Miller Vieira Paula, DDS

Using crowns and fillings to fix crooked teeth and bimaxillary protrusion without extractions is less common but can be considered in specific situations. Here's how these options might be applied:
1. Crowns for Crooked Teeth- Reshaping Teeth with Crowns: Crowns can be used to correct the appearance of mild crookedness by reshaping the visible portions of the teeth. This involves:- Preparing the teeth by reducing their size. -Placing custom-made crowns to create the illusion of straight and aligned teeth.- Limitations: - This approach is primarily cosmetic and doesn't address underlying misalignment issues. - It works best for minor cases where the crookedness is not severe. - It may require significant tooth structure reduction, which can weaken the teeth over time.
2. Fillings for Crooked TeethCosmetic Bonding: - Tooth-colored filling material (composite resin) can be used to reshape or add volume to teeth to make them appear straighter or more aligned. - Advantages: Less invasive than crowns, as minimal tooth preparation is required. Can provide a quick aesthetic solution.- Limitations: This is a purely cosmetic fix and doesn’t actually align the teeth or adjust the bite. Composite materials are less durable than crowns and may require frequent maintenance.
3. Bimaxillary ProtrusionIf the protrusion is primarily due to the teeth (rather than jaw structure), crowns or cosmetic veneers can reduce the bulk of the teeth and make them appear less protruded.For filling materials, reshaping or contouring teeth may help slightly reduce their forward projection.
4. Combination ApproachIn some cases, orthodontic pre-treatment (like braces or aligners) is done first to partially align teeth and reduce protrusion, followed by crowns or fillings to perfect the shape and aesthetics of the teeth. - Key Considerations: Crowns and fillings are cosmetic fixes and don't correct the functional or skeletal issues of crooked teeth or bimaxillary protrusion. They work best in mild cases or when the patient seeks an aesthetic improvement rather than complete functional alignment. If there’s an underlying bite or jaw issue, orthodontic treatment is the preferred solution.
Consultation with a dentist or orthodontist is crucial to assess the suitability of these methods for your case. They may recommend a combined approach to achieve the best results without extractions.
Dr. Miller Vieira

Thank you for providing the information and the X-ray image. Based on your description and the image, it sounds like you’re dealing with a cracked tooth (#12) with a compromised filling. Let me address your questions in detail:

1. Is crowning the tooth the best course to avoid future issues?

• Yes, placing a crown is generally the best solution for a tooth with cracks and damaged fillings, as it provides structural reinforcement and prevents the crack from worsening. Your dentist’s plan to avoid unnecessary tooth structure removal (no flattening or reduction) and opting for a crown without a root canal (if the nerve is healthy) aligns with modern conservative dental principles.

2. Using a temporary crown first:

• The use of a temporary crown allows for observation of the tooth’s response. If you experience no pain or sensitivity during the two-week period, it indicates the nerve is healthy, and a root canal is likely unnecessary. This step is prudent, especially given your dental anxiety, as it minimizes the risk of post-treatment complications.

3. Dental mesh to protect the tooth:

• Using mesh (likely referring to a fiber-reinforced material or matrix) is a good choice to stabilize the remaining tooth structure while preparing for the crown. This technique helps preserve as much of the natural tooth as possible, reducing the chances of further cracking or failure.

4. Pain with air or pressure:

• The severe pain with air or cleaning suggests the crack has exposed the dentin or is near the pulp (nerve chamber). Crowning the tooth will seal and protect it from external stimuli, alleviating sensitivity.

Recommendations:

• Follow Your Dentist’s Plan: Your dentist’s approach appears well thought out and minimally invasive, prioritizing preservation and avoiding unnecessary procedures.
• Manage Dental Anxiety: Consider discussing sedation options (e.g., nitrous oxide or oral sedation) to keep you comfortable during the procedure.
• Monitor Symptoms: If you develop lingering pain (spontaneous or constant), discuss the possibility of pulp testing or further diagnostics to rule out the need for a root canal.

You’re taking the right steps to address this issue. Ensuring proper communication with your dentist and following their guidance will help achieve a successful outcome with minimal stress.

The choice of a lip injector depends much more on experience, skill, and specialization than on ethnicity. Let me address your concerns in detail:

Does the injector's ethnicity matter?

