Services

Facial Aesthetics

Increasing the lower face height vertical dimension of occlusion can have far reaching effects on facial aesthetics, not just on the peri-oral areas but on the whole face.

If the teeth look great but we ignore the rest of the face, then we have really limited what we can accomplish with aesthetic dentistry.

It is certainly time to advance what we have done in cosmetic dentistry and incorporate the surrounding tissues outside of the mouth which will fully complete the entire aesthetic dental picture we are creating.

Facial ageing is a biological phenomenon. Ageing is an inevitable fact of life – from the time we are born our genes lead our body through a series of changes ranging from growth and development to maturation, ageing and finally death. This process appears to be not only programmed genetically but also influenced by lifestyle and environment. Our obsession with attractiveness and youthfulness is partly related to this aging process.

Aging causes an increase in the vertical length of the nose, decreased tip projection and a tip droop. In the peri-oral area, naso-labial folds develop, fine vertical rhytids appear, and lips appear thin with loss of exposed vermillion. There is diminished tooth display of the maxillary anterior teeth and increased display of mandibular anterior teeth.7 Corners of the lips tend to droop downwards and join up with the marionette folds. The jaw line appears irregular due to the presence of jowls. The chin also tends to droop and the neck shows platysma banding and horizontal wrinkling.

Loss of vertical dimension of occlusion ( bite collapse) may result in loss of lower facial height and could lead to signs of premature aging.

A decrease in face height occurs as a result of the collapse of bone height when teeth are lost. This results in several facial changes. The decrease in the angle next to the lips and deepening of vertical lines on the lips create a harsher appearance.

As the vertical bone loss progressively and rapidly increases, the bite relationship deteriorates. As a result, the chin rotates forward and gives a “witches profile” facial appearance. These conditions result in a decrease in the angle at the corner of the lips, and the patient appears unhappy when the mouth is at rest.

This loss of facial height leads to diminished facial contour and leads to the typical ‘witches profile’. Facial height has a profound
effect on attractiveness. Occlusal vertical dimension (OVD) determines facial proportions at maximum intercuspation and influences facial dimension at rest. Underdevelopment of alveolar bone may result in loss of lower facial height and could lead to signs of premature aging.

Bite collapse can cause lower face height loss

A decrease in face height occurs as a result of the collapse of bone height when teeth are lost. This results in several facial changes. The decrease in the angle next to the lips and deepening of vertical lines on the lips create a harsher appearance.

As the vertical bone loss progressively and rapidly increases, the bite relationship deteriorates. As a result, the chin rotates forward and gives a poorer facial appearance. These conditions result in a decrease in the angle at the corner of the lips, and the patient appears unhappy when the mouth is at rest.

Reasons for vertical loss of occlusion

Loss of vertical dimension of occlusion (bite collapse) occurs in one of two situations. In the first, the patient grinds (bruxes) their teeth so aggressively, and reduces the biting surfaces so extensively that the upper and lower jaws rotate closer together than normal (Figure 2). It is important to note that there is significant professional literature refuting that excess wear leads to bite collapse, citing the tendency of teeth to extrude (move toward each other) as they wear. However, aggressive bruxers can certainly destroy tooth structure at a greater rate than extrusion can compensate for. Bite collapse can also happen in patients who are not bruxers. This occurs when enough teeth are lost that the remaining teeth and supporting (alveolar) bone are unable to withstand even normal biting forces, and begin to tip sideways, resulting in over-closure of the jaws (collapsed bite).

SEVERE GRINDING

Severe attrition like that shown in Figure 2 can be a serious problem. It can result in damage to the jaw joints (TMJs); severe pain or dysfunction in the jaw joints (TMJ dysfunction); frequent muscle tension headaches; excessive muscle contraction forces as the closing muscles of the jaw shorten (which can accelerate the destruction); tooth fractures and tooth loss; aggravation of periodontal disease if present (secondary occlusal trauma); shortening of the lower face height (which can change one’s appearance, although it may not be obvious to a casual observer); an inverted smile (corners of the mouth sag); a “toothless” smile; frequent cracking or chapping at the corners of the mouth (angular cheilitis); and problems chewing.


