Smiles All Around

High-tech practice gives failing bridge, broken tooth careful attention.

Despite holding down several jobs, John Alden never had much money while attending college. During his final semester, after his financial situation turned dire, John applied for and accepted a ground job with a major airline.

John Alden’s photo by Jordan Pysz.

John Alden

“I worked ground jobs for the airline for several years,” the 80-year-old native of Medina, Ohio, remembers. “But eventually, I was promoted into their flight program. I became a pilot and ended up logging 21,000 flight hours. But back then, pilots had to retire at age 60, so that’s what I did.”

John flew out of several major airports. Typically, larger airports can accommodate a greater variety of aircraft. The opportunity for career diversity was a big motivator.

“I was based all over the country,” he relates. “At different times over the years, I was based in Miami, Chicago, Washington and Cleveland. I moved around to where I could fly the airplanes I wanted to fly.”

As a young man, John was always short on cash and his family was never covered by dental insurance, so he rarely visited a dentist for routine care. Fortunately, he had few problems with his teeth. As his career became more established, he decided to find a regular provider but was astonished by what was recommended on the first visit.

“There wasn’t much wrong with my teeth, but the dentist told me I needed crowns on 15 teeth,” John recalls. “I forget now what it would’ve cost, but it was a huge amount. I thought, This guy must need a new automobile, and walked out. Pardon the pun, but that experience left a bad taste in my mouth, so I stayed away from dentists for a long time.

“But last year, one of my front teeth broke off, and getting a crown became a necessity. I read an article in Volusia Health Care News about Dr. Lester and the computerized equipment he uses to manufacture crowns and how quickly it’s done. I called Dr. Lester’s office and they got me
right in that same day.”

John entrusted his smile to Stephen P. Lester, DDS, at Park Avenue Dentistry in Edgewater. When John arrived for his appointment, he was immediately struck by the environment of the office.

“It’s like walking into someone’s living room,” he describes. “First thing, they gave me a tour of the facility. It’s not fancy, but it’s very homey and cared for meticulously. I felt great comfort when I saw everything they have. There’s a library and a large chair to sit in while waiting for your crowns to be made.

“From the dental chair, you look out through two large windows at a beautiful garden with a waterfall, and you can see the squirrels playing outside. Somebody put a lot of thought into setting up the office so that it’s pretty and comfortable, something that patients can appreciate and enjoy.”

E4D system

During John’s initial appointment, Dr. Lester examined his broken tooth, then asked him to return the next day to receive his crown. Dr. Lester created the crown in his office with the E4D system, which uses computer-aided design and computer-aided manufacturing (CAD/CAM technology) to expedite the process of creating dental restorations.

Retooled Technology

CAD/CAM technology has been used for years to design and manufacture products such as machine and auto parts. More recently, it was retooled for use in dentistry to meet the growing need for comfort and convenience. That fueled the development of in-office CAD/CAM systems such as the E4D.

“The E4D system is a technology that creates porcelain restorations quickly and easily right in the dentist’s office, often in one visit,” Dr. Lester acknowledges. “It can make dental crowns, inlays, onlays, veneers, even bridges.”

The system consists of three main parts: the computer system, the software and the milling machine. These parts work in concert to create the finished restoration, which in John’s case was a crown.

The process began with Dr. Lester using a high-tech laser to quickly and accurately scan John’s teeth into the computer. Dr. Lester then used the E4D software to design the crown.

The computer took Dr. Lester’s design and prepared it for the milling machine, which cuts the restorations out of a block of porcelain. For John, this happened during the same appointment.

“Dr. Lester used a laser device to scan my tooth’s dimensions, which he used to create the crown,” John recalls. “He ground down the tooth to the healthy part to prepare it for the crown, and in just a short time, he made the crown using his computerized machine. It was made from a material that matched the tone and color of my other teeth.

