), and a soft tissue diode laser called the Ivoclar Odyssey (operating at 810 nm). Dr. Nick has two types of lasers because they each work at different wavelengths, providing benefits for different types of tissues and procedures. The Solea is the first and only dental laser that is FDA approved to efficiently cut (or technically “ablate”) any tissue in the oral cavity (tooth, bone, gum, mucosa) with a single setting, thanks to it’s amazing technical properties and its unique 9.3 µm wavelength. As of the summer of 2017, our practice is the only practice in the entire state of Arkansas to own the Solea laser.  As such, patients travel to us from all over to experience cavity removal which typically does not require anesthetic injections (the dreaded “shot”) for most cavities.  Both the Solea and Odyssey lasers can be used for standalone or adjunctive treatment for scaling and root planing (deep cleaning) gum procedures, aphthous ulcer care, gum shaping, control of minor hemorrhage (or bleeding of the gums during surgical procedures), improving CEREC CAD/CAM digital impressions, and several other surgical procedures.

Examples of procedures that are routinely performed with the Solea and Odyssey Lasers are:

  • Fillings in baby and permanent teeth (typically without anesthetic injections)
  • Bone recontouring/flapless crown lengthening
  • Biopsy
  • As an aid for extractions
  • Uncovering implants
  • Removing old white composite fillings
  • Soft tissue clinical crown lengthening
  • Soft tissue debridement
  • Orthodontic tissue control
  • Frenum release
  • Biopsies
  • Cold sore treatment
  • As an aid in CAD/CAM dental procedures

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Patient Visualization

Intraoral and extraoral photography:  Dr. Nick uses USB enabled miniature cameras to display to patients any problems that might be going on in their oral cavity.

This technology captures amazingly clear images directly to the dual monitors in the dental treatment room so that the patient and the doctor can review them immediately together.  Dr. Nick also uses professional digital SLR cameras and mirrors to take superbly high quality images for his esthetic and cosmetic work.  These images allow him to more accurately mimic the exact “look” that a tooth has when he customizes a CEREC® crown or veneer in the office while staining and glazing the restoration, on site, that day.  We also use the digital SLR’s to document the condition of a patient’s bite to help diagnose “TMJ” and bite issues as well.

Virtual modeling:  Dr. Nick uses this software to demonstrate to the patient various anatomy relating to the head and neck.   Particularly useful for patients with oro-facial pain and “TMJ” problems, Anomalous Medical, LLC  software allows total customization of the virtual model, allowing us to mimic the patient’s problems virtually when combined with our 3-D imaging and other objective modalities.

Videography:  For years, our practice has been recording and uploading patient case studies to the World Wide Web.  Dr. Nick has compiled and edited every one of the videos himself, which demonstrate everything from our CEREC® CAD/CAM restorations, to root canals, to digital implant placement, to our TMD treatments.  On YouTube, our channel, drnickdds, houses over 100 of these videos.

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

Some sample videos:

Resolving TMJ:

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

1 visit CEREC porcelain veneers:

http://youtu.be/t80e5aNh0pU?list=PLrsyoxXDGZ4bpvzbJLXMGCJqphSLlLV9Z

DIGITAL dental implant & crown-safe and precise! :

http://youtu.be/8p_hVLeKmSg?list=PLrsyoxXDGZ4bpvzbJLXMGCJqphSLlLV9Z

The CURE for sensitive teeth:

http://youtu.be/YaDGFEQAPyc?list=PLrsyoxXDGZ4bpvzbJLXMGCJqphSLlLV9Z

 

 

Sterilization in the dental practice:

http://youtu.be/RnBtCm9_c98?list=PLrsyoxXDGZ4bpvzbJLXMGCJqphSLlLV9Z

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Isolite® Dentist

Isolite® Dentist

The Isolite® Dentist-a MUST for modern dental treatments!

Isolite® Dentist. What is so important about a soft, plastic block that creates a vacuum, pours oodles of fiberoptic light upon the operative field for better visualization, and comfortably fits in your mouth during dental treatment?  Modern dental materials are typically tooth-colored porcelains or composites (white fillings), and they both share one characteristic:  they require a dry field for optimum fusion/bonding to tooth structure.  Even the humidity in ones breath can compromise this dry field requirement, let alone any saliva that might enter the procedural field.  Enter the Isolite®, a single use, disposable, fiber optically lit, dry field technology that helps to ensure predictable modern restorative dental treatment.  The vacuum (which envelopes an entire half of the mouth) also expedites dental treatment by keeping the cheeks and tongue out of the way, so that the dentist can accomplish more treatment per unit time so that the patient spends less time in the dental practice.  Additionally, when old mercury amalgam fillings are removed in the course of dental treatment, the vacuum theoretically helps serve to protect both the patient and dental personnel from the toxic mercury vapors created upon its removal, since the powerful vacuum envelopes the entire perimeter of the tooth being worked on.

