Julio Rodriguez, DDS

There are a few reasons why the "mock up smile" may not be an exact replica of the final veneers.  The teeth have been prepared on the model but not in your mouth so they are definitely going to feel a little fat.  The material used to make the mock up is nice but it's not as nice as the ceramic of the final product.  On your natural dentition, I feel like the two central incisors stick out a bit too much so I don't think there's any way around preparing those teeth.  An alternative, which will certainly add some time and cost to the procedure, is doing some orthodontics (Invisalign or traditional) to align the teeth before placing veneers. Results are really nice this way and the preparations on the teeth are kept to a minimum.  Don't feel bad if you don't want to go through all that, you are not alone. You can still get a nice result by just going straight to veneers.  Picture your anticipated final result looking like it does in the mockup but just a bit thinner and set back a bit.  If that is OK with you then I think it's totally achievable and you're going to look great with your new smile.  By all means have this conversation with your doctor.  If he is going through the effort of making a diagnostic waxup doing a "mock up smile" for you and working with a good lab like DaVinci then this sounds to me like somebody who takes a lot of pride in his or her work.  Tell them everything that's on your mind so there are no surprises at the final visit.  I sometimes modify my diagnostic waxup a few times before I ever touch the teeth so it is not an odd request.  Think of this as getting the blueprints correct before starting on the house.  Enjoy that great smile!

By now you should be enjoying the results of the Juvederm as it settles in.  The Vampire Facial does a really beautiful job on the surface of the skin to give it a smooth, glossy look and feel.  We often perform both the Vampire Facial+Dermal Filler at the same time in what's referred to as the Vampire Facelift so yes they are safe to do together or in your case a week apart.  Hopefully it's the same doctor that did the dermal filler but if it's not then just let him know you had the filler done a week ago.  If it were me, I would do the micro-needling with the PRP and avoid injecting the sites that were recently treated with Juvederm, especially if you already had a satisfactory correction from the Juvederm.  I would be absolutely OK to inject PRP into areas that did not receive the Juvederm.  No hard rules on this, I tend to be a little more conservative so take my advice with that in mind.  Hope this helps.  

It's nice when you can treat 3 conditions with one treatment modality.  Botox will slim the hypertrophic masseter muscle, it will improve the tension in the muscle and help with lateral grinding type bruxism.  I say it like that because the masseter muscle seldom acts alone.  There is another gigantic and super strong muscle that is more likely the one causing the headaches and the severe clenching.  That is the temporalis muscle.  Make sure that your doctor palpates the temporalis muscle as well as the masseter and treats it accordingly.  If not, you may get slimming of the muscle but the headaches will persevere as will the clenching.  As far as units are concerned, I make a determination  once I palpate the muscles so I would go by the recommendation of your doctor.  In the meantime if you are chewing a lot of gum you may want to swap out for mints as gum gives those muscles thousands of reps at a time and contributes to the hypertrophy.  A little bit of gum in moderation is OK.  I hope you give this a try, we have been treating these since 2004 and done correctly you will be looking and felling great in no time.  Good Luck.  Hope this helps.

Hello.  Thanks for your question.  I feel like you may look into the cause for the premature failure of your crowns.  Generally speaking implant crowns are very robust and should give you years of trouble free service.  The first thing I would look at is: Is this a short crown due to not enough space from the implant to opposing tooth on the bottom or a collapsed bite?  If so this ones easy.  Instead of a cement-retained crown go to a screw-retained crown which screws onto the implant instead of cement.  It's also better for the implant health than cement.  If finances are tight you could also make a screw retained temporary crown for much less money.  (This would be a great space maintainer until you can place a permanent crown.) The second question I would ask is: Are you clenching or grinding? As strong as our biomaterials are they are no match for clenching or grinding.  Agree with the doctor who stated that a nightguard is a must.  If you cannot tolerate a nightguard then consider botox injections to the temporalis and masseter muscles to attenuate the force of contraction during bruxism episodes.  Hope this was helpful.  Good Luck.

Hi.  Thanks for your question.  The thing that makes this tricky is that the bony defect looks to include the back wall (lingual) of the jaw so it makes it hard to get anything to stay in place.  That's not to say that it can't be done.  There are more advanced grafting techniques than just particulate grafting.  Ask your dentist  about 1. grafting with PRP or PRGF, 2. the technique of guided bone and tissue regeneration with barrier membranes and 3. possibly block grafting.  The thing is that you have to remove the tooth and you might as well do some kind of grafting because as the other doctor stated you really need to start thinking about those neighboring teeth and a graft could possibly help those teeth.  Also don't rule out the possibility of re-entering the site a second time after the first one heals and re-grafting.  It's definitely a challenging situation but certainly possible.  Good Luck.  Hope this was helpful