I got all upper crowns (12) summer 2012 to open up my bite and replace lumineers. I grind at night and have tmj so lumineers should have never been an option. I had bonding for 8 yrs, lumineers placed twice and now crowns. Tmj pain is greatly improved but can't chew hard things on bicuspids and speech is greatly affected. had about 20 adjustments since last summer and it is a little better but crowns do not feel like my real teeth. feel bulky, i feel a ledge on backside of the front teeth. back not so bad. main issue is speech can't speak normally consonants especially s and z sound are very difficult and hitting the back of front teeth. after last adjustment dentist shortened front teeth and now i hit the back of the eye teeth. he will be replacing front 4 since they are chipping, prob due to all adjustments and i'm concerned i will need to live with this for the rest of my life. do not have another $15K to start over. he's a nice guy but it shouldn't be this hard. i did have an unusual deep bite so i'm not a textbook case. what should next step be before we replace crowns again? also concerned about damage to my teeth even though he said i have lots of tooth structure left. highly reputable dentist. webste has about 350 5 star responses. feel bite it off and teeth aren't hitting properly after opening up my bite. i wear a night guard at night. saw a neuromuscular dentist last yr for second opinion and said my bite is bad and lower jaw rolls forward so i bite down and shift forward. She said no one would be able to help me but her. Because normal dentists aren't trained to treat according to bite. etc. had a naturally very deep bite which i was told why the lumineers didn't work, not enough support on back teeth. I also feel coldness when i eat or drink sometimes on one upper molar which was crowed. He doesn't seem too concerned with that. 2 years ago I had to have an extraction on a tooth that was crowned and root canaled on bottom left molar. I'm in the process of getting implant but not finished yet. would that space be affecting speech? I'm only 43 and only got original bonding to fill in a small space between front teeth. If only I could go back in time i would make much better decisions, I would have had orthodontics again. I should mention I had braces as a teenager. That dentist pulled 4 teeth to correct overbite. The neuromuscular dentist who gave me a second opinion last year said that was the start of my troubles. I understand I'm giving you a lot of information and any guidance is appreciated! I just am looking for ideas before I have the front 4 crowns redone. I want them redone for the final time. I worry how much my natural teeth that are left underneath can take. My dentist says I am fine because he didn't grind them down too much. I saw them after they were ground and it doesn't look like much there to me. I feel like my front teeth overjet more than they used to since he opened my bite. But the positive effect on the tmj headaches has been substantial over where I was a year ago with the dreaded lumineers. Please contact me with any clarification needed prior to answering my questions. Thank you!
Person's Gender: Female
Person's Age: 44
numerous adjustments, patience hoping my mouth would adjust
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Welcome to JustAnswer, and thank you for putting your trust in me!Issues of occlusion (bite) are perhaps the most arcane and controversial aspects of prosthetic dentistry. There are many schools of thought on this topic, and the diversity of opinion suggests that either many of these parochial views are wrong, or the human oral mechanism can tolerate a variety of different bites. The conventional wisdom among mainstream dentists is that many jaw situations are functionally adequate despite what dentists do to them, rather than because of what dentists do to them. In point of fact, the mouth can tolerate a range of different bite strategies-- to a point.Obviously, your mouth has been stretched beyond its range of physiologic tolerance, and regardless of what school of occlusion is followed, the wise dentist takes a pragmatic view and learns from mistakes. And in your case, you have demonstrated one of the better-known truisms of occlusion: opening the bite is not always well tolerated. In retrospect, the cure was worse than the disease, and your poor accommodation to your increased height of occlusion logically suggests that your bite must be returned to its original position.Speech and phonetic issues are almost certainly a by-product of this increased vertical height; patients routinely adapt phonetically to much more drastic changes in tooth shape, such as the placement of complete dentures and orthodontic appliances.You can safely disregard the guidance of your "neuromuscular dentist". Not only are clinicians in this group widely regarded by the mainstream as occupying the very fringes of the dental profession, but any dentist who claims to be your last hope is clearly suffering from megalomania. You have enough on your plate without dealing with a doctor who has a tenuous grip on reality.Other matters are peripheral to the central concern of the bite, but still merit attention: sensitivity of any of the newly-crowned teeth may suggest pulpitis, and your dentist may need to intervene with root canal if this symptom persists or intensifies. However, with the benefit of 20-20 hindsight, it is clear that opening the bite is a source, if not THE source, of most of your current difficulties, and the height of occlusion should be returned to its original dimension. It may be helpful for your dentist to use processed acrylic temporary crowns of progressively diminishing height so that the optimal vertical dimension can be functionally determined prior to fabrication of the permanent crowns. In retrospect, your dentist might have used the same strategy when he was raising your bite, but it's too late for that now. The important thing is to learn from experience, and your dentist should be methodical about finding the correct bite height for you.Because your dentist has a stake in your current predicament, you might broach the subject of whether he would be willing to make some concession on his fee for setting things right. It would be the compassionate thing to do, and it would be the wise thing to do in terms of good business sense and maintaining good will.I acknowledge that the increase in your bite was not an unequivocal failure, in that your TMJ symptoms responded to that treatment. However, there are more conservative measures, such as the wearing of an occlusal splint device at night, that will provide similar benefit for your symptoms and bruxism (nocturnal grinding) in a far more conservative and less intrusive way. If the restoration of your original vertical dimension does not completely address your phonetic impairment, a consultation with a speech therapist may be helpful; I suspect that would not be necessary.Hope this helps...Mark Bornfeld DDS41034.0821443287
Thank you very much for the thorough reply. Believe it or not I understand most of what you're saying and agree. I'm an intelligent person and although I'm obviously not a dentist, I've tried to educate myself the best I can. However I'd like to get clarification on just a few items:
When I was in temps the last time instead of putting my upper back molars in temps, he added composite to my bottom molars. Every other week I'd go in and add a little unti we thought we were at a good place. When we were finished, there was never an issue with speech so I figured we'd be good to go. He also works with a very reputable prostdodontist (not sure if that's the correct word) who is supposed to be the best around. When I first went to him for a second opinion when I had the lumineers he took one look at me and said crowns were my only option. He said lumineers will never work based on my bite and grinding and he was right! He agreed it was a good idea to open me up a little, but even he said not too much. He consulted with us twice. My original upper molars kind of sat at an angle, almost on their side so I believe the thought was that was causing the headaches (which were bad to the point I went to physical therapy for 6 months) which I had on a daily basis. I wish you could see the xrays before I had the teeth prepped. My upper and bottom teeth didn't hit right on and my midline has always been off. And when he first placed the front crowns in they looked to be jetting out and I stopped him and said no they don't look right. Also there was a little space at bottom between the front ones which I never liked which will be corrected with the new crowns. I should also mention I have no speech problems on the left side. Maybe due to the opposing lower molar not having the implant and crown yet?