Dr. Nick uses this technology on just about every patient.  This includes the placement of white/composite fillings, CEREC® CAD/CAM porcelain crowns and veneers, air abrasion procedures, dental implant placements, oral surgical procedures; just about everything he does.  The advantages to the patient are tremendous:  safety, predictability, comfort, and better visualization.  Though this single use technology is quite expensive, Dr. Nick will not perform his dental work without it for two main reasons:

1) he wants everyone protected

2) he wants his work to last!

Step into the future of dentistry

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Dental Implants

Dental implants are basically artificial roots made of biocompatible titanium upon which a crown is placed to regain a missing tooth or teeth in form, function, and esthetics.

Natural tooth structure in bone and gum left, artificial replacement implant in bone and gum right.

Natural tooth structure in bone and gum left, artificial replacement implant in bone and gum right.

 

 

Am I a candidate for dental implants?

It depends.  Dr. Nick has decades of experience in answering this question.  It basically depends upon two things:

  • how much bone you have in the space where you lost your tooth
  • how much gum tissue is left in that area after the loss of the tooth

 

Is there anything else that I need to know about before getting an implant?

On the top jaw, or maxilla, there are limitations and anatomical landmarks that have to be considered.  These include your sinuses, the floor of your nose, and the condition and density of the bone and gum in the region that the implant is to be placed.  On the lower jaw, or mandible, the primary considerations are the location and distance of several nerves and blood vessels that exist in the area where the implant will potentially be placed.  Dr. Nick typically uses 3-D imaging to objectively ascertain if any of these complications exists prior to undertaking implant placement, so that measures can be taken to circumvent any potential complications (see sample video demonstrating screening via 3-D imaging at the bottom of this page).

 

Are there different kinds of dental implants?

Yes.  There are a plethora of different shapes, sizes, and brands available.  Dr. Nick has worked with many different types of implants in the past 20 years and will be able to decide which type is best for your situation.

 

What is the success rate for dental implants?

Well above 90% across the board.  Many factors dictate the potential success or failure for the dental implant, including oral hygiene habits, general health, social habits such as smoking (decreases prognosis), as well as the initial quality, quantity and thickness of bone and gum tissue at the time of surgery.

 

Can Dr. Nick do my dental implant?

In most cases, yes.  On occasion, referral to either a periodontist or oral surgeon is indicated for complex cases.

 

Can Dr. Nick do the crown that sits on top of the implant?

Of course he can.  He usually does them the same day you come in with his CAD/CAM technology, creating the permanent crown in one visit with beautiful and strong porcelain.

 

What is bone grafting?

When a tooth is extracted and we plan on placing an implant, it is prudent to augment the thickness of bone by doing a bone graft.  Basically, we place sterile bone in the hole where the roots used to be to encourage that the bone will grow in place of the root, rather than allowing the extraction site to heal naturally, with a concurrent loss of bone height and thickness.  A bone grafting procedure helps to ensure that there will be plenty of bone to allow subsequent implant placement several months later.  The implant should be placed within a year’s time or so, otherwise the grafted and augmented extraction extracted site will melt away over time, eliminating the advantage of ample bone thickness that was once there after the graft. Grafting ideally is accomplished the day the tooth is removed.

A diagrammatic representation of the bone loss that may occur after natural tooth extraction. Note placement of bone grafting material, which over time, allowed for adequate thickness of bone growth to allow subsequent placement of a dental implant.

 

Here is a diagrammatic example of deficient thickness of bone from an extraction site years ago (far left) making implant placement impossible without bone grafting. A bone grafting procedure was implemented to increase thickness (middle), which allowed for subsequent implant and crown placement (far right).

 

What is the goal of dental implant therapy?

To give you your tooth back of course!  The loss of a tooth or teeth is not to be taken lightly.  The remaining teeth may take excessive loads, tip, and/or fracture over time, leading to a domino effect of more trouble than most would care to deal with.  The end result is highly dependent upon precise positioning of the titanium implant relative to where the porcelain crown will need to be.  The most precise way to manage this is via 3-D guided implant placement following the design of a properly shaped crown in the missing space via CAD/CAM virtual placement, BEFORE the implant surgery:

 

 

See the following video that Dr. Nick compiled illustrating one of his guided dental implant cases to replace a lower right first molar tooth:

 

 

With proper care, your teeth should last a lifetime.  However, occasionally life happens and if you find that you need to lose one, be sure and ask us if dental implant treatment is right for you!

 

 Dental Implant in NWA and Rogers arkansas

Because oral health matters,

 

Dr. Nick Yiannios

 

 

 

 

 

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Microscope Dentistry

Why use a microscope in dental medicine?   Simply put, many of the things that we are evaluating and treating are small, so small, that many times we must visualize with a high-output, high-magnification LED-powered surgical microscope to affect the most effective treatment for our valued patients.  ENT’s, neurosurgeons and other medical specialists who routinely deal with minute surgeries, have been using high-powered magnification for decades, though few dentists have followed suit, unfortunately, in Dr. Nick’s opinion.  The increased visualization and information gleaned from the usage of a microscope results in more precise, deliberate, and improved patient treatment outcomes.

A high-powered dental microscope in use by Dr. Yiannios on a dental patient.