No, ethnicity itself does not inherently affect the outcome of your procedure. What truly matters is:

-Expertise and Skill: The injector's knowledge of anatomy, technical ability, and experience with lip fillers.
-Aesthetic Sense: Their ability to understand and achieve the specific look you desire, regardless of their ethnicity.
-Specialization: Some injectors specialize in creating natural-looking lips, while others excel at dramatic, full-volume results. Choose someone whose work aligns with your aesthetic goals.

Why do some people suggest matching ethnicity?

Your friend might have suggested this because individuals of similar backgrounds may share common facial features, skin types, or beauty standards. However:

-A skilled injector, regardless of their ethnicity, can work with a wide variety of facial structures and features.
-Communication about your aesthetic preferences is far more important than ethnicity. Be specific and clear about what you want.

I’m sorry to hear about the challenges you’ve been facing. Chronic pain can be incredibly frustrating, especially when diagnostic tests don’t provide clear answers. Let’s carefully assess your situation.

Could Invisalign or teeth shifting cause these issues?
Yes, it is possible. While Invisalign is generally considered safe, the alignment of teeth can influence the jaw (temporomandibular joint or TMJ) and surrounding structures, including the neck and shoulders.
Misalignment or changes in bite during or after orthodontic treatment can lead to TMJ dysfunction, which might cause:

-Headaches
-Dizziness (sometimes related to TMJ or cervical spine tension)
-Neck and shoulder pain
-Numbness or tingling (potentially from muscle tension irritating nearby nerves)

The jaw and cervical spine are biomechanically connected, meaning shifts in one can influence the other. Invisalign moves teeth gradually, and some individuals may experience unintended strain or tension in the TMJ or surrounding muscles, which can radiate to the neck and shoulders.

What should you do now?
Here’s a structured approach to addressing your pain:

-Consult a TMJ Specialist:
A dentist or oral maxillofacial specialist with expertise in TMJ disorders can evaluate your jaw alignment and determine if your symptoms are related to bite changes. They may recommend a bite adjustment, splint therapy, or other interventions.

-Physical Therapy:
Seek out a physical therapist experienced in treating TMJ disorders and cervical spine issues. They can assess whether muscle tension or postural changes contribute to your symptoms and design a tailored program to relieve pain.

-Postural Assessment:
Orthodontic changes can sometimes alter posture. Poor posture (especially forward head posture) can exacerbate neck and shoulder pain. A physical therapist or chiropractor can help identify and correct any postural imbalances.

-Neurological Assessment:
Although your nerve testing has been clear, consider a second opinion if symptoms persist. Rarely, nerve compression or irritation from cervical spine issues (like herniated discs) can cause referred pain and numbness.

-Stress Management:
Chronic pain can lead to tension and exacerbate symptoms. Consider relaxation techniques, such as mindfulness, yoga, or biofeedback, to reduce stress on the muscles of your neck and jaw.

-Orthodontic Review:
Discuss your symptoms with the orthodontist who oversaw your Invisalign treatment. They may identify if bite alignment issues remain or if further adjustments are necessary.

Dr. Miller Vieira Paula

Botox can be a helpful tool in reducing the appearance of an enlarged temporalis muscle, but it may not be the most ideal long-term solution, especially if you are seeking a significant and lasting reduction in muscle size and a substantial improvement in facial contour.

Here are the key considerations based on your situation:

Effectiveness of Botox on the Temporalis Muscle

1.- Mechanism: Botox works by temporarily paralyzing the muscle, reducing its activity, which can lead to a decrease in muscle bulk over time. This effect is commonly used in cases of masseter hypertrophy to slim the lower face.
2.- Temporalis Muscle: Like the masseter, the temporalis muscle can respond to Botox, but the change might be less noticeable because it is not as prominent or superficial as the masseter. Results may vary depending on the degree of hypertrophy and other contributing factors.

Limitations of Botox for Long-Term Solutions

1.- Temporary Results: Botox effects typically last 3–6 months. For sustained results, regular treatments are required, which can become costly and time-consuming.
2.- Diminishing Returns: While Botox may reduce muscle bulk with repeated treatments, the degree of improvement can plateau over time. For significant soft tissue changes, Botox might not be sufficient.
3.- No Direct Effect on Eye Spacing: Botox won’t physically alter your interpupillary distance or bone structure. The perceived improvement would come from soft tissue slimming, which may create the illusion of improved proportions.

Dr. Miller Vieira Paula