Getting Aligned - Teeth Whitening & Straightening

Jeff came to Dr. Adler of Adler Cosmetic & Family Dentistry seeking to brighten and straiten his smile. Dr. Adler sat down with Jeff and discussed exactly what Jeff’s expectations and goals were. He found that Jeff wanted his teeth to be healthy but also wanted them to look good and appear natural. Based on Dr. Adler’s thorough exam, he noted that Jeff had decay on several teeth and that one of his lateral teeth (#10 upper left next to middle front teeth) was peg shaped, under sized and out of proportion. He also saw that Jeff’s teeth were discolored and varied in shade, crowded, in an unhealthy bite, and had extreme wear and gum line problems. Dr. Adler recommended that Jeff first have fillings done to remove the decay and get his teeth healthy and then proceed with Invisalign and Zoom Whitening to straighten and brighten his teeth. He also recommended that Jeff restore his lateral teeth (#7 and 10, on either side of his upper front teeth) to their correct size and proportion with porcelain veneers.



The fillings were important to do first not only to remove the decay before the cavity got worse but also because Jeff would not have been able to have any restorative work done once the Invisalign treatment had started until it was finished. This is because the trays that are used in the treatment are made all at once and progressively shift the teeth into position as the trays are changed out. If restorative dentistry work was done during treatment then the trays would not fit.



For each tooth with a cavity, Dr. Adler removed the decay from the tooth and then placed tooth colored composite resin in the prepared tooth reshaping it to its original shape. A harmless curing light is used to harden and set the material. The tooth is then good as new and the filling is unnoticeable.

Once all the cavities had been restored with composite fillings, Dr. Adler was able to start the Invisalign. An impression of Jeff’s teeth and bite were taken and then sent to Invisalign labs. There a model of Jeff’s mouth was made and scanned as 3-D virtual image. They then made small incremental movements of the virtual teeth to simulate how the aligners would shift the teeth into their final position. Buttons, small tooth colored composite dots placed on selected teeth, were required to help certain teeth shift and rotate more. Once this virtual model was completed, it was sent to Dr. Adler for approval and/or modification. Once approved, the aligners were fabricated for the entire treatment phase and sent back to Dr. Adler. The buttons were places on the selected teeth and Jeff was given his first set of aligners. Each aligner was worn for about two weeks and each new aligner was slightly different to help slowly move the teeth into their proper position. The aligners were clear so it was hard for anyone to know that Jeff had “braces” on. They were removable for easy cleaning and were not worn when eating. Since Jeff had crowded teeth, IPR (inter proximal reduction) was required to give the teeth more room to move. IPR is a very simple and painless procedure that involves Dr. Adler filing a very minuscule portion between the teeth to create a small amount of space that the teeth will later move into. Treatment was completed in 6 month, much less time than traditional braces. The buttons were removed once treatment was done and clear aligner retainers were given to be worn at night to keep the teeth from shifting back.

Jeff had Zoom teeth whitening treatment done to brighten his new smile and remove the discoloration. The Zoom whitening gel was applied to each tooth and then cured with a high intensity curing light that activates the whitening gel. The Zoom light aids in activating the hydrogen peroxide and helps it penetrate the surface of the tooth. This procedure was repeated four times to maximize the whitening effect. After the treatment, Jeff had a noticeably brighter smile. He was given more whitening gel to use with his Invisalign retainers for any need touch up or maintenance bleaching.



Now that Jeff’s teeth were all a beautiful shade of white, the veneers could be placed. A veneer is a thin shell of porcelain that is bonded to a tooth to improve its color or shape. A veneer generally covers only the front and top of a tooth. Veneers can be used to close spaces between teeth, lengthen small or misshapen teeth, or whiten stained or dark teeth.



Jeff’s two upper front teeth on either side of the middle teeth (#7 & 10) were first shaped and roughened to prepare them for the veneers. Impressions were then taken of the teeth and sent to Aurum Ceramic Dental Laboratory, where the veneers were artistically custom crafted. Once the porcelain veneers had returned from the lab, they were cemented onto Jeff’s teeth using a durable adhesive bond. The bond was then cured with a harmless high-intensity light. This final touch completed Jeff’s treatment and he now has exactly what he wanted, a straight and white natural looking smile. The results are stunning and Jeff loves showing off his smile now.

For more information about Boulder cosmetic dentistry procedures please visit our website or call our office at 303-449-11

Ice Breaker - Treatment of Chipped Teeth

With just a slip of the foot, Katie’s appearance was instantly changed.

After slipping on ice and falling face first, Katie was left with at least two of her upper front teeth broken. A large portion of her upper left middle tooth was fractured off and her upper right tooth next to the middle was also chipped. She immediately sought treatment from Dr. Adler of Adler Cosmetic & Family Dentistry. Dr. Adler examined the damaged area using the aid of both x-rays and an interoral camera to help diagnose the multiple fractures that were not apparent to the naked eye and to determine the extent of the damage.