Case 1

Ruthy

In some selected cases, implants can be restored the same day. With the proper planning and provided that there is enough bone, a patient can have implant surgery in the morning and walk out in the afternoon with a beautiful smile already screwed into implants. It is a team work between the surgeon and the prosthodontist.


Case 2

Sharry

In some selected cases, implants can be restored the same day.

With the proper planning and provided that there is enough bone, a patient can have implant surgery in the morning and walk out in the afternoon with a beautiful smile already screwed into implants. It is a team work between the surgeon and the prosthodontist.

When replacing dentures, implants can provide even more benefits. Implants do not slip nor do they have the potential of limiting the diet to easily chewed foods as can happen with poorly fitting dentures. If appropriate, implants are the method most able to surgically restore one or more missing teeth to their original conditions.

Today you can walk in to Dr. Siranli’s office with a set of of dentures or failing teeth and leave a few hours later with a brand new smile!

Just wanted to write you and let you know what a very special daughter you have. I’m enclosing a copy of a letter I sent to “Dr. Sam” thanking her for the wonderful work she does; she is such a perfectionist. She didn’t “Fix” my teeth, she restored them to the way I looked 30 years ago. Now that is what I would call a success story!

-Sharry


Case 3

Nermin

Nermin was a 58 year old female who wanted to have a better and brighter smile. Her chief complaints were “ I feel like I have buck teeth and my front break slowly and get shorter everyday”

When examined, it was seen that Nermin’s front teeth were flared out. Due to Nermin’s teeth grinding habit, all the teeth on one side were getting shorter and breaking which compromised her smile.


Case 4

Esther

Esther’s teeth’s enamel and most of her dentin were eroded due to acid reflux. The erosion did not only cause the loss of the most of her tooth structure and gave her teeth a brownish color but also compromised the lower face aesthetics due to loss of lower face height ( loss of vertical dimension of occlusion).


Porcelain Veneers

Porcelain veneers are thin pieces of porcelain used to recreate the natural look of teeth, while also providing strength and resilience comparable to natural tooth enamel. Since veneers are individually sculpted for each patient, it is nearly impossible to tell the difference between a veneer and a natural tooth. With veneers as opposed to crowns your natural teeth remain largely intact with only a minimal amount being altered to fit the veneer.

Indications of the need for porcelain veneers

  • Porcelain veneers are a very successful option in many situations:
  • Discolored Teeth
  • Teeth with Poor Shapes and Contours
  • Fractured Teeth
  • Gaps in Between Teeth
  • Tooth Position Problems
  • Minor Bite Related Problems
  • Non-Responsive Stains to Bleaching
  • Hypocalcificed Teeth

It is also a good choice for fractured teeth, gaps between teeth and in some situations where the tooth position is compromised and there are minor bite related problems. For some people, superficial stains do not respond well to tooth whitening or bleaching. In these situations, a porcelain veneer may be the best option. For teeth that resist whitening, veneers can make even the darkest teeth appear bright white.

In our practice, we start with smile analyses together with the facial analyses to determine what steps are necessary to achieve the smile you desire. In addition, we create a diagnostic mock-up with the new smile design that will allow you to “try-on” veneers to see if the final result is actually what you are looking for.

Do Porcelain Veneers Stain?

Unlike natural teeth, custom made porcelain veneers resist coffee, tea and cigarette smoke stains since porcelain does not stain in the mouth.

Maintenance of porcelain veneers

Treat them as you would your original teeth, with routine brushing and flossing. Using non abrasive fluoride tooth paste is suggested.


Case 1

Fayelyn

Fayelyn was in acting school when she came to our office. Her major concern was the hypocalcification (white spots) on her teeth. She wanted to have an attractive but a very natural looking smile. Previously she had tried home and office bleaching. Unfortunately, she couldn’t achieve the results she desired with conservative methods such as bleaching. In our office we fabricated twelve veneers on the upper jaw with very minimal tooth preparation resulting in the natural look she desired.