“Once the machine polished the crown, Dr. Lester fit it right over my prepared tooth. He told me the process takes two hours, but I don’t believe I was there that long. It’s amazing that a crown can be made so quickly.”

Using the E4D system has a number of benefits for patients, Dr. Lester reports.

“They do not have to put that messy goo in their mouths to make the impressions of their teeth because impressions are created digitally,” he says.
“And they do not have to wear temporary restorations, which always want to to fall off at inconvenient times. They also do not have to return for a second visit because usually, their restorations can be designed and fabricated in a single day.”

“They’re a great bunch of people at Park Avenue Dentistry and I’m very comfortable with them.” -John

During a recent visit, Dr. Lester found a crack in one of John’s molars. He recommended a crown made with the E4D system for that tooth as well.

“We had to consider cosmetics for John’s front tooth, but the molar in the back is primarily functional. Its job is to grind food,” Dr. Lester adds.

“By using our E4D system, we created crowns for John that are strong as well as aesthetic.”

John is very happy with his crowns, but he’s even more impressed by the efforts of Dr. Lester and his staff at Park Avenue Dentistry, where they have continued to work in a safe and efficient manner through the COVID-19 pandemic.

“For them to work on people’s mouths during this time and keep the facility open shows some kind of commitment,” John says. “I look at
Dr. Lester and his staff as first responders, and I’d be surprised if you could get care and service with everything so safety-oriented anywhere else.

“They’re a great bunch of people at Park Avenue Dentistry, and I’m very comfortable with them. I think I’m more comfortable paying for the environment and attitude, and to see the whole team doing their jobs well, than paying for the dentistry. And as it turned out, I never needed 15 crowns.”

Stabilizing Suggestion

John “Scooter” Bethmann, 78, was among the last of the draftees for active duty in the Vietnam War. While in the Army, the Schenectady, New York, native was trained to be a medic, specifically to assist surgeons in Mobile Army Surgical Hospitals, or MASH units.

John Bethmann’s photo courtesy of John Bethmann.

Scooter is thrilled with the appearance of his new lower denture.

The skills he learned translated into a successful career after the war in civilian life.

“I worked as a surgical assistant for 40 years but am now retired,” he elaborates. “My job encompassed all of surgery, but I did work for an orthopedic surgeon for 13 years. I liked my job. I liked taking care of people.”

Early in his career, Scooter traveled across the country offering his services. But in 1988, he met a woman from Wisconsin and settled down in the Badger State, where the couple purchased a small farm.

“It was my hobby farm,” Scooter describes. “We kept horses and sheep, and that’s where we raised our two daughters. After 30 years, we sold the farm and moved to a place on a lake. It’s a large property and requires a lot of care, but I enjoy it.”

For a few years in the early ’80s, Scooter’s job as a surgical assistant brought him to Florida. He liked living in the Sunshine State so much that he and his wife eventually became snowbirds. While visiting Florida this year, Scooter required a dentist after a bridge he had for more than 30 years finally faltered.

“That bridge is a result of an incident that happened when I was a teenager,’’ Scooter explains. “I got some of my teeth knocked out playing pickup football, and over the years I went through a lot of dental work. I eventually ended up with a bridge on my bottom jaw.

“About the time that prosthetic started to fail, I was visiting a friend who’s a next-door neighbor of Dr. Lester’s office. I was at my friend’s shop and saw Dr. Lester outside, so I approached him and described my dental problem. After talking with him for a few minutes, I decided to give Dr. Lester a try.”

Upon Scooter’s arrival at Park Avenue Dentistry, Dr. Lester performed a thorough examination of the Army veteran’s teeth and determined that his remaining lower teeth were unsalvageable and required extraction. The dentist recommended a full lower denture to replace Scooter’s extracted teeth.

“I suspected that Scooter would not be happy with a traditional lower denture,” Dr. Lester maintains. “Traditional lower dentures tend to move around, and that can be annoying and uncomfortable.