Teeth #7 and 9 were visibly broken so Dr. Adler placed a composite dental bonding material on the teeth as a temporary solution to restore the aesthetic look of the teeth until permanent dental restorations could be completed. Tooth #8 did not appear visibly damaged but the interoral camera did reveal that the tooth was fractured. Dr. Adler suspected that the tooth was more heavily damaged than it appeared since the teeth on both sided had visible damage due to the impact. A week after the fall, a portion of tooth #8 broke off due to the trauma it sustained during the accident. Dr. Adler determined that porcelain veneers should be placed on teeth #7-10 to restore the patient’s smile to its original brilliance.



Tooth #10 (upper left tooth, second from the middle) did not have any visible fractures but needed to be restored partly as a precaution since not all damage from a fall is immediately apparent and mostly for aesthetics. It is recommended that front teeth especially should be restored in sets of two to insure that the patient’s smile remains symmetrical. Tooth #10 was already shorter than its counter part #7, so if Dr. Adler was to only restore the teeth that had visible fractures (# 7-9), then tooth #10 would appear short and out of place, giving the patient an uneven smile.

A veneer is a thin shell of porcelain that is bonded to a tooth to improve its color or shape. A veneer generally covers only the front and top of a tooth. Veneers can be used to close spaces between teeth, lengthen small or misshapen teeth, or whiten stained or dark teeth. When teeth are chipped, as in Katie’s case, or beginning to wear, veneers can protect them from damage and restore their original appearance.

Katie’s four upper front teeth were first shaped and roughened to prepare them for the veneers. Impressions were then taken of the teeth and sent to Aurum Ceramic Dental Laboratory, where the veneers were artistically custom crafted. Once the veneers had returned from the lab, they were cemented onto Katie’s teeth using a durable adhesive bond. The bond was then cured with a harmless high-intensity light. The pain Katie initial experienced from the accident was relieved after the veneers were placed. The final results were a beautiful and natural looking smile.



Trauma cause to a tooth in a fall can take several months before all the damage is known. A root can be fractured but not cause symptoms for several months after the accident. Dr. Adler was concerned that Katie might eventually need a root canal for that very reason. With this in mind, Dr. Adler specifically designed the veneers to allow an access opening for a root canal without damaging the porcelain restorations if one was needed at a later time.

Four months after the fall, Katie did begin to have symptoms in tooth #8 that warranted a root canal. The blood supply to the tooth was likely damaged in the accident but was not symptomatic until several months later. Dr. Adler referred Katie to Dr. Joseph Parsons of Boulder Endodontics, P.C. for the root canal. Dr. Parsons successful performed the root canal and the veneer was not damaged in the procedure. Because symptoms can develop long after the accident continuous follow up is needed to monitor the tooth’s nerves.



Katie is good as new and now her brilliant smile is the best ice breaker of all.

For more information about Boulder porcelain veneers specialist Dr. Adler please visit our website or call the office at 303-449-1119.

The Other White Crown - Dental Crown Restoration

It is a common myth that silver amalgam fillings last forever. They are very durable but are not indestructible. There are several reasons why a silver filling can fail. Fillings have to endure an incredible amount of biting force and over time, they become worn and turn black, and their edges wear away. Moisture and temperature changes can also cause the filling to expand and contract. This expansion can create a wedging effect in the tooth, which can fracture or break off tooth structure. The expansion can also lift the surface of the filling slightly creating a gap where the filling meets the tooth and allow bacteria into the tooth.

Jamie had begun to have sensitivity when flossing in her lower right molar, which had a large silver amalgam filling. Dr. Adler diagnosed recurrent decay in the tooth and recommended that an inlay (dental crown) be placed.



An inlay is similar to a filling and lies in between the cusps of the tooth. They are custom-made to fit the prepared cavity and are then cemented into place. An onlay is a more extensive dental restoration that replaces one or more cusps of a tooth. Onlays are indicated in situations where a substantial reconstruction is required. However, more of the tooth structure can be conserved compared to the placement of a crown.
To repair damage to the tooth’s biting surface, rather than using a simple filling, or a crown, Dr. Adler will often use an inlay, or an onlay. Inlays and onlays are made from porcelain because of its strength and ability to match the natural color of the tooth.



Dr. Adler prepared Jamie’s tooth by removing the old amalgam filling and the underlying decay. He then painted a reflective powder over the prepared tooth. Using a special camera, he took an accurate picture of the tooth which was then displayed on a computer screen, where he designed the inlay. Then the CEREC crown machine took over and automatically fabricated and shaped the restoration. CEREC is an acronym for Chairside Economical Restoration of Esthetic Ceramics. With CEREC there was no need for us to make an impression and send it to a lab. The inlay was then permanently bonded to Jamie’s tooth. The whole process took about an hour and Jamie was able to leave with a beautiful and healthy white tooth verses the discolored and decayed one that she came in with.

For more information about Boulder restorative dentist Dr. Adler, DDS please visit our website or call 303-449-1119 to schedule an appointment.