I am a student at NYU for theater which is the reason I wanted to get my veneers done. I didn’t want to be self-conscious about my smile and now I don’t have to be. I was very specific about what I wanted and that is what I got.

-Fayelyn


Case 2

Dr. Morgan

Dr. Morgan is a Dentist (Prosthodontist) who had tetracycline staining affecting all of his teeth. As a dentist he tried many conservative solutions like bleaching or bonding on his teeth. Non of these methods gave him the successful result he was seeking. Finally he decided to have porcelain veneers. In his case, since we were blocking a darker color the thickness of the porcelain veneer was studied and precisely crafted. Having such dark teeth all his life he chose the ultra bright white option.


Case 3

Astrid

Astrid had a traumatic event in her childhood where her right central inciser (right front tooth) was damaged. She felt like it had always affected the quality of her smile. Later on in life that she lost that tooth after receiving multiple root canal therapies and surgeries. When she presented to our office there was no alveolar bone width or length available to predictably restore the area without additional surgery. Astrid received a gum graft only and her smile was restored with bridge and veneers.


Case 4

Chris

Chris had a common case of grinding his front teeth by moving his jaw forward and back involuntarily at night. His front teeth were getting shorter and he was beginning to show more and more gingival tissue (gum) as he was speaking or smiling because of the continuous bone formation to compensate the shortening of his teeth. In order to give Chris the smile he was seeking for, with minimal tooth reduction, his gums were leveled according to the ideal gingival (gum) aesthetics guidelines. This way ideal tooth lengths were achieved without grinding extra tooth structure or making them too long towards the lower teeth which would have comprised the long term structural durability of his porcelain veneers.

“Dr. Siranli, your vision elevates me and the whole world around you. I do owe you words and so much more, lucky me…”

-Chris

Before Treatment

Smile Design Prior to Starting the Veneers

After Treatment


Case 5

Harvey

Harvey has a common case of sever grinding which damaged his teeth and compromised his smile. Harvey requested dental veneers instead of full crowns for minimal reduction. His bite was edge-to-edge which made his case more complicated than most. In order to complete his rehabilitation with minimal tooth reduction he was sent to an orthodontist to create space for the long term prognosis of veneers with minimal tooth reduction.

“My experience was, and continues to be, extremely pleasant and professional. The staff was very polite and helpful. Dr. Siranli is the consummate professional, meticulous in every detail as witnessed by her work.”

-Harvey

Before Orthodontic Treatment

After Orthodontic Treatment – Space for veneer is created

After veneers are bonded


Teeth in a Day

In some selected cases, implants can be restored the same day.

With the proper planning and provided that there is enough bone, a patient can have implant surgery in the morning and walk out in the afternoon with a beautiful smile already screwed into implants. It is a teamwork between the surgeon and the prosthodontist.

When replacing dentures, implants can provide even more benefits. Implants do not slip nor do they have the potential of limiting the diet to easily chewed foods as can happen with poorly fitting dentures. If appropriate, implants are the method most able to surgically restore one or more missing teeth to their original conditions.

Today you can walk into Dr. Siranli’s office with a set of dentures or failing teeth and leave a few hours later with a brand new smile!

A dental implant is an artificial tooth root (titanium screw) that is placed in a jawbone to replace a missing tooth or teeth. By replacing a lost tooth with a dental implant, the overall health and function of the surrounding teeth are maintained. The implant can prevent tooth migration and loss of structure and will help loss of bone from the jaw in that area.

Dental Implants are the state of the art alternative for replacing missing teeth. Dental Implants are long lasting and have a very high success rate.

In our practice, we perform a CT scan on our patients right in our office. The procedure only takes a few minutes. Images are captured in multiple cross-sections which allow us to do accurate bone measurements.


Case 1

Allison

Allison is a 22 year old female. She was very shy and self-conscious about her smile. Her grandparents made an appointment with our office to alleviate Allison’s pain and restore her smile.

She had very large decays going below the gum level with multiple infections.

