Nicholas Wangler, DDS

Thank you for you question,

First, the results you see from Botox are somewhat dependent the current size of you masseter muscles. If you have large masseters from grinding you teeth, you may see more of a decrease in their size. It will often take more than one treatment to see a reduction in size, as the muscles atrophy from lack of use. Secondly, after the Botox wears off and if you are still over using your masseters you will see them return to a large size. 

Thank you for submitting this question. 

I have been asked this by my patients. The use of BOTOX or other neuromodulators are not contraindicated during your period. The injections could feel slightly more painful, but my patients have not noticed a difference in the minimal discomfort that occurs with the injection. Injection technique will probably be a bigger factor in the amount of discomfort felt. 

While it is recommended to see your dentist on a regular schedule, it is even more important to continue seeing your dentist before a joint replacement. The bump above the implants should be evaluated by a dentist, be it the one who placed the implants, the one who placed the crowns or another new dentist of your choice. The dentist you see will determine if you need a pre-med for your appointment. 

Bone grafting at the time of extraction is a much simpler and often a less expensive procedure than trying to gain bone at a later date. On the other side, is the cost of the graft. Implants for tooth #2 can be difficult to restore and many patients do just fine without tooth #2. The decision is yours. I sure you will make the right choice. 

You can anything after whitening. You may want to stay away from foods like red wine, coffee and tea which will stain your teeth again. You may also want to avoid very cold foods, as your teeth may be sensitive to cold foods after a whitening treatment. 

A 'Snap On Smile' is a cosmetic treatment. If your only concern is you want a wider smile, then yes a 'Snap On Smile' can help. One must remember that usually it is not functional, meaning you can wear it to obtain a different look with you teeth, but it is not strong enough for eating. They are not a definitive treatment, but a good way of knowing what one's smile could look like with braces and/or veneers.  

Depending on the type of temporary material used, they may need to thrown away or they may be given back to the patient. If they are given back to you make sure to save them. Sometimes they can be used temporarily again if your All-On-4 breaks and needs repair.

There is no right answer. Putting in an implant is a great way to give you more teeth to eat with. On the other hand, one can definitely live without that tooth. Studies would show that loosing just #18 would decrease you chewing capacity by 5%. Secondly replacing a second molar with an implant can be a difficult procedure for the surgeon and restoring dentist, as there may not be enough room for the implant or the instruments used to place it. Whatever decision you make, it will be the right one. Dr. Nick 

Your teeth look great. There will always be some rebound after any whitening, as Zoom will dehydrate you teeth and you will look the most white after you leave. Secondly the food you eat can affect the results, for example drinking red wine or coffee right after is not recommended. You can do another Zoom! in the future, your teeth should be just fine. 

Unfortunately not every procedure turns out exactly as the patient expected. The dentist's job is not only drilling on you teeth but it includes evaluating the cosmetic needs of each patient. While your front teeth don't look horrible they could look better. Make sure the dentist is using a high quality laboratory that does cosmetic dental work, I am sure your smile will look great again.