“Most people are unhappy with traditional lower dentures for that reason, and that’s why I suggested we secure Scooter’s lower denture using dental implants. The denture would then snap onto the top of the implants, which locks the denture in place and makes it more stable.”

Alternate Approach

Dental implants are small, threaded metal posts that resemble screws. They are surgically implanted into the jawbone to serve as the foundation for replacement teeth, which can be a crown to replace a single tooth, a bridge to replace multiple teeth or a denture to replace an arch of teeth. Dr. Lester recommended a full implant-secured denture for Scooter.

“There are many benefits to securing a lower denture with dental implants,” Dr. Lester asserts. “For one thing, food cannot accumulate underneath an implant-secured denture the way it can with traditional dentures.

“The best case scenario with traditional dentures is that people excuse themselves from the table after the meal to go to the restroom and rinse the food from their dentures. Often, however, they do not make it that long. They must get up from the table in the middle of the meal to rinse. That is inconvenient and, for some people, humiliating.

“Another benefit of implant-secured dentures is they improve speech. This happens because people can use their stabilized denture teeth to form hard-to-pronounce sounds such as S, F and V.

“Implant-secured dentures also provide security in social situations. If a person suddenly coughs or sneezes, their denture will not come out of their mouth and fly across the room, which can be extremely embarrassing.”

“The appearance of the denture wasn’t a priority in my view, but it’s beautifully made. If you don’t know that it’s a denture, you can’t tell.” – Scooter

In cases such as Scooter’s, where the teeth are missing or have been extracted, Dr. Lester typically secures lower dentures using two to four implants. But in cases where some of the teeth are healthy, lower dentures can be secured using the patient’s tooth roots.

“For patients who have a few good, strategically placed teeth, we can remove the top portion of those teeth and utilize their roots, which lie under the gums within the bone,” Dr. Lester explains. “We can snap the dentures onto the roots in the same fashion that we snap them onto dental implants and achieve the same effect.

“The main advantage of this alternate approach is that patients are not required to undergo implant surgery. And some patients are not candidates for dental implants because they do not have enough bone or have a health condition that precludes them from getting implants. These patients can still secure their dentures with this method.”

The tooth root approach is also a quicker process. Patients receiving a denture secured only by implants typically need to wait three or four months for the implants to integrate with the jawbone before they can be fit with their permanent denture.

“When patients come to me seeking dental implants to secure their dentures, I first look for teeth that I think will last,” Dr. Lester observes. “If I find several good teeth, I suggest that the patients secure their dentures using their tooth roots instead. It is easier, quicker and less expensive, and it is just as effective as securing the dentures with implants.”

“Warm and Welcoming”

Graphic from kisspng.

Implant-secured denture

Scooter had no remaining teeth to serve as anchors for his denture, so he was fit with implants that needed a few months to integrate with his jawbone. During that period, he wore a temporary denture.

The temporary bothered him greatly because it moved around in his mouth. When Scooter received his final denture, Dr. Lester discovered that it had some give to it as well.

“Aesthetically, the denture is fine, but when I eat, it moves a little,” Scooter reports. “Dr. Lester gave me the option of securing my denture with four dental implants, but I elected to use just two. That was my decision. There’s an option to place additional dental implants to add more stability to the denture and make it perfect, and I’m considering that. Right now, I’m adjusting to the denture as it is.

“The appearance of the denture wasn’t a priority in my view, but it’s beautifully made. If you don’t know that it’s a denture, you can’t tell.”
Like John, Scooter has a high opinion of Dr. Lester and his staff.

“Dr. Lester is a very nice gentleman and very knowledgeable,” Scooter describes. “His staff is totally accommodating and very communicative. They sent texts to remind me of my visits and always checked on me after an appointment to see if I was doing alright. And they sent a lovely birthday card.

“The staff is very warm and welcoming. If someone needs dental work, I would tell them that Park Avenue Dentistry is a good place to go.”
“I recommend them to anyone,” John adds.

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