In addition to the extensive tooth carious lesions (decay) and pain, Allison was suffering from facial skeletal problems. Her lower jaw was too retrusive (pulled back) and her upper jaw was too protrusive (forward) which is classified as Class II malocclusion.

Allison’s facial skeletal problem was taken into consideration at the time of her treatment planning.

The day of the treatment, all of Allison’s teeth were removed and the dental infections were cleaned. Her alveolar bone on the upper jaw and lower jaw was modified. A total of fourteen implants were placed, eight on the maxilla (upper jaw) and six on the mandible (lower jaw). A very good primary stability was achieved on all the implants. Allison received her new teeth already connected to the implants the day of her surgery. The whole treatment was completed in just 1 day which is known as “teeth in a day”. Allison came back to the office two weeks after her surgery for a follow-up visit.


Case 2

Marilyn

Marilyn is a brilliant 63 year old. She holds 15 U.S. patents. She neglected her teeth during her very busy research and academic career.

Marilyn not only had multiple missing teeth, grossly decayed existing teeth with bone loss but also a severe facial skeletal problem. Her upper jaw was retrusive and her lower jaw was protrusive which gave her a severe underbite. Her existing bite and lower face height were also collapsed due to the lack of back teeth. Marilyn’s new smile and bite were designed in advance at the time of treatment planning. The new smile design and bite were scanned with an intra-oral camera and a 3-D CT (Computerized Tomography) was taken. Images were transferred and overlapped to a computer. Her implants were placed with Computer Guided Surgery where the new smile design dictated the proper sites of the implant placement and the angles. The new increased occlusion (bite) rotated her lower jaw back to its original position and helped to correct her underbite. Since her implants were placed according to her ideal smile and lower face height, we had total freedom to create the best facial aesthetics for Marilyn. Implant supported, screw-retained temporary prostheses were inserted the day of her surgery and Marilyn received the smile shown in the “after” picture on the day of the surgery.


Case 3

Lavern

Lavern is a 51 year old female who had lost most of her upper teeth and was using a removable partial denture.

When you look at her closely, Lavern’s problem list was:

  • Missing Teeth
  • Excessive gum display when smiling. She was even displaying the upper edges of her partial denture when she smiled. The replacement of only the missing teeth, without considering the facial aesthetics, would have not improved Lavern’s facial aesthetics. As practitioners, it is our responsibility to diagnose and restore not only the teeth, but also the overall facial aesthetics to achieve the best treatment outcome for our patients.
  • Increased Lower Face Height. Her lower face height was proportionally longer than her upper face height, which was possibly caused by an overgrowth of her ramus (lower jaw) in her growth pattern.

As the ideal treatment plan:

  • Lavern’s smile was designed independently from her existing teeth by removing the teeth.
  • Bone reduction at the time of teeth removal prior to implant placement.

By reducing bone, the excessive gummy smile and the excessive lower face height were corrected.

As a result of Lavern’s dental treatment, her facial aesthetics were greatly improved, not only by making her facial proportions ideal, but also by eliminating her gummy smile.

With the teeth in a day procedure, we not only gave her implants and teeth but we also completely recreated her smile and improved her facial aesthetics on the same day of her surgery.


Case 4

Stephanie

Stephanie presented to our office with an upper denture. She had been told by many doctors that she lost so much bone that implants could not be placed unless she had a major bone grafting procedure on the upper jaw. (Major Bone Grafting Procedure- Bone graft taken from the hip bone and placed on the jaw bone).

When Stephanie was referred to us, she was certain that she did not want a major bone graft done prior to placing her implants.

After a few consultations with the surgeon and myself, we decided to go with implants placed on the zygomatic bone, and pterygoid and vomer bones on the maxilla.

On the lower jaw Stephanie had a few front teeth left, which were extracted and replaced with dental implants. The lower implants were loaded immediately while Stephanie waited for six months for the upper implants to heal. Stephanie now has fixed teeth connected to the implants both on the upper and lower jaw.
Stephanie’s smile is radiant and she can now eat whatever she wants without the fear of her denture coming loose.

The increased lines around her peri-oral tissues immediately disappeared upon the insertion of her new teeth which made her look 30 years younger.