Dr. Nick routinely uses his Carl Zeiss microscope for endodontic (root canal) therapy, and at times pulls it out for restorative and esthetic dentistry as well.  He even has a digital camera and video recorder integrated into the microscope in the event he needs to document the treatment.  You will never see him not using magnification, whether it be through his hi-powered head loupes or the microscope, period.  After all, if he can’t see it, he can’t treat it, and he totally gets that…!

High magnification dental loupes which provide a much improved view of the oral cavity.

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Comfort

Dr. Nick’s definition of comfort in the dental practice: a lack of fear, pain, and/or anxiety, often accompanied by the patient possessing a sense of control and empowerment.

Over the years, Dr. Nick has found that a combination of the following does just that for his dental patients:

Communication: Dr. Nick has been referred to by many his patients as “the House of Dentistry”! Why? Because he knows what he’s doing and explains everything as he accomplishes it for the patient. After all, knowledge is power! Knowledge provides a sense of relief for the defenseless dental patient in the dental chair, and without trust, there is fear. Dr. Nick routinely shows the patient virtual modeling, intraoral pictures, and even videos of what he plans on doing for the patient, should they have an interest. Most often they do have an interest, and this honest and complete dissemination of knowledge empowers them, thereby allowing them to eliminate their anxiety and fear.
Informed Consent: we always explain what needs to happen, why, how long it will take, and (most importantly) what will go right!
Right hand rule: anytime a patient feels any discomfort whatsoever, the right hand rule always applies. The patient is simply asked to raise his/her right hand, and Dr. Nick ceases whatever he’s doing, pronto!
Nitrous/laughing gas: it’s always available for anyone who wants it. Nicest part, the patient breathes it off within minutes of leaving the dental chair, so that they can safely drive themselves back to work or home, without any residual effects.
Isolite dry field technology: A soft, comfortable plastic block that is attached to a gentle vacuum which illuminates and evacuates the oral cavity with light and suction, respectively. This technology eliminates any fear of cheek or tongue slipping into the operating field as the dental work occurs, and even helps to remove any fluid and debris that might be created during the procedure.
Air abrasion technology: Kinetic rather than mechanical energy; a sandblaster of sorts, on teeth. No whiny noise because there’s no drill; it’s simply tiny aluminum oxide particles under pressure removing small cavities from teeth. This technology is typically not felt at all, and local anesthetic is usually not needed. So, no shot, no numbness! Air abrasion is indicated for smaller virgin cavity situations, and it’s amazing stuff!
Electric handpieces: quieter than the normal hi-speed air driven drill (handpiece) that dentists usually use. It also has more torque, meaning that it can do it’s job faster too!
Local anesthesia: Dr. Nick’s secrets to comfortable local anesthesia: Secret #1: topical gels are rarely used properly in a dental practice. The area where the anesthetic infection will occur needs to be wiped completely dry and then the gel needs to actually sit there on the dry tissue for a good minute or more to be effective. Dr. Nick always does this… Secret #2: Part of the reason the “shot” stings at the dentist is due to the pH (acidity) of the local anesthetic drug. Typically dentists use anesthetics that contain epinephrine. The epi is present to constrict the blood vessels (which always travel with nerves, and we’re targeting nerves with the injection to stop the feeling of course) around where the anesthetic is injected, making it harder for the bloodstream to whisk away the anesthetic, so it will last longer. Problem is, the epi makes the pH even more acidic/drops the pH even further! Well, this low, acidic pH STINGS! There exists pH neutral local anesthetics that are much closer to body pH, so there’s less chance of a sting. These anesthetics are expensive, but Dr. Nick always uses them to help ensure patient comfort. Secret #3: there exists a computerized gadget known as “the Wand” that actually senses how much pressure the operator can comfortably use during the injection so that secret #4 is not violated. Secret #4: injecting slowly is critical. Pushing too quickly when the dentist is in a hurry actually tears the tissue a bit, and this trauma can hurt! Dr. Nick always takes his time with this critical step. A combination of the above four “secrets” are why Dr. Nick’s patients always brag how they’re simply not afraid of getting numb anymore!
Anti-anxiety meds as needed such as Xanax or valium: if it’s safe for the adult patient, we are happy to call it in for them before the appointment.
No temporaries for porcelain restorations: Almost all dentists take molds, place temporaries, and send off to a dental laboratory for porcelain restorations such as crowns. Dr. Nick rarely places temporaries or takes molds. This is huge, because more control is afforded with the digital imaging modalities at our disposal. More control means more predictable dental treatment outcomes. With our CEREC® CAD/CAM technology, the permanent porcelain crown, inlay, onlay or veneer is completed in our office, the same visit, while the patient is numb (for the first and last time for the given procedure). No return visits, no uncomfortable temporary, no bad tastes, no additional injections, no bite feeling off. Dr. Nick has been using the CEREC technology for over a decade and has created over 7,000 same day restorations with this amazing technology!
Dr. Nick Yiannios

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
Dr. Nick’s primary goal: to become the least intimidating, most informative, most trusted, and best dentist in NWA, and beyond-PERIOD!

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