emergency dentist nyc (9)

 

Achieving a beautiful smile is more than a dream for some people. For some people they have the perfect smile already and it only requires minimal effort and 6 monthly trips to the dentist. For others it may require extensive cosmetic procedures such as periodontal work, dental crowns, dental implants, porcelain veneers, root canal treatments or more. There is a process in dentistry known as full mouth reconstruction and it is a process of rebuilding a patients teeth using a number of cosmetic procedures. Full mouth reconstruction can cost anywhere from $15 to $20,000 up to $80,000 or even $100,000. The search for a cosmetic dentist begins with a look on the internet to understand what procedures you might need.

 

Secondly you would visit a dentist, one that you were recommended to go to or one that you found by yourself. Once you have discussed the procedures that you may need or would like to have ( you may want to see two or three dentists so that you can get a consensus opinion) then you go with who your heart tells you to go with, taking into account their previous work that you have seen, their understanding of what you would like to achieve and the price that you can afford and what seems most sensible. Make sure the dentist does wax-ups or is able to show you how your smile looks on the computer program he is using. Get a feeling for the staff. Are they able to answer all your questions? Make sure that you ask them have they attended lots of courses for the work that they are about to perform and have a look at their previous work. Is the location convenient to your home or work? Ask the dentist how long he thinks the treatment will take? Lastly check their reputation online.

Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

M. Marc Liechtung, DMD also owns a practice in New Rochelle NY called New Rochelle Dental Arts. The practice in New Rochelle offers emergency dentistry, dental cleanings, dental crowns, root canal treatments, dental implants, invisalign, porcelain veneers, full mouth reconstruction, cosmetic dentistry and we have an in-house periodontist and a pediatric dentist at our New Rochelle dental office.

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Life Changing Acronyms:SOS and DSO

 
 
 

For people interested in inventions, or creating technology or software, or starting a company — inventions sometimes sit ‘right under our nose’, and we don’t even know it. M. Marc Liechtung, DDS

It was a spring day in 2008 when I received a call from my father that would forever change my life both professionally and personally. Unsuspecting of anything unusual, I answered only to hear him frantic.

“Could you please head over to your grandmother’s nursing home, her partial was thrown into the incinerator by her roommate who suffers from dementia. Your grandmother is exponentially upset, she has a myriad events to attend and she’s in hysterics over this. Could you please head over there and see if you can do something”?

“Dad, it takes weeks to have another partial made“ I replied, insistent my father asked me again to head over and see what her options were.

Determined to fix this problem I had my head assistant Sylvia — who has been with Manhattan Dental Arts for 28 years, pack me a hand engine, acrylic, impression material, composite and I made his way over to her nursing home in Williamsburg, Brooklyn where I then proceeded to hand craft her a temporary. After a grueling 9 hours I had accomplished my goal and my grandmother was ecstatic.

Nonetheless, the work didn’t stop in Williamsburg. On my drive home my brain was working a mile a minute. Seeing how overjoyed the instantaneity of the hand-crafted temporary made my grandmother, I knew he there had to be a way to gauge the same reaction from people in similar situations. Thus, the idea for the Snap On Smile ® emerged and the search for the perfect material began.

The ideal material was a material that possessed the following properties:

· flexible enough to snap on over existing teeth to secure retention,

· come in various shades or colors

· did not stain

· did not get soft or imbibed with liquids thus enhancing the longevity

· removable by the patient and could appeal as a completely non-invasive appliance which meant no drill or preparations and would not need cement or bonding agents.

Once I found the perfect material — crystalized resin acetyl, the Snap On Smile ® was born and there was no turning back.

From hereon my life exponentially changed, both professionally and personally and this was one of the most exciting aspects of my career. Everyone wanted to know about the Snap On Smile ®; I was asked to speak on several TV shows, such as, The View, CBS Early Show, The Couch and CNN Headline News, just to name a few. Through the Snap On Smile I was able to travel the world and lecture about the Snap On Smile to various dentists and to large groups of practice decision makers and having met a a multitude of influential people along the way.

My career would undergo another metamorphosis when I sold Snap On Smile ® to DenMat (Lumineer) and signed a 2 year contact to lecture for the company around the world. While traveling proved to be enjoyable it was hard to leave behind my family and so I made the decision to focus on my private practice in New York. With the combination of an excellent team and superb teamwork, the practice grew into a multi-million dollar one allowing me the confidence to open 4 more practices that all provided out-of-this-world customer care and quality and outstanding service.

After careful consideration, I decided to sell my practice to a large private-equity-backed Dental Service Organization (DSO) in order to be able to grow the 4 practices I had freshly acquired. As with everything in life, there are positives and negatives associated with selling your practice to a DSO. Positively speaking, the advantages are as follows:

· A DSO tends to price practices slightly higher than the traditional doctor to doctor purchase.

· There is no need for a mortgage contingency which is the status quo in a conventional transaction.