Case 5

Jacki

Jacki was worried about addressing her dental problems. In her case more than a fear of the dental procedure, she was fearful about the outcome. She knew she had dental problems, but as happens to all of us, Jacki got used to the subtle changes that occurred over the years.

It was hard for Jacki to take the first step. She had her remaining upper teeth removed and received four implants on the upper jaw and single crowns on her natural lower teeth. Jacki received her implant-retained teeth which were already connected to her implants the day of the surgery. Jacki received porcelain teeth as her final restorations.

“My smile is such a confidence booster and now I can eat anything I want. Basically Dr. Siranli really changed my whole life.”

-Jacki


Case 6

Mr. Zando

Mr. Zando was so pleased when he was informed about a much better alternative to dentures and still have fixed teeth instead of removable dentures with just 4 implants on each jaw. He was also so excited to learn that he does not need to wait for the implants to heal for him to receive his teeth already fixed to his implants.

Mr. Zando said he had minimal discomfort after the surgery. The after picture was taken two weeks following his surgery.


Case 7

Rebecca

Rebecca was tired of her upper denture, which she had for years. She hated the significant and noticeable gaps between her lower teeth. The lower teeth were also loose due to massive bone-loss around them.

Rebecca’s lower teeth were removed and four implants were placed in each jaw and her implant supported fixed teeth were delivered the day of her surgery. The after picture displayed here was taken the day of her surgery.


Case 8

John

John had severe generalized horizontal bone loss around his natural teeth. He had four existing implants on the maxilla. The plan was to remove the rest of his upper teeth, place six more implants and give John teeth on the same day of his surgery. His existing four implants as well as the six newly placed implants were loaded together immediately.

John’s surgery was planned on a computer with his oral surgeon and all his implants were placed with computer guided surgery. John received his implant supported teeth the day of his surgery.


Case 9

Olena

Olena is a 34 year female. She had been treated for generalized severe periodontitis by her periodontist (gum specialist) for years. Olena was tired of repeated surgeries and gum infections. Olena experienced constant pain because of infections and decay.

Finally, she decided on a treatment plan with a good long term prognosis and a better aesthetic outcome. The day of the treatment, her remaining teeth were removed, and dental and gingival (gum) infections were cleaned. A total of 11 implants were placed, six on the upper jaw and five on the lower jaw. Olena received her implant-retained teeth which were already connected to the implants the day of the surgery.

Once Olena’s implants were integrated in the bone, she received porcelain teeth. She loves her new smile created with dental implants more than her previous smile with her natural teeth. Her new smile was designed in a way that showed less gum when she smiled and her lips were better supported and shaped.


Case 10

Betsy

Betsy is the sunshine of the practice where she works as a nurse. She says that even the patients recognize and cherish the gorgeous smile she has. Her new smile had changed her whole appearance in one day.


Case 11

Wendy

Wendy’s smile and self confidence had changed JUST in ONE DAY…


Dental Implants

A dental implant is an artificial tooth root (titanium screw) that is placed in a jaw bone to replace a missing tooth or teeth. By replacing a lost tooth with a dental implant, the overall health and function of the surrounding teeth is maintained. The implant can prevent tooth migration and loss of structure and will help loss of bone from the jaw in that area.

Dental Implants are the state of the art alternative for replacing missing teeth. Dental Implants are long lasting and have a very high success rate.

In our practice, we perform a CT scan on our patients right in our office. The procedure only takes a few minutes. Images are captured in multiple cross sections which allow us to do accurate bone measurements.

There are three sub categories of dental implant procedures

Congenitally Missing Teeth

Case 1

Christina

Christine never developed the tooth on the upper left side (congenitally missing teeth). Diagnosis of the problem, orthodontic positioning of the teeth to create the ideal space for the missing tooth and timing of implant surgery and restoration of the missing tooth are all imperative for long-term, successful results.

Christine had a team of doctors to replace her missing tooth in the most ideal way for the long-term, successful results. We worked with her orthodontist as a team to create the ideal space for the missing tooth. Following the creation of the ideal space, we worked with the oral surgeon as a team and her implant was placed with the surgical guide. The day of her implant surgery she immediately received a temporary implant crown. Her final implant crown was delivered four months after the implant placement.

“Dr. Siranli actually performed a miracle. She very much tried to keep me pain free. I can say that she is highly skilled and nobody can believe how good it looks now.”

-Christina


Trauma

Case 2

Patrick

Patrick had a bad car accident when he was 19 and lost his upper front teeth. Patrick did not only lost 5 front teeth but also most of the bone at that area. He presented to our clinic 6 months after the accident. He went through orthodontic treatment for his bite corrected and received 4 implants and bone graft. His final prostheses has pink porcelain to replace the missing bone and gums.

Patrick was so happy when he went back to school with a gorgeous smile as if he never had the accident.


Case 3

Michelle

41 year old female was referred by her general dentist after she had an accident and traumatized her ant teeth.

When she was at work, she fell down while trying to change a light bulb. According to the trauma notes, where she was initially seen, her left front tooth was completely avulsed. Her other three teeth in the front were somewhat mobile with fractures on them. She received root canal therapies in an effort to save them. At the 3 month re-evaluation by the endodontist, it was seen that she was still in pain. Finally, the teeth were diagnosed as unsalvageable.

It is essential to aesthetically design the smile prior to the removal of the teeth even though they were diagnosed as hopeless.

Wax-up was completed for the ideal smile design to guide:

  • with the implant placement
  • with the elimination of the gummy smile
  • tooth display at smile and resting position

Michelle also received orthodontic treatment to pull her lower teeth more in so we can give her longer teeth by bringing her upper teeth more out for an ideal position.


Case 4

Jasmine

Jasmine is a 21 year old female who broke her upper front tooth while playing sports. Unfortunately, the tooth was not salvageable. Jasmine was so worried about losing the tooth in the middle of her smile. Jasmine’s tooth was replaced with an immediate implant placement and tooth placement on the implant. She had her five year follow up visit and its impossible to identify the implant tooth versus her natural teeth.


Case 5

Andreas

Andreas is a 21 year old male who had multiple operations to save his teeth. His three front teeth were extracted by his periodontologist because they were diagnosed as unsalvageable. He was extremely worried about the replacement of his teeth in the middle of his smile. Andreas’s teeth were replaced with implants and implant crowns with custom shade matching to mimic the shades of his natural front teeth. He was thrilled with the final results and to this day none of his friends know that his front teeth right in the midline of his smile were removed and replaced with implants.


Decay

Case 6

Margaret

Margaret had numerous crowns and restorations done over the years by multiple doctors. This caused a lot of color and shape discrepancies in the existing crowns. She also had a decreased lower face height due to grinding and multiple crowns having been done at different times.

Margaret’s crowns had secondary carious lesions (decay) underneath them. She was informed about the decay and advised to clean and redo her crowns. A few of unsalvageable teeth were replaced with dental implants. She was also advised to do a full-mouth rehabilitation in order to re-establish her lower face height and fabricate aesthetically proportional crowns. Margaret’s dental rehabilitation was completed with full mouth crown restorations that were done on her natural teeth and implants with continuous harmony.

Margaret not only received more proportional and natural looking teeth but also an improved facial appearance with the increase of lower face height. A broader smile was also given to Margaret which gave her more pronounced cheek bones

Dr. Siranli actually performed a miracle. She very much tried to keep me painfree. I can say that she is highly skilled and nobody can believe how good it looks now.”

-Margaret


Case 7

Glenny

Glenny was referred to us by one of my patients. She has been tired of her partials and the esthetics of her teeth when she smiled. Eating was a major difficulty for her. Even though Glenny was almost 80 years old, she really wanted her smile and face to look beautiful and natural.

Glenny’s existing teeth were extracted since they were not salvageable. On the upper jaw, she received a denture and the lower teeth were fixated with implants.

Glenny is just very happy now. Her friends tell her she look 20 years younger. Glenny began smiling without the need of hiding her smile anymore and now can eat whatever she wishes to