BLUEPRINTING YOUR SMILE insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 –

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – Once we have collected the necessary information, we are then ready for your consultation. A discussion occurs of not only what the patient sees as being wrong with the smile, but also, with patients permission, the doctor also introduces some of the finer points of things the patient doesnt normally think about.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – Everything begins with the positions of the teeth, and whether they come together evenly, and flows forward from there. Rationale: if there are imperfections in the occlusion (the bite), and they are not removed before treatment has begun, those imperfections will be compounded, rather than eliminated prior to any planning for the smile makeover are commenced. We are one of a small group of offices nationally that use Tekscan to determine how the teeth come together. We actually watch a movie that shows us whether forces are normal. This movie shows that the molars on the right side are hitting too hard, and need adjustment

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – The records we take can include any, or all of the following: Digital Radiographs of the teeth Photographs of the teeth Plaster casts are made from impressions taken of the teeth A Facebow transfer is taken to allow the mounting of these plaster casts on a jaw-movement simulator called an Articulator Bite records are taken, including a TekScan analysis, which is a movie that shows how strongly the teeth hit one another, the objective being even bite force distribution on all teeth.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – The dentist then sends these records to the laboratory technician who then creates the desired changes, in wax, on a copy of the patients plaster casts, and then takes an impression of that in a material called Syltek.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – Typically, I request two of these per jaw, and use one of them to make the temporaries for the patient, but more importantly, to be able to deliver the desired results, the other is used as a Reduction Guide to insure that enough tooth reduction has been done to allow the lab sufficient thickness of porcelain to provide strong, esthetic restorations. Reduction Guide

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – This slide illustrates the subtle before and after changes achieved by using these guides. The photo on the top left is the before, and you can see how crooked the arches were, and in the after pictures, see how nicely the arches have been rounded out in the two bottom images. The indices take the guesswork out of preparing the case properly.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – After the patient has reviewed their wax up, and approved it, an appointment is scheduled to prepare the teeth for porcelain. The reduction guide is first used to insure adequate reduction, and then, once the final impression of the prepared teeth has been taken, the second Syltek index is lined with quick-setting tooth-colored plastic, and inserted in the mouth. About 90 seconds later, the index is removed, the plastic is now attached to the teeth, and the first set of temporaries is completed for patient trial. Illustrating the conversion of the existing teeth into a gorgeous set of temporary crowns

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – After reviewing how to maintain oral hygiene in the temporaries, the patient is dismissed and scheduled a week later for review of hygiene, and also to determine their satisfaction with the shape of the temporaries. If they are satisfied, they sign off on them, and the lab is instructed to begin the duplication of the laboratory wax-up into porcelain. Top left picture: existing, crooked smile Middle photo: temporaries made from lab wax up Bottom: Note how the shapes of the permanent crowns match the wax-up, with some slight changes that were given to the lab in the photo on the next slide

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – This is a picture sent to the lab with proposed changes.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – When the porcelain comes back from the lab, the patient is scheduled and one front temporary is removed, and a permanent one is tried in to insure that the laboratory has gotten the length of the permanent veneer or crown exactly correct. If correct, the remaining veneers and crowns are tried in, the patient is handed a mirror, and they must approve the esthetics before we will permanently cement these to the teeth.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – After permanently bonding them in, the bite is assessed, excess bonding cement is removed, and the patient is scheduled for a week later for fine tuning and portraits in our portrait studio. Fine tuning includes bite assessment, reshaping if necessary, scrupulous inspection to insure all cement is gone, and often, the fabrication of a nite guard to protect the porcelain from the unconscious forces exerted by those who grind their teeth in their sleep. This movie shows even force everywhere, except on the implants which are not supposed to absorb force early in the closure of the jaws

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – By following this strict protocol we can offer at 7 year warranty on our Edge crowns, and an unheard-of 15 year warranty on our Edge veneers. Be sure to inquire about getting a written copy of our warranty when you come in for your makeover!

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – There are many tools we use to communicate with the lab. On the top left, is The Ladder which enables us to communicate customization issues such as texture, edge design, microfracture, and perikamata. Using photography, extensively in our process from beginning to end enables us to achieve these great results you see on our website.

BLUEPRINTING YOUR SMILE – insuring cosmetic smile enhancement results Dr. Steve Markus – copyright 2012 – When would you like to get started?