· The selling doctor is able to stay and practice with his original staff which is actually getting more to your practice than the original pay day

· Many things, such as, malpractice insurance bonuses for production and other perks can and should be negotiated with the corporate buyers

· If the doctor owns the real estate, as well as, the practice then this is another added perk upon selling to a corporate entity. The doctor has the chance to have a very strong and every financially stronger opportunity as opposed to a conventional doctor to doctor transaction.

While this sounds nothing short of a positive experience there are also negatives associated with selling to a corporate entity as a dentist. Below are a few reasons why selling to a corporate entity might be negative:

· From a legal perspective, legal fees and the size of the purchase agreement will be so much more arduous than a standard deal. The doctor who is selling will find that they will acquire higher legal fees than any other type of transaction

· Pre-close is a very critical time period for the seller. The DSO or corporate entity will scrutinize the TTY or the Trailing Twelve Months of Revenue. If a doctor does not maintain the numbers between agreement and close, they will recall the deal or conversely, they will change (lower) the purchase price. This is never in favor of the seller.

· Selling to a corporate entity can create several issues post close as well. Large groups tend to impose their own supply orders. This means they will expect the doctor and staff to use different materials and they almost always try and use a less expensive lab. This can create a problem for the selling doctor who has established long term relationships with particular labs, as well as, their sales rep from various vendors. Several things can and should be negotiated prior to the closing

· Another negative that can arise is concerning staff. Although it will like a honeymoon at the beginning, after a period of time the DSO will turn on particular staff members. The fact is that these are long standing staff members that have become family throughout the years. To the corporation it’s a large salary that can be replaced. We as clinicians will have no say whether this happens or not.

In an ironic turn of events, I was approached by the same DSO that I sold my practice to with the offer to buy it back. The corporation was not experienced with running a practice as big as Manhattan Dental Arts and in as diverse a location as the Upper West Side. Once again, I found himself in a position in which the offer was too good to refuse. I bought Manhattan Dental Arts back and have been practicing at the office since August 2018. Although I originally embarked on an entirely different journey I am wholeheartedly excited to continue seeing all of my long-standing patients along with his new patients.

Selling to a DSO or corporate entity is a decision that must be made after much thought and consideration, there are both positives and negatives associated with selling to a corporate entity and it is important to weigh both against each other, but one thing I can say with certainty is that SOS (Snap-On-Smile) and DSO have ultimately been two life-changing acronyms for me.

Manhattan Dental Arts is located on the upper west side of Manhattan. I am available to any young aspiring dentists looking for advice. I am  the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

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If coffee, cigarettes, red wine and food have left their mark on your teeth, you’re not alone.  The rule of thumb is anything that can stain a white T-shirt can stain your teeth too, that what we tell all our patients. 

That does not mean you have to give up your morning cup of coffee or your evening glass of red wine, if your teeth are discoloring, you might want to consider consuming less and thoroughly rinsing your mouth with water after you’re done eating or drinking. 

Dr. Liechtung’s dirty dozen foods that stain your teeth include:

1. Black Coffee and Black Tea—The darker the beverage, the more staining that can occur. So try adding a little extra milk to lighten the color and reduce the staining effect.

2. Wine—Both red and white wines, if taken in excess, will stain your teeth.   Although red stains, white wine’s acidic composition actually etches tiny grooves in your teeth, making them more porous and more easily stained.

3. Colas and Sports Drinks—Because they are so highly acidic, they help promote staining by other foods.

 

4. Berries– Blueberries, raspberries, cranberries, cherries and other berries, although excellent for your overall health, can stain your teeth. So, if you’re crazy for berries, be sure to rinse out your mouth thoroughly with water after each indulgence.

5. Sauces—Soy sauce and tomato sauce, as well as other deeply colored sauces, are believed to have significant staining potential.

6. Juice—Grape, pomegranate and cranberry are highly pigmented and can cause staining.  So, if you must imbibe, try rinsing your mouth out with water or drinking juices through a straw, thereby bypassing the fronts of your teeth.

7. Pickles and ketchup—These acidic foods are good at opening up the pores of your tooth enamel allowing for easy staining.

8. Balsamic Vinegar—While great on a salad, it can cause havoc to your teeth.  If you must, try it on lettuce, which has a natural ability to provide a protective film over your teeth.

 

9. Candy–Sweets contain teeth-staining coloring agents. If your tongue turns a funny color, there’s a good chance that your teeth will too.

10. Beets—Now here’s a vegetable that could put a powerful stain in your t-shirt, so, like all foods that stain, moderation is called for with this one.

11. Curry—Although great on Indian food, this yellow-staining food flavoring can be harsh on teeth. So make sure to rinse thoroughly after indulging.

12. Popsicles—Did you ever look at your tongue after you’ve finished your fruity, sugary pop? Not only does it color your tongue, but also your teeth. Plus, it has an added double whammy negative effect because of all of that sugar.