My main question is where do I go from here? He's a pretty busy dentist and his staff is getting very annoyed at me. I know they just think I'm a pita. When they decided that opening my bite was the best option for me and I balked at the additional $4K I'd have to pay she got pretty perturbed and said I didn't know how lucky I was. She said she worked for many other dentists and others would have released me a long time ago. I said "with all due respect, you haven't been with us since the beginning of my case and have no idea what I've been through. If the Dr couldn't treat me effectively, he should have let me know upfront!" Since he did the original lumineers twice, he didn't charge for the crowns on the teeth that were already done. He ate that fee. My argument was if Dr Brian didn't know how to adequately treat my case, I should have known that already. I have been through 4 set of temps, 2 lumineers and 1 set of crowns now. I don't want to have him just replace the 4 front teeth if I'm going to have the same speech problems.
During the last visit I asked him to close my bite a little in the back and that did make an improvement. Is it possible he can do that without resorting to removing those 4 back upper crowns? I highly doubt he'll do that. I feel like maybe the lab didn't do exactly what we needed in regards XXXXX XXXXX opening of the bite. Although I never really understood how adding bonding material on the bottom teeth would translate to them knowing how to add to the new crowns? These bicusipds really don't feel right and the front teeth feel like they flare out since the opening of the bite.
Do you have a recommendation of another dentist in my area I maybe could go to for a second opinion? I know dentists do not like to speak out against another dentists and get involved midstream. But I just need someone to help me. I do not have another $15K to start from scratch and worry the effect it will have on my existing tooth structure.
I really appreciate your help.
It appears that I owe your doctor an apology-- he did use provisional temporaries to diagnostically explore the amount of bite opening you could tolerate, so he was being prudent and rational in his approach, even while knowing the potential risks of bite opening. That he replaced your anterior veneers at his expense is further evidence that he is not only aware of the cost to himself in his attempts to rectify the persistent issues, but he is also aware of the toll that your treatment has taken on you.I am often mystified by how oblivious some dentists' ancillary staff can be when communicating with patients. Unaware of how her interactions with you reflected on the ambiance of your dentist's practice, the office manager ran the risk of sabotaging all the good will your dentist was trying to generate with his extensive efforts. Suffice it to say that some people are better than others when it comes to empathy.I do think your perception that your dentist should have known from the outset whether he could successfully manage your case is misguided. All extensive prosthetic treatment plans are shared journeys for both patient and dentist, and although the destination may be clear, the path is littered with uncertainty. The oral neuromuscular mechanisms are surprisingly complex, and their ability to adapt to change varies from patient to patient. There is not a therapeutic method in existence that offers a 100% success rate, and your treatment is just one case in point."During the last visit I asked him to close my bite a little in the back and that did make an improvement. Is it possible he can do that without resorting to removing those 4 back upper crowns?" That would depend on the thickness of the crowns. If he has already done extensive grinding of the crowns, additional grinding runs the risk of metal exposure or outright perforation, which would ruin the crowns. However, if the intent is to ultimately replace those crowns again, perforation would carry little consequence, and your response to the bite closure would be of diagnostic value.I agree that a second opinion could be beneficial, if only to verify the protocols of your current dentist. Because this is fundamentally a prosthetic course of treatment, you should consult with another prosthodontist. You can find contact information for other prosthodontists in your community by referring to the online directory of the American Board of Prosthodontics.If there is any thought to transitioning your treatment to another prosthetic dentist and there are financial considerations, you should give some thought to seeking care in a dental school prosthodontics department. Rather than being viewed as a challenge, your case will be considered an educational opportunity, and the fees at a dental school are significantly below those in private practice settings. The level of expertise at dental school clinics is the highest available, consistent with the current academic standards and protocols.The fact that you were able to speak properly before your new crowns were placed logically means that you will be able to speak properly after appropriate modification of your prosthetic work has been done. Your prosthodontist's task is to find that proper modification, and skill and persistence will ultimately be rewarded.Good luck!
35 years experience, member Academy of General Dentistry