But, did you know that Mother Nature has some natural solutions to whitening your pearly whites?  Here is Dr. Liechtung’s list of tooth-whitening foods:

12 Tooth Whitening Foods

1. Apples, pears and guavas increase salivary production which flushes away stains over time.

2. Cauliflower and cucumbers also help to increase salivary production, the natural way to flush away stains.

 

3. Cheese is rich in protein, calcium and phosphorus, all of which can help safeguard  against the acids in your mouth.

4. Sesame seeds help scrub away plaque. (Read more reasons to love sesame seeds.)

5. Salmon provides calcium and vitamin D, nutrients needed for healthy bones and teeth.

6. Shiitake mushrooms help inhibit bacteria from growing in your mouth.

7. Onions help reduce bacteria that cause tooth decay.

8. Pineapple acts as a natural stain remover.

 

9. Green vegetables like broccoli, lettuce and spinach contains iron which helps form an acid-resistant film or barrier that can help scrub away stubborn stains and protect the enamel on your teeth.

10. Ginger acts as an anti-inflammatory to support healthy mouth tissue.

11. Carrots contain vitamin A, which is needed for healthy tooth enamel.

12. Basil is a natural antibiotic that reduces bacteria in the mouth.

Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

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As an emergency dentist in Queens and and emergency dentist in NYC I have basically seen it all. Canker sores, broken teeth, chipped teeth, lost teeth. Here is some advice for those that may experience a dental emergency. 

Often I receive frequent complaints about canker sores. I suggest  that people with frequent canker sores check to see if their toothpaste contains sodium lauryl sulfate, or SLS. SLS is a foaming agent that in some studies has been linked to the development of canker sores. Toothpaste that doesn't contain SLS usually makes a big deal about it by saying 'SLS free' on its label.  An additional remedy for both canker sores and gum pain is tea tree oil. Tea tree oil should be applied directly to the infected site and can even be purchased in mouthwash form to soothe inflammation. Another preventive measure for canker sores is to avoid eating chips and other jagged foods that can cause tiny cuts and scrapes, which can be an entryway for a virus to set up shop in your mouth. Besides that, stay away from foods that trigger canker sores. Potential troublemakers include whole wheat, rye, barley, shellfish, pineapple, chocolate and tomatoes, as well as salty or citrus fruits. There is a remedy of 1/3 Mylanta, 1/3 Benedryl, and1/3 viscous Lidocaine. This will ease the discomfort of canker soars.


It should be further noted that about 80 percent of our population deals with gum problems - from gingivitis all the way up to losing teeth. Ginseng can be used to alleviate the pain associated with irritated gum tissue. A ginseng tonic can be directly applied to the gum to promote circulation and speed healing. An additional home remedy suggestion is to use a wet tea bag for tooth or gum pain. Tea contains astringent tannins, which have the power to shrink swollen tissue and stop bleeding. No toothache will heal on its own. A toothache is a dental problem that needs to be treated as soon as possible.

What should you do if you've knocked out a tooth - whether from a blow, a fall or accident?

Shake off debris (rinsing or scrubbing could remove important periodontal ligament), place it in a container of milk or back in its socket and try to reach the dentist within 30 minutes. Unfortunately, not all teeth can be saved. Alternative methods, such as a bridge or implants, may need to be considered.

What should you do if you've broken a tooth?

Again, if you've lost the broken piece, just get to the dentist. If you have it, gently shake off surface dirt and definitely keep it. Even if the piece can't be bonded back to the original tooth, it can be used to help re-create the look of that tooth.

If something (food, other foreign matter) is wedged between your teeth, should you try to dislodge it?

Gentle flossing or brushing is fine, but if the object does not respond to that treatment and the surrounding gum begins to swell, make an appointment with your dentist. A bit of broken filling or chipped enamel can throw your bite off and make you panic. Popcorn husks are one of the worst problems and occasionally need to be removed by a dentist.

What should you do if you lose a filling or crown?

If you lose a filling, it's not worth saving. However, just cover the hole with temporary material, do not try to put the old filling back in the tooth. If you lose a crown, you'll want to try and salvage it (you can use Temparin or Dentemp, available in pharmacies, to put the crown back in place until you can reach a dentist). In either case, visit the dentist as soon as possible. Many people don't realize that when a filling falls out, there's a reason for that, whether it's a cracked tooth or more severe. You need to see a dentist.

ABOUT DR. LIECHTUNG:

Dr. Marc Liechtung, D.M.D. and inventor of Snap-On Smile, graduated from The University of Pennsylvania, one of the most world-renowned dental schools, as well as having the best fellowship programs in the country. After graduation, he attended an Advanced Restorative and Implant fellowship at The University of Pennsylvania, and graduated from that fellowship in 1987. Dr. Marc Liechtung has had his prestigious dental practice for over 18 years, and is dedicated to each of his patients’ dental needs. Dr. Marc Liechtung believes in treating each of his patients on an individual basis, because needs and treatment differ from person to person. Dr. Liechtung is a member of the following professional organizations: New York City Dental Society, American Dental Association, Academy of Cosmetic Dentistry, Mid-Manhattan Advanced Dental Study Club and has recently been Elected to a Fellowship in the International Academy for Dental Facial Esthetics.Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

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With implants being the fastest growing restorative procedure we have in dentistry, a number of hurdles have presented themselves that we must address to avoid certain pitfalls. The hurdle that will be addressed in this article is the issue of the healing site, post-extraction, and how this plays a crucial role in the aesthetic outcome for implant crowns placed by the restorative dentist. Prefabricated multipurpose restorative appliances (such as Snap-On Smile [DenMat]) (Figure 1) when used properly for implant cases, in both postextraction as well as postimplant placement, can help the clinician prevent the aesthetic failure known as the “black triangle” (Figure 2).

BACKGROUND
The many difficulties associated with implant placement, especially in the anterior region, can cause many cases to fall short of both patient and doctor expectations. The issues that arise can be avoided, but we first must know what we are avoiding:

  • Postsurgical recession in the area after extractions can result in longer and unaesthetic teeth due to this receded zone.
  • The use of a flipper (acrylic denture) can retard the papilla formation and the black triangle can result after inserting the final crown.
  • The length of time a patient may need to wear an interim appliance can cause increasing stress on the treatment of the case. Flippers or unsightly temporary appliances can cause increasing patient anxiety. They are also extremely uncomfortable.
  • Aesthetic preview can result in a more comfortable and confident patient that will result in a smooth outcome. Managing the patient is as important as managing the gingival health.
  • Using an appliance that can preview the final result is immeasurably important; along with size of teeth, mesiodistally, as well as emergence profile are all extremely important to create a fantastic outcome. Producing an ideal emergence profile with the provisional restoration is critically important. This is because it gives the clinician a road map for the final outcome.The pontic area and the papillae are kept stable and vibrant by the provisional appliance, resulting in a successful and aesthetic final prosthesis.

The previous list of concerns can be negated and minimized with the use of the multipurpose restorative appliance known as Snap-On Smile. When the periodontist and restorative dentist are knowledgeable in the proper use of this provisional appliance, a restorative case that requires extraction, bone grafting, and implant placement can result in a more aesthetic and pleasing final restoration.

The purpose of this article is to educate clinicians on how to fabricate, insert, and adjust (when needed) this class of provisional appliances.

CASE REPORT
Diagnosis and Treatment Planning

A 60-year-old male patient presented in need of periodontal treatment (Figure 3). Intraoral radiographs showed extensive bone loss in several teeth, both upper and lower arches (Figure 4). The teeth had 2+ mobility with extensive bone loss, deeming them hopeless. The patient’s medical condition was uneventful and was not deemed to be a hindrance in any of the planned dental treatment.

After several treatment planning sessions, it was determined that the patient’s main goal was to save as many teeth as possible. He also wanted to have the ability to function throughout the course of his treatment.

A decision was made between the periodontist and restorative dentist to extract several anterior teeth. These extractions would be accompanied with bone grafts and a provisional appliance that would be used to allow for proper healing. This temporary would be worn a total of almost a full year through the healing phase of the extraction sites, and then during healing after the implants were placed.

Being sensitive to the patient’s desires, we chose to utilize the Snap-On Smile implant provisional appliance. This provisional would be aesthetic and comfortable, allowing the patient to continue to function with confidence. The appliance will not only create the gingival pontic formation, but it will also allow the papillae to maintain its health throughout the entire treatment. A very important aspect to keep in mind when working with an acetyl resin-fabricated appliance is that it is much easier to remove than to add to the appliance. So, if we are not sure that it should extend 2.0 mm or a bit longer, it is best to have a little extra length (3.0 mm, for example) and then to remove some if necessary. Also, be aware that, after adjustment using the Snap-On Smile bur kit, the appliance is easily polished to the same comfort and texture that the appliance was originally received from the laboratory.

After the appliance was received, an appointment was scheduled with the periodontist to remove several teeth (Figure 5). Although it is not within the scope of this article to elaborate and describe the surgical technique performed by the periodontist, it is essential to know that the Snap-On Smile is inserted immediately after postsurgical extraction and graft placement is carried out. This immediate insertion allows for the tissue to start healing around the polished resin pontic from the onset of the primary healing. This procedure turned out to be a huge success on many levels (Figure 6).

After insertion of the Snap-On Smile provisional appliance, the patient was very satisfied with the aesthetics of the appliance. This is essential on so many levels, as was discussed earlier. It also established proper pontic formation with the preservation of the papillae, which is very important to the aesthetic outcome of this entire treatment plan.

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Figure 1. Snap-On Smile Appliance (DenMat).Figure 2. The dreaded aesthetic nightmare known as the black triangle.
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Figure 3. A 60-year-old male patient; visually healthy teeth, but the radiographs show otherwise.Figure 4. Extensive bone loss and generalized periodontal disease causing need for extraction.
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Figure 5. Postsurgical extractions and bone graft placement.Figure 6. Facial view of the immediate insertion, after extractions of multiple teeth due to extensive periodontal disease.

A Review of the Clinical Protocol
After the patient accepted treatment, but prior to any treatment at all, impressions were taken to create the upper and lower Snap-On Smile appliances.

A stock tray can be used for both arches. First, the trays were tried-in to make sure they each incorporated the entire dentition in the arch. The impression must envelop the buccal and lingual aspects when inserted into the mouth. After the selection of trays was completed, the impression was then taken using heavy-light body impression technique with 2 vinyl polysiloxane (VPS) materials (SPLASH! [DenMat]; PRECISION [DenMat]). An accurate technique must be employed in order to capture all the anatomic intricacies of the teeth. In this case, the initial step was carried out by placing SPLASH! into the stock tray to create a “custom” tray (Figure 7). After this step, the internal aspect of the tooth compartments of the impression was reemed out slightly (Figure 8) to allow room for the light body material (PRECISION) to be syringed into the “custom” tray that we had created and reseated. This technique allows for an exact impression of the existing dentition that allow the proper fabrication of the Snap-On Smile appliance. The better the impression, the better fit of the appliance! (Figure 9).

After the impressions were completed, a proper bite registration was taken. This is also vital to the success of the procedure for many reasons. A proper bite allows for excellent patient comfort and oral health, especially with an aesthetic appliance that is to replace multiple missing anterior teeth and needs to be worn for an extended period of time. It is optimal to use a rigid and accurate VPS bite registration material (such as MegaBite [DenMat]) to accomplish this important task. After the bite was taken, the clinical aspect of fabricating a Snap-On Smile appliance was complete.

The next phase, the selection of shade and shape, must also incorporate the patient’s opinion. In this particular case, this was an easy step because the patient was 60 years old and he did not want teeth that looked fake and/or too white. The shade A1 was selected to look healthy yet more genuine than a bleaching shade. The manufacturer has a designated shade guide for Snap-On Smile, so we can show our patient the exact shade in which this acetyl resin appliance will be fabricated.

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Figure 7. Using a heavy body material with a stock tray, we start the initial process for making the provisional appliance.Figure 8. Creating a “custom” tray using the heavy body to accomplish the task.
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Figure 9. Using light body to gain the nuances of the arch. This enables us to fabricate a perfect-fitting Snap-On Smile.Figure 10. Pontic tissue surface is usually extended 2 to 5 mm into the extraction site, depending on the case.
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Figure 11. Patient presented one week postoperatively with the Snap-On Smile implant provisional appliance in the mouth.Figure 12. Tissue shown in the healing phase, at one week postoperatively. Note that the tissue and the papillae were looking healthy.

In this particular case, as in all cases where we are extracting teeth and using the appliance as an immediate removable partial appliance, we must indicate on the laboratory prescription form which teeth we are extracting as well as how long we want the pontic to extend into the newly created socket. In most of these cases, it is standard procedure to extend the pontic 2 to 3 mm into the socket (Figure 10). This is dependent on the amount of periodontal disease, because this would add to the postsurgical recession of the extraction site. In this particular case, there was extensive disease so we actually asked for almost 4 mm of pontic extension into the surgical site.

The most obvious way to view success of the surgical visit and immediate insertion of the Snap-On Smile is in observing the patient 7 to 10 days postoperatively (Figure 11). This is when we are able to view the tissue forming properly for implant placement; and, unlike a flipper, the Snap-On Smile appliance will not place unwanted stress on the surgical site. As we can see from pictures of the surgical sites one week postoperatively, the sites were well on their way to healing and the papillae were saved (preserved) and intact (Figure 12). This is especially important when dealing with anterior implant cases, so as to avoid the dreaded black triangle effect when we are inserting the final prostheses.

CLOSING COMMENTS
There are many options that clinicians have to provisionalize anterior surgical and implant cases. The technique described in this article utilizes an acetyl resin based appliance that is extremely soft-tissue friendly, placing no pressure on the tissue itself, has retention that is completely toothborne, and the long-term provisional appliance allows excellent healing throughout the procedure.


Dr. Liechtung graduated from The University of Pennsylvania School of Dental Medicine in 1986. After graduation, he attended the prestigious Advanced Restorative and Implant fellowship at the University of Pennsylvania, which he completed in 1987. Dr. Liechtung has practiced in New York City for many years, during which time he has acquired a vast amount of experience in restorative and cosmetic dentistry. That experience has enabled him to invent the multipurpose restorative appliance known as the Snap-On Smile. Dr. Liechtung has lectured internationally and has published more than 50 articles pertaining to restorative dentistry, as well as Snap-On Smile. Dr. Liechtung has always had the belief that a comprehensive oriented group practice is the best way to fulfill the needs of his patients; therefore, he has gathered what he believes is an extraordinary group of dentists, both cosmetic and restorative, as well as specialists who practice together at Manhattan Dental Arts and deliver optimum care to all patients. He can be reached at (212) 247-2330, at info@manhattandentalarts.com, or at manhattandentalarts.comMarc Liechtung, DMD is also the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease.  

Disclosure: Dr. Liechtung reports no disclosures.

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Marc Liechtung, DMD is an emergency dentist in NYC and a cosmetic dentist in NYC

Here are 9 facts that may burst your bubble about that old stick of gum. Or that fresh one you just put in your mouth. 

With the world's oldest piece of chewing gum clocking in at 9,000 years old, and the total value of the US gum industry racking up more than $19 billion in sales, chewing gum is one of the oldest and most popular activities, with research shwoing that the oldest piece of gum was 9000 years old. Howver is it  a healthy habit?

Here we have some insight into the good, the bad and the ugly on gum chewing.

The Good:

· Chewing as little as one piece of gum per day can stimulate saliva, which helps wash away those harmful acids from your teeth, and in turn helps fight cavities, neutralizes plaque acids, and washes away food particles.

· Chewing gum might be helpful after meals when additional enzymes are needed for digestion. Chewing gum for a few minutes after eating does seem to help some people avoid indigestion, heartburn, or reflux.

· Most chewing gum is sweetened with a chemical called xylitol, an additive that is allowed by the U.S. Food and Drug Administration to make the medical claim that it does not promote dental cavities. The harmful micro-organisms within your mouth are starved in the presence of xylitol, allowing the mouth to "remineralize" damaged teeth with less interruption.

The Bad:

· Probably the number one reason to avoid most chewing gums is that they are loaded with chemicals and synthetic ingredients. Corn syrup, artificial colors and flavors and chemical sweeteners are enough to cause any label-reading person to steer clear of these seemingly harmless treats.

· Most people don't realize that the amount of digestive enzymes your body can produce in a given lifetime is relatively finite. If you chew gum frequently between meals, it is very feasible that you are using up your digestive enzyme reserves so that the next time you eat, you won't have enough digestive enzymes on hand to fully digest the meal.

· According to the International Chewing Gum Association, the average person chews over 3,000 sticks of gum yearly. Recent reports have found that excessive gum chewing can easily aggravate jaw muscles and thereby ultimately cause TJM syndrome (temporomandibular joint disorder) - a clicking or popping noise in the jaw.

The Ugly:

· Probably the most important reason to abstain from chewing gum is that it releases mercury from dental amalgam fillings. Given that mercury is a neurotoxin in any amount in the body, it seems that chewing gum is an activity that should be undertaken with extreme caution if you have even a single silver filling.

· For pregnant women with silver fillings, chewing gum can prove toxic to the fetus should any mercury whatsoever be released into the bloodstream

· All sugar free gums contain the ingredient Sorbitol. Eating even three pieces of gum a day can lead to excessive amounts of Sorbitol in the system which can lead to severe abdominal pain, fructose malabsorption and in extreme cases colon cancer.

You might want to think twice the next time you pop a piece of chewing gum into your mouth.

Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

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Marc Liechtung, DMD is an emergency dentist in NYC and has seen thousands of emergency dental patients over the years. Here he gives some useful advice for patients that may have a dental emergency and are not near their usual dentist.  


There is nothing worse than being on your honeymoon, in-flight, on a camping trip, or a long car ride when it strikes - an unrelenting toothache so severe you feel like you want to die. Toothaches and other dental inconveniences occur regardless of the fact that it may be 2 AM or that your dentist is away on a Caribbean vacation. Knowing what to do can prevent major discomfort. Toothaches can range from a distressing inconvenience to an intense, miserable experience. Severe, emergency dental pain may be as unrelenting as kidney stones or even labor contractions. Fortunately, the chance of an unforeseen dental crisis can usually be prevented by early detection and treatment of dental disease. When dental disaster does strike, (and it always seems to be at the most inopportune time) knowing how to alleviate the pain is invaluable information everyone can use.

A toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection. Generally, a toothache occurs if tooth decay is very close to or has penetrated the pulp chamber that contains nerves and tiny blood vessels. Ideally, it’s best to undergo dental treatment at once. Dr. Marc Liechtung is a cosmetic and restorative dentist in New York City. Throughout his many years in practice, he has heeded the call of many a patient in dental distress. Dr. Liechtung has developed an arsenal of at-home tips to help patients with toothaches and other emergencies until they reach his dental chair. “If your toothache is caused by trapped food, you should rinse the area with warm water and swish it about. Floss between the teeth this should dislodge the food or it may loosen whatever is causing the pain.

There are many over-the-counter (OTC) pain relievers to cure toothaches that you can choose from. Most common are paracetamol, aspirin, and acetaminophen. If you feel that a small swelling has occurred, you may take non-steroidal anti-inflammatory drugs (NSAID) for their inflammatory components, like ibuprofen, (Advil, Aleve) and mefenamic acid. However, those with a history of ulcers as well as pregnant women need a doctor's recommendation before taking NSAID and aspirin.

A definite dont is to rub aspirin on your gums to numb an aching tooth isn't a good idea. It will in factdo more harm than good, due to the fact that aspirin contains salicylic acid, which can burn and damage gum tissue. For general pain relief, it's a better idea to simply swallow the aspirin. Or stop by a pharmacy for pain-relieving gels like Anbesol or Orajel.

 

There is also something that a patient can buy called Dentemp. It’s over the counter and can be used to cement a temporary or permanent crown until the person gets to his/her dentist. It could also be used to caulk or fill a hole in case a filling breaks.

Other home remedies for a toothache include rinsing your mouth with salt water or dabbing some clove oil directly on the bad tooth. Clove oil has bacteria-slaying properties, along with a remarkable numbing effect.

 

Clove oil has been used in dentistry for years and is responsible for that stereotypical dental office smell. Years ago, we would dab clove oil over a tooth before putting a filling in it, but now we have better ways of decreasing the sensitivity. For another home remedy, there is numbing power in cooled peppermint tea. Swish, then swallow if you like the flavor.

 

Patients can try putting some ice on the area, but the temperature of the ice could send them over the edge - most challenging are toothaches that stem from inside a tooth, but in cases where a lost filling or a broken tooth is causing the pain the sore tooth with softened chewing gum can ease the pain - covering the sensitive area until it can be repaired.

Dr. Liechtung also receives frequent complaints about canker sores. He suggests that people with frequent canker sores check to see if their toothpaste contains sodium lauryl sulfate, or SLS. SLS is a foaming agent that in some studies has been linked to the development of canker sores. "Toothpaste that doesn't contain SLS usually makes a big deal about it by saying 'SLS free' on its label," says Dr. Liechtung. An additional remedy for both canker sores and gum pain is tea tree oil. Tea tree oil should be applied directly to the infected site and can even be purchased in mouthwash form to soothe inflammation. Another preventive measure for canker sores is to avoid eating chips and other jagged foods that can cause tiny cuts and scrapes, which can be an entryway for a virus to set up shop in your mouth. Besides that, stay away from foods that trigger canker sores. Potential troublemakers include whole wheat, rye, barley, shellfish, pineapple, chocolate and tomatoes, as well as salty or citrus fruits. There is a remedy of 1/3 Mylanta, 1/3 Benedryl, and1/3 viscous Lidocaine. This will ease the discomfort of canker soars.

"About 80 percent of our population deals with gum problems - from gingivitis all the way up to losing teeth," according to Dr. Liechtung. Ginseng can be used to alleviate the pain associated with irritated gum tissue. A ginseng tonic can be directly applied to the gum to promote circulation and speed healing. An additional home remedy suggestion is to use a wet tea bag for tooth or gum pain. Tea contains astringent tannins, which have the power to shrink swollen tissue and stop bleeding. No toothache will heal on its own. A toothache is a dental problem that needs to be treated as soon as possible.

What should you do if you've knocked out a tooth - whether from a blow, a fall or accident?

Shake off debris (rinsing or scrubbing could remove important periodontal ligament), place it in a container of milk or back in its socket and try to reach the dentist within 30 minutes. “Unfortunately, not all teeth can be saved,” cautions Dr. Liechtung. Alternative methods, such as a bridge or implants, may need to be considered."

What should you do if you've broken a tooth?

Again, if you've lost the broken piece, just get to the dentist. “If you have it, gently shake off surface dirt and definitely keep it,” says Dr. Liechtung. "Even if the piece can't be bonded back to the original tooth, it can be used to help re-create the look of that tooth."

If something (food, other foreign matter) is wedged between your teeth, should you try to dislodge it?

Gentle flossing or brushing is fine, but if the object does not respond to that treatment and the surrounding gum begins to swell, make an appointment with your dentist. A bit of broken filling or chipped enamel can throw your bite off and make you panic. Popcorn husks are one of the worst problems and occasionally need to be removed by a dentist.

What should you do if you lose a filling or crown?

If you lose a filling, it's not worth saving. However, just cover the hole with temporary material, do not try to put the old filling back in the tooth. If you lose a crown, you'll want to try and salvage it (you can use Temparin or Dentemp, available in pharmacies, to put the crown back in place until you can reach a dentist). In either case, visit the dentist as soon as possible. Many people don't realize that when a filling falls out, there's a reason for that, whether it's a cracked tooth or more severe. You need to see a dentist.

ABOUT DR. LIECHTUNG:
Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queensemergency dentistry in Queensteeth cleaning in Queensdental crownsdental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

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Drinking pineapple juice can is a natural stain remover - Believe it or not 

Here Marc Liechtung, DMD a dentist in Queens and a dentist in NYC  lists some of the things that stain your teeth and some of the things that can remove stains from your teeth. 

1.     Black Coffee and Black Tea—The darker the beverage, the more staining that can occur. So try adding a little extra milk to lighten the color and reduce the staining effect.

2.     Wine—Both red and white wines if taken in excess will stain your teeth.   Although red stains, white wine’s acidic composition actually etches tiny grooves in your teeth making them more porous and more easily stained.

3.     Colas and Sports Drinks—Because they are so highly acidic, they help promote staining by other foods.

4.     Berries– Blueberries, raspberries, cranberries, cherries and other berries, although excellent for your overall health, can stain your teeth. So, if you’re crazy for berries, be sure to rinse out your mouth thoroughly with water after each indulgence.

5.     Beets—Now here’s a vegetable that could put a powerful stain in your t-shirt, so, like all foods that stain, moderation is called for with this one.

6.     Sauces—Soy sauce and tomato sauce, as well as other deeply colored sauces, are believed to have significant staining potential.

7.     Juice—Grape, pomegranate and cranberry are highly pigmented and can cause staining.  So, if you must imbibe, try rinsing your mouth out with water or drinking juices through a straw, thereby bypassing the fronts of your teeth

8.     Pickles and ketchup—These acidic foods are good at opening up the pores of your tooth enamel allowing for easy staining.

9.     Balsamic Vinegar—While great on a salad, causes havoc to your teeth.  If you must, try it on lettuce, which has a natural ability to provide a protective film over your teeth.

10.  Candy–Sweets contain teeth-staining coloring agents. If your tongue turns a funny color, there’s a good chance that your teeth will too.

11.  Curry—Although great on Indian food, this yellow-staining food flavoring can be harsh on teeth. So make sure to rinse thoroughly after indulging.

12.  Popsicles—Did you ever look at your tongue after you’ve finished your fruity, sugary pop? Not only does it color your tongue, but also your teeth.  Plus, it has added double whammy negative effect produced by all of that sugar. So, limit your intake and rinse with water after finishing.

12 Tooth-Whitening Foods 

1.     Apples and pears increase salivary production which flushes away stains over time.

2.     Pineapple acts as a natural stain remover.

3.     Carrots contain vitamin A which is needed for healthy tooth enamel.

4.     Cauliflower and cucumbers also help to increase salivary production the natural way to flush away stains.

5.     Green vegetables like broccoli, lettuce and spinach contains iron which helps form an acid-resistant film or barrier that can protect the enamel on your teeth.

6.     Shitake mushrooms help inhibit bacteria from growing in your mouth.

7.     Onions help reduce bacteria that cause tooth decay.

8.     Cheese is rich in protein, calcium and phosphorus, all of which can help safeguard the acids in your mouth.

9.     Salmon provides calcium and vitamin D, nutrients needed for healthy bones and teeth.

10.  Poppy and sesame seeds help scrub away plaque.

11.  Ginger acts as an anti-inflammatory to support healthy mouth tissue.

12.  Basil is a natural antibiotic that reduces bacteria in the mouth.

 The basic rule of thumb is - " If it stains your t-shirt -it will stain your teeth." 

 Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. If you are looking for an emergency dentist in NYC then we offer free consultations. The practice group also owns Kew Gardens Dental Arts, a dental practice in Queens offering dental implants in Queens, emergency dentistry in Queens, teeth cleaning in Queens, dental crowns, dental bridges and all forms of cosmetic and general dentistry. If you are looking for a periodontist in Queens we offer all gum disease treatments at our practice for patients with all types of gum disease. 

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Pregnancy can lead to a number of dental problems in many women, including gum disease and increased risk of tooth decay. During pregnancy, your increased hormones can affect your body's response to plaque (the layer of germs on your teeth). Pregnancy does not automatically damage your teeth

Pregnancy can lead to dental problems in some women, including gum disease and the increased risk of tooth decay. During pregnancy your body is in turmoil  and your increased hormones can affect your body's response to plaque (the layer of germs on your teeth). Howver pregnancy does not automatically damage your teeth

Preventive dental cleanings and annual exams during pregnancy are not only safe, but are recommended, according to the American Dental Association.

 
 

Marc Liechtung, DMD, inventor of the Snap-on-Smile™ and principal in New York-based Manhattan Dental Arts, a practice that specializes in cosmetic and restorative dentistry, recommends the following guidelines for pregnant women:

Tell your dentist that you are pregnant.
Have preventive exams and cleanings during your pregnancy.
Postpone non-emergency dental work until the second trimester or until after delivery, if possible.
Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth.
Routine x-rays, usually taken during annual exams, can usually be postponed until after the birth.
Sometimes emergency dental work is necessary:
Cavity fillings and crowns should be treated to reduce the chance of infection.
If dental work is needed, the amount of anesthesia administered should be as little as possible, but still enough to make you comfortable.
Emergency dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled safe in pregnancy, may be prescribed after your procedure.
X-rays may be necessary to perform many dental emergencies. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus.
The safest course of action is to postpone all unnecessary dental work until after the birth.

The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. Preventive dental work while pregnant is essential to avoid oral infections such as gum disease, which has been linked to premature birth.

Marc Liechtung, DMD is an emergency dentist in NYC and offers free appointments to expecant mother worried about gum disease, periodontal disease or other conditions that arise during pregnancy. 

Marc Liechtung, DMD is the founder of Manhattan Dental Arts and the Inventor of the Snap-on-Smile®. Manhattan Dental Arts P.C. is located on the Upper West Side at 68th and Broadway. We specialize in dental cleanings,emergency dentistrydental implantsall-on-4 dental implants, full mouth reconstructiondental crownsroot canals,periodonticsSnap on Smile, dental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry. The practice group also owns New Rochelle Dental Arts. New Rochelle Dental Arts specializes in dental cleanings,emergency dentistrydental implantsall-on-4 dental implantsfull mouth reconstructiondental crownsroot canalsperiodonticsSnap on Smiledental bridgesdenturesextractionssmile makeovers and all forms of general and cosmetic dentistry